Women in Scotland who are admitted to intensive care while pregnant are 12 times more likely to suffer a stillbirth, according the first major study to explore maternal critical care outcomes.

The research, led by Edinburgh University and based on Scottish hospital records covering 2005 to 2018, also found that women admitted to ICU during pregnancy or up to 42 days after birth were 40 times more likely to die over the subsequent 12 months compared to mothers who never required critical care.

The most common cause of deaths over this time were cardiovascular diseases, such as blood clots.

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While stillbirths and maternal mortality remain rare events, the researchers said the findings indicate that "a proactive approach to longer-term post-partum care may be needed for women who survive critical illness".

The study also found that there was a seven-fold increase in neonatal critical care admissions for babies born to mothers with an intensive care admission.

Dr Nazir Lone, a professor of critical care and epidemiology at Edinburgh University who led the study, said the statistics were not necessarily surprising since the most common causes of maternal admission to ICU - such as post-partum haemorrhage, pre-eclampsia, sepsis, and placental abruption - can also precipitate stillbirths or pre-term delivery.

However, the study is the first in Scotland to "quantify" the problem.

He said: "In some ways we would expect to see women coming to ICU having a higher likelihood of dying as well despite all these interventions because they're so severely ill - it's a bit circular in some ways.

"And similarly for stillbirth: the things that might make women severely ill will obviously impact on the unborn baby as well, and because of them becoming so severely ill they will come to intensive care, so yes - we would expect stillbirths to be higher despite all the treatments we give to support the mother.

"But it's actually having the number and knowing how frequently it's happening mean we can highlight much more helpfully the need for support services.

"The one thing to bear in mind is that these are relative measures.

"Thankfully these are still quite uncommon events, so whilst stillbirths may be 12 times higher among women who have been in intensive care that's because we're starting from a very uncommon starting point."

The Herald: Maternal intensive care admissions remain rare in Scotland, although risk factors are on the increase among expectant mothersMaternal intensive care admissions remain rare in Scotland, although risk factors are on the increase among expectant mothers (Image: PA)

Previous studies among the general population have identified a so-called 'Post-Intensive Care Syndrome' where patients experience higher rates of mortality, psychological distress, and physical impairment for a prolonged period following discharge, but there has been a lack of research on maternal outcomes.

The Edinburgh University study, published in the journal Intensive Care Medicine, identified a total of 1,449 maternal ICU admissions over the 13-year period out of a total of nearly 763,000 deliveries.

The women admitted to intensive care tended to be older, were more likely to be obese or severely obese, and to have one or more co-morbidities - factors which are all becoming more prevalent overall among expectant mothers.

There were a total of 29 maternal deaths in the year following discharge from hospital.

The researchers also want to find out how psychological outcomes compared between mothers with and without ICU experiences after previous evaluations - including a large study in Florida - identified an increased risk of psychiatric illness.

The Scottish study identified a total of nine psychiatric inpatient admissions within one year of delivery among mothers who had required critical care before or after birth.

This put the incidence rate at 0.6% compared to 0.3% for mothers who had not spent any time in ICU, but after adjusting for other risk factors the researchers could find no statistically significant difference.

The Herald: Neonatal critical care admissions were also significantly higher among mothers who required intensive careNeonatal critical care admissions were also significantly higher among mothers who required intensive care (Image: PA)

Prof Lone said the analysis had been complicated by a lack of access to primary care data and mental health prescribing statistics.

Had this been available, he believes they would have been able to detect higher rates of anxiety, depression, and other mental health problems associated with the trauma of baby loss or surviving intensive care.

He said: "We ended up with this single measure left for mental health which was inpatient psychiatric admission, and from clinical experience it really is a tiny minority of people who have mental health problems after pregnancy and actually end up in a psychiatric hospital.

"Trying to find a signal from just nine admissions is difficult - it's not surprising that we didn't."

Prof Lone said he would like to see maternity and critical care services adopt a "more joined up and proactive approach" to support women at higher risk of health problems.

He added: "There are services available for people after intensive care and there are services available in maternity units.

"The key point is to ensure that women who end up under the care of maternity services who have been through intensive care are flagged up so that the intensive care services know about them, and vice versa.

"That means things like bereavement care after a stillbirth but also the specific problems that women have after pregnancy when they've been ill - that isn't something that services looking after general intensive care survivors will be very familiar with.

"But the expertise is there - we don't need a brand new service for women specifically who've been pregnant while in intensive care - it's just about avoiding the siloed way of working."