Prenatal Prediction of Poor Maternal and Offspring Outcomes: Implications for Selection into Intensive Parent Support Programs

This study examined the predictive ability of mother’s age, antenatal depression, education, financial difficulties, partner
status, and smoking for a range of poor maternal and offspring outcomes assessed up to 61 months postnatally. Outcomes obtained
from the Avon Longitudinal Study of Parents and Children (ALSPAC) were maternal postnatal depression at 8 weeks (n = 10,070),
never breastfeeding (n = 7,976), feelings of poor attachment (n = 8,253) and hostility (n = 8,159) at 47 months, and not in
employment, education or training (NEET, n = 8,265) at 61 months. Only a small proportion of women with each outcome were
aged less than 20 years when they were pregnant. At least half of the women experiencing these outcomes, and up to 74.7% of
women with postnatal depression, could be identified if they had at least one of the predictors measured during pregnancy
(age < 20, depression, education less than O level, financial difficulties, no partner, or smoking). Model discrimination
was poor using maternal age only (area under the receiver operator characteristic (AUROC) curve approximately 0.52), except
for never breastfeeding (0.63). Discrimination improved (AUROC: 0.80, 0.69, 0.62, 0.60, 0.66 for depression, never breastfeeding,
poor attachment, hostility and NEET, respectively) when all six predictors were included in the model. Calibration improved
for all outcomes with the model including all six predictors, except never breastfeeding where even age alone demonstrated
good calibration. Factors other than young maternal age, including education, smoking and depression during pregnancy should
be considered in identifying women and their offspring likely to benefit from parenting support interventions.