Impact of perinatal anxiety on healthcare utilisation: a matched cohort study using electronic health records in the UK

Objectives To examine differences in healthcare utilisation patterns among women with perinatal anxiety (PNA) compared with women with anxiety but not pregnant and women with pregnancy but no anxiety.

Design A retrospective cohort study using electronic health records from the Clinical Practice Research Datalink (CPRD) Aurum (1998–2020), linked to Hospital Episode Statistics, the Index of Multiple Deprivation, Mother Baby Link and Pregnancy Register in England.

Setting Primary care records from general practices contributing to CPRD in England.

Participants The study included records for 103 287 women with PNA and two matched comparison cohorts: 413 148 women with anxiety but no pregnancy (anxiety-only cohort) and 413 148 women with pregnancy but no anxiety (pregnancy-only cohort). Women were matched 1:4 on age, general practice and index year.

Primary and secondary outcome measures Healthcare utilisation was assessed by primary care clinical encounters (recorded primary care consultations/contacts, including general practitioner (GP) and other primary care clinician contacts), prescriptions, referrals and hospitalisations. Outcomes were measured in five time periods: (1) pregnancy to delivery, (2) delivery to 72 days post partum, (3) 73 days to 6 months post partum, (4) 7–12 months post partum and (5) 13–24 months post partum. Incidence rate ratios (IRR) and absolute risk differences were calculated using conditional Poisson regression models adjusting for sociodemographic and comorbidity-related confounders.

Results Women with PNA consistently had higher rates of healthcare utilisation across all time periods. Compared with the anxiety-only cohort, the adjusted IRR for primary care encounters was 1.742 (95% CI 1.739 to 1.746) during pregnancy and 2.288 (95% CI 2.283 to 2.293) in the 72 days postpartum period. compared with the pregnancy-only cohort, the adjusted IRR for primary care encounters was 1.653 (95% CI 1.651 to 1.655) during pregnancy and 2.319 (95% CI 2.314 to 2.324) in the 72 days postpartum period. Prescriptions and referrals followed similar patterns, while increased hospitalisation rates postdelivery were not observed in the PNA cohort.

Conclusions Women with PNA exhibited higher healthcare utilisation up to 24 months after delivery, particularly in the period immediately after delivery. These findings highlight the necessity for early identification and sustained support for this population.