Maternal and newborn outcomes among women with schizophrenia: a retrospective population-based cohort study.
OBJECTIVE
More women with schizophrenia are becoming pregnant, such that contemporary data are needed about maternal and newborn outcomes in this potentially vulnerable group. We aimed to quantify maternal and newborn health outcomes among women with schizophrenia.


METHODS
Retrospective cohort study.


METHODS
Population based in Ontario, Canada, from 2002 to 2011.


METHODS
Ontario women aged 15-49 years who gave birth to a liveborn or stillborn singleton infant.


METHODS
Women with schizophrenia (n = 1391) were identified based on either an inpatient diagnosis or two or more outpatient physician service claims for schizophrenia within 5 years prior to conception. The reference group comprised 432 358 women without diagnosed mental illness within the 5 years preceding conception in the index pregnancy.


METHODS
The primary maternal outcomes were gestational diabetes mellitus, gestational hypertension, pre-eclampsia/eclampsia, and venous thromboembolism. The primary neonatal outcomes were preterm birth, and small and large birthweight for gestational age (SGA and LGA). Secondary outcomes included additional key perinatal health indicators.


RESULTS
Schizophrenia was associated with a higher risk of pre-eclampsia (adjusted odds ratio, aOR 1.84; 95% confidence interval, 95% CI 1.28-2.66), venous thromboembolism (aOR 1.72, 95% CI 1.04-2.85), preterm birth (aOR 1.75, 95% CI 1.46-2.08), SGA (aOR 1.49, 95% CI 1.19-1.86), and LGA (aOR 1.53, 95% CI 1.17-1.99). Women with schizophrenia also required more intensive hospital resources, including operative delivery and admission to a maternal intensive care unit, paralleled by higher neonatal morbidity.


CONCLUSIONS
Women with schizophrenia are at higher risk of multiple adverse pregnancy outcomes, paralleled by higher neonatal morbidity. Attention should focus on interventions to reduce the identified health disparities.
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada.
S N
SN
Vigod
P A
PA
Kurdyak
C L
CL
Dennis
A
A
Gruneir
A
A
Newman
M V
MV
Seeman
P A
PA
Rochon
G M
GM
Anderson
S
S
Grigoriadis
J G
JG
Ray
D000037:Abruptio Placentae / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D015331:Cohort Studies; D016640:Diabetes, Gestational / Q000453:epidemiology; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology; D007226:Infant Mortality; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007751:Labor, Induced / Q000706:statistics & numerical data; D008428:Maternal Mortality; D008875:Middle Aged; D009357:Neonatal Abstinence Syndrome / Q000453:epidemiology; D009864:Ontario / Q000453:epidemiology; D010359:Patient Readmission / Q000706:statistics & numerical data; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D047928:Premature Birth / Q000453:epidemiology*; D012189:Retrospective Studies; D012559:Schizophrenia / Q000453:epidemiology*; D012772:Shock, Septic / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000453:epidemiology; D055815:Young Adult
Eclampsia; gestational diabetes; gestational hypertension; large for gestational age; pre-eclampsia; pregnancy; preterm birth; schizophrenia; small for gestational age