Pregnancy, delivery, and neonatal complications in a population cohort of women with schizophrenia and major affective disorders.
OBJECTIVE
This study ascertained the incidence of complications during pregnancy, labor, and delivery and the neonatal characteristics of infants born to women with schizophrenia, bipolar disorder, or major depression in a population-based cohort.


METHODS
Based on records linkage across a psychiatric case register and prospectively recorded obstetric data, the study comprised women with schizophrenia or major affective disorders who had given birth to 3,174 children during 1980-1992 in Western Australia. A comparison sample of 3,129 births to women without a psychiatric diagnosis was randomly selected from women giving birth during 1980-1992. Complications were scored with the McNeil-Sjöström Scale. Odds ratios were calculated for specific reproductive events.


RESULTS
Both schizophrenic and affective disorder patients had increased risks of pregnancy, birth, and neonatal complications, including placental abnormalities, antepartum hemorrhages, and fetal distress. Women with schizophrenia were significantly more likely to have placental abruption, to give birth to infants in the lowest weight/growth population decile, and to have children with cardiovascular congenital anomalies. Neonatal complications were significantly more likely to occur in winter; low birth weight peaked in spring. Complications other than low birth weight and congenital anomalies were higher in pregnancies after psychiatric illness than in pregnancies preceding the diagnosis.


CONCLUSIONS
While genetic liability and gene-environment interactions may account for some outcomes, maternal risk factors and biological and behavioral concomitants of severe mental illness appear to be major determinants of increases in reproductive pathology in this cohort. Risk reduction in these vulnerable groups may be achievable through antenatal and postnatal interventions.
Jablensky
Assen V
AV
Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Western Australia, Australia. assen@cyllene.uwa.edu.au
Morgan
Vera
V
Zubrick
Stephen R
SR
Bower
Carol
C
Yellachich
Li-Anne
LA
D001714:Bipolar Disorder / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D000013:Congenital Abnormalities / Q000453:epidemiology; D003865:Major Depressive Disorder / Q000453:epidemiology*; D005260:Female; D005316:Fetal Distress / Q000453:epidemiology; D006801:Humans; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007744:Obstetric Labor Complications / Q000453:epidemiology; D010922:Placenta Diseases / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome / Q000453:epidemiology; D011446:Prospective Studies; D012559:Schizophrenia / Q000453:epidemiology*; D012621:Seasons; D014904:Western Australia / Q000453:epidemiology