Psychosocial risks during pregnancy: The impact of screening and early referral on child outcomes

Chief Investigator: Dr Jacqui Beall

Funding Amount: $73,375

Recipient: Flinders University


The first 1,000 days of a child’s life, from pregnancy to their 2nd birthday, are crucial for development. It forms the foundation for lifelong health and functioning yet is also the time when children are most vulnerable. At Flinders Medical Centre we identify pregnant women who are facing difficulties which may pose risks to their baby, and aim to link them to services which can help even before their baby is born. But does this make a difference? In the first stage of a large cohort study we will look at how psychosocial risks identified during pregnancy impact on babies’ health and safety.

Research Outcomes:

Researchers: Dr Jacqui Beall, Ms Naomi Guiver, Dr Scott Morris, Associate Professor Peter Marshall

Research Completed: 2020

Research Findings:

To give children the best possible start to life, we should start as early as possible – even before they are born. We know that pregnant women’s physical health affects their babies’ health, and that good medical care can help. But we know less about how other life circumstances can affect young babies, and how hospitals can best help pregnant women with those challenges.

We looked at how one hospital, Flinders Medical Centre, helps women to address these challenges, and whether doing this makes a difference for babies. We connected information from pregnancy care, with information on babies’ health and wellbeing, in a way that kept each person’s information private. So far, we have learned that a quarter of all pregnant women who came to our hospital were facing hard challenges like mental illness, domestic violence, or problems with drugs. Such challenges, particularly when combined, affect babies’ health and wellbeing. But it can be hard for women in these circumstances to take up the services that our hospital offers. We are using these results to help design better care for pregnant women and their babies.

Key Outcomes:

The first thousand days of a child’s life, from conception to their 2nd birthday, forms the basis for their lifelong health and functioning. However, this is also the time when children are most vulnerable. At Flinders Medical Centre we use screening to identify pregnant women who are facing difficulties in their lives (psychosocial difficulties) which may pose risks to their baby’s health, development and safety, and refer these women to services that could help reduce those risks. While similar programs operate in some other hospitals, there is almost no information about whether this approach helps to keep babies healthy and safe.

Our project has successfully brought together two sources of detailed psychosocial and medical information from Flinders Medical Centre regarding the clinical care provided to more than 22,000 pregnant women and their babies from 2009 to 2015. We have named this new data resource “the Flinders Infant Risk Study (FIRSt)”, as it focusses on pregnancy as our first opportunity to support the health and wellbeing of infants.

So far, early results indicate that a quarter of all pregnant women who attended our hospital were experiencing difficult psychosocial conditions, such as exposure to domestic violence, substance abuse, or mental ill-health. Further, mothers’ overall psychosocial burden appears to affect babies’ birth outcomes. From the program perspective, we have identified a relatively low uptake of referrals to psychosocial services during pregnancy. This work is now ongoing, with results already informing the development of a new Model of Care for pregnant women at Flinders Medical Centre, as well as being presented at conferences and prepared for publication in peer reviewed journals.

In addition, we have also completed the long process of negotiation, approvals and agreements to enable our FIRSt cohort to be linked with a broad range of South Australian administrative datasets. At time of writing, SA NT Datalink have successfully located every baby from our cohort within their SA-wide Master Linkage File. This means that we can now proceed with confidence when using a data linkage approach to examine the longer term (post birth) outcomes of babies in our FIRSt cohort. We are immensely grateful to the Channel 7 Research Foundation for making this project possible. This project has provided a launchpad for answering key questions about how we identify and address psychosocial difficulties in pregnancy, and whether psychosocial care provided in pregnancy can make a difference to babies’ outcomes at birth. Now, through forging a new collaboration with the BetterStart Research Group at the University of Adelaide, we will integrate our deidentified FIRSt dataset with their comprehensive Early Childhood Data Project (SA ECDP) platform, which will enable us to examine, as our first priority, whether screening and referral for psychosocial risks in pregnancy helps reduce child maltreatment.

Research Papers:

Guiver, N, Beall, J, Pilkington, R, Lawrence, D & Forsyth, K (In preparation) ‘Referral is not enough: Poor uptake of psychosocial services by pregnant women referred through antenatal psychosocial screening’, for submission to the Medical Journal of Australia by mid 2020.

Conference Presentations:

Beall, J, Guiver, N, Pilkington, R, Lynch, J & Forsyth, K 2019, ‘Detecting and responding to child protection risk during hospital-based antenatal care’, Australian Association for Infant Mental Health National Conference, Adelaide, 5 September 2019.

Guiver, N, Pilkington, R, Beall, J, Lynch, J & Forsyth, K 2019, ‘Psychosocial risks in pregnancy: Detecting and responding to risk during antenatal care’, Academy of Child and Adolescent Health National Conference, Adelaide, 19 October 2019.

Guiver, N, Pilkington, R, Beall, J, Lynch, J & Forsyth, K 2020 (Accepted, forthcoming), ‘Could antenatal psychosocial screening-referral programs improve outcomes for babies? Examining processes and outcomes using linked data’, 17th World Association for Infant Mental Health World Congress, Brisbane,  June 2020.

Related Publications: N/A

Future Outcomes: TBA

Leave a Reply