The psychosocial outcome of pregnancy in women with psychotic disorders.
OBJECTIVE
To investigate the psychosocial outcome of pregnancies in women with a history of psychotic disorder in an epidemiologically representative sample and to determine the predictors of having a baby looked after by social services in the first year of life.


METHODS
Historical matched controlled cohort study and nested case control study using the General Practice Research Database (GPRD), an anonymised primary care database, in women with a history of psychotic disorders who gave birth in 1996-1998 (199 cases and 787 controls).


RESULTS
Twenty-seven percent of cases had a psychotic episode and a further 38% had nonpsychotic depression in the first year after birth. Women with nonaffective psychoses were at a significantly higher risk of postnatal depression compared with controls (adjusted rate ratio 2.07, 95% CI 1.45-2.96, p<0.001). Cases were well supported with 72% in a cohabiting relationship and only 38% on benefits. The only significant predictor of parenting difficulties was recent contact with psychiatric services.


CONCLUSIONS
Women with a history of psychotic disorder are at high risk of psychiatric illness postpartum, particularly a twofold risk of postnatal depression, even if they have not been in contact with psychiatric services during pregnancy. However, this epidemiologically representative sample has better parenting outcomes than has been previously reported for specialist treated cases. Liaison between all professionals involved in the care of mothers with psychotic disorders during and after pregnancy is essential to optimise care for them and their families.
Howard
Louise Michele
LM
PO29, Section of Community Psychiatry, Health Services Research Department, Institute of Psychiatry, London SE5 8AF, UK. spjelmh@iop.kcl.ac.uk
Goss
Claudia
C
Leese
Morven
M
Appleby
Louis
L
Thornicroft
Graham
G
D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D015331:Cohort Studies; D019052:Depression, Postpartum / Q000453:epidemiology; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D011320:Primary Health Care; D011584:Psychology; D011618:Psychotic Disorders / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D012008:Recurrence; D011795:Surveys and Questionnaires
D014150:Antipsychotic Agents