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Pregnancy and postpartum specifics in women with schizophrenia: a meta-study

  • Materno-fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

This meta-study intends to elucidate schizophrenia–pregnancy inferences.

Methods

A total of 63 quasi-randomized, case–control, linkage studies on outcomes of singleton pregnancies in women with schizophrenia are identified through PubMed, ACOG, and SCOPUS. A sample of 216 pregnant and puerperal women with schizophrenia, allocated from studies of level I–IIA evidence, is compared with a sample of 487 births to unaffected women. Calculations use births as unit of analysis. Poisson regression model is used in exchangeable correlation structure.

Results

Older age (2.13), excessive smoking (1.85) and less antenatal care (1.92) in women with schizophrenia determine high risk for prematurity (2.08), including miscarriages (2.04) and preterm birth (1.98). Neonates to mothers with schizophrenia are profiled with twice likelihood of low Apgar scores (2.22), intrauterine growth retardation (2.16), and congenital defects (2.1). Poor maternal–fetal attachment and preoccupation about fetus are related to negative symptoms of schizophrenia (−0.518), length of antipsychotic treatment (−0.304) and are not associated with maternal age (0.216). Postpartum period is eventful with psychotic relapse (7.86), and parenting difficulties (11.2).

Conclusions

After adjusting for age, parity, unhealthy behaviors, length of antipsychotic treatment, and maternal–fetal attachment, maternal schizophrenia remains predictive to prematurity and postpartum psychosis.

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References

  1. Ahern N, Ruland JP (2003) Maternal–fetal attachment. J Perinat Educ 12(4):27–35

    PubMed  Google Scholar 

  2. Aichhorn W, Stuppaeck C, Whitworth AB (2005) Risperidone and breast-feeding. J Psychopharmacol 19:211–213

    Article  CAS  PubMed  Google Scholar 

  3. Alhusen JL (2008) A literature update on maternal–fetal attachment. J Obstet Gynecol Neonat Nurs 37(3):315–328

    Article  Google Scholar 

  4. Altshuler LL, Cohen L, Szuba MP et al (1996) Pharmacological management of psychiatric illness during pregnancy: dilemmas and guidelines. Am J Psychiatry 153:592–606

    CAS  PubMed  Google Scholar 

  5. Bennedsen BE, Mortensen PB, Olesen AV et al (1999) Preterm birth and intra-uterine growth retardation among children of women with schizophrenia. Br J Psychiatry 175:239–245

    Article  CAS  PubMed  Google Scholar 

  6. Bennedsen BE, Mortensen PB, Olesen AV et al (2001) Obstetric complications in women with schizophrenia. Schizophr Res 47(203):167–175

    Article  CAS  PubMed  Google Scholar 

  7. Condon JT (1993) The assessment of antenatal emotional attachment: development of a questionnaire instrument. Br J Med Psychol 66(pt 2):167–183

    PubMed  Google Scholar 

  8. Cranley MS (1981) Development of a tool for the measurement of maternal attachment during pregnancy. Nurs Res 30:281–284

    Article  CAS  PubMed  Google Scholar 

  9. Dev V, Krupp P (1995) Adverse event profile and safety of clozapine. Rev Contemp Pharmacother 6:197–208

    CAS  Google Scholar 

  10. Dudzinski DM, Sullivan M (2004) When agreeing with the patient is not enough: a schizophrenic woman requests pregnancy termination. Law Ethics Psychiatry

  11. Ellman LN, Huttenen M, Lönnqvist J et al (2007) The effects of genetic liability for schizophrenia and maternal smoking during pregnancy on obstetrical complications. Schizophr Res 93(1–3):229–236

    Article  PubMed  Google Scholar 

  12. Field MA (1989) Controlling the woman to protect the fetus. Law Med Health Care 17(2):114–129

    CAS  PubMed  Google Scholar 

  13. Gardiner SJ, Kristensen JH, Begg EJ et al (2003) Transfer of olanzapine into breast milk, calculation of infant drug dose, and effect on breast-fed infants. Am J Psychiatry 160:1428–1431

    Article  PubMed  Google Scholar 

  14. Hendrick V (2006) Psychiatric disorders in pregnancy and the postpartum: principles and treatment. (Current Clinical Practice Series) Hardcover, Humana Press

  15. Hill RC, McIvor RJ, Wojnar-Horton RE et al (2000) Risperidone distribution and excretion into human milk: case report and estimated infant exposure during breast-feeding. J Clin Psychopharmacol 20:285–286

    Article  CAS  PubMed  Google Scholar 

  16. Hizkiyahu R, Levy A, Sheiner E (2009) Pregnancy outcome of patients with schizophrenia. Am J Perinatol 27(1):19–23

    Article  PubMed  Google Scholar 

  17. Howard LM, Kumar R, Thornicroft G (2001) Psychosocial characteristics and needs of mothers with psychotic disorders. Br J Psychiatry 178:427–432

    Article  CAS  PubMed  Google Scholar 

  18. Howard LM (2005) Fertility and pregnancy in women with psychotic disorders. Eur J Obstetrics Gynecology Reprod Biol 119:3–10

    Article  Google Scholar 

  19. Hultman CM, Cnattingius S, Olausson PO et al (2008) Schizophrenia and offspring’s risk for adverse pregnancy outcomes and infant death. Br J Psychiatry 193:311–315

    Article  PubMed  Google Scholar 

  20. Ilett KF, Hackett LP, Kristensen JH et al (2004) Transfer of risperidone and 9-hydroxyrisperidone into human milk. Ann Pharmacother 38:273–276

    Article  PubMed  Google Scholar 

  21. Jablensky AV, Morgan V, Soc MS et al (2005) Pregnancy, delivery, and neonatal complications in a population cohort of women with schizophrenia and major affective disorders. Am J Psychiatry 162:79–91

    Article  PubMed  Google Scholar 

  22. Jeffries JJ, Plummer E, Thornton JF, Seeman MV (1999) Living and working with schizophrenia, 2nd edn, Hardcover

  23. King-Hele SA, Abel KM, Webb RT et al (2007) Risk of sudden infant death syndrome with parental mental illness. Arch Gen Psychiatry 64(11):1323–1330

    Article  PubMed  Google Scholar 

  24. Kolder VE, Gallagher J (1987) Court-ordered obstetrical interventions. N Engl J Med 316(19):1192–1196

    Article  CAS  PubMed  Google Scholar 

  25. Kotlicka AM, Gmitrowitcz A, Sobow TM et al (2001) Obstetrical complications and Apgar score in early-onset schizophrenic patients with prominent positive and prominent negative symptoms. J Psychiatr Res 35(4):249–257

    Article  Google Scholar 

  26. Lee HC, Lin HC (2009) Maternal bipolar disorder increased low birth weight and preterm births: a nationwide population-based study. J Affect Disord 121(1–2):100–105

    PubMed  Google Scholar 

  27. Lee A, Giesbrecht E, Dunn E et al (2004) Excretion of quetiapine in breast milk. Am J Psychiatry 161:1715–1716

    Article  PubMed  Google Scholar 

  28. Lerum CW, LoBiondo-Wood G (1989) The relationship of maternal age, quickening, and physical symptoms of pregnancy to the development of maternal–fetal attachment. Birth 16:13–17

    Article  CAS  PubMed  Google Scholar 

  29. Lin HC, Chen IJ, Chen YH et al (2010) Maternal schizophrenia and pregnancy outcome: does the use of antipsychotics make a difference? Schizophr Res 116(1):55–60

    Article  PubMed  Google Scholar 

  30. Lindgren K (2001) Relationships among maternal-fetal attachment, prenatal depression, and health practices in pregnancy. Res Nurs Health 24(3):203–217

    Article  CAS  PubMed  Google Scholar 

  31. Maret SM (1989) Frank Lake’s maternal–fetal distress syndrome:—an analysis, Chap. 3, Caldwell University, Caldwell

  32. Maskenzie TB, Nagel TC (1986) When a pregnant woman endangers her fetus. Hastings Center Report 16(1):24–25

    Article  Google Scholar 

  33. McIntosh AM, Homes S, Gleeson S et al (2002) Maternal recall bias, obstetric history and schizophrenia. Br J Psychiatry 181:520–525

    Article  CAS  PubMed  Google Scholar 

  34. Miller LJ, Shah A (1999) Major mental illness during pregnancy. Primary Care Update for OB/GYNS 6(5, 10):163–168

    Google Scholar 

  35. Miller LJ (2007) Comprehensive care of pregnant mentally ill women. J Behav Health Serv Res

  36. Miller LJ (1997) Sexuality, reproduction, and family planning in women with schizophrenia. Schizophr Bull 23(4):623–635

    CAS  PubMed  Google Scholar 

  37. McK. Doan H, Cox NL et al (2003) The maternal fetal attachment scale: some methodological pondering. J Prenat Perinat Psychol Health 18(2):167–188

    Google Scholar 

  38. Muller ME (1993) Development of the prenatal attachment inventory. Western J Nurs Res 15:199–215

    Article  CAS  Google Scholar 

  39. Nilsson E, Lichtenstein P, Cnattingius S et al (2002) Women with schizophrenia: pregnancy outcome and infant death among their offspring. Schizophr Res 58:221–229

    Article  PubMed  Google Scholar 

  40. Ogle A, Mazzullo L (2002) Before your pregnancy: a 90 day guide for couples on how to prepare for a healthy conception, Hardcover

  41. Ostler T (2009) Mental illness in peripartum period. Zero to Three 29(5)

  42. Pinkerton JV, Finerty JJ (1996) Resolving the clinical and ethical dilemmas involved in fetal–maternal conflicts. Am J Obstet Gynecol 175(2):289–295

    Article  CAS  PubMed  Google Scholar 

  43. Preti A, Cardascia L, Zen T et al (2000) Risk for obstetric complications and schizophrenia. Psychiatry Res 96(2):127–139

    Article  CAS  PubMed  Google Scholar 

  44. Righetti PL, Dell’Avanzo M, Grigio M et al (2005) Maternal/paternal antenatal attachment and fourth-dimensional ultrasound technique: a preliminary report. Br J Psychol 96(Pt 1):129–137

    Article  CAS  PubMed  Google Scholar 

  45. Riley D (1995) Perinatal mental health, Hardcover. Radcliffe Medical Press, Oxford

    Google Scholar 

  46. Salisbury A, Law K, LaGasse L et al (2003) Maternal–fetal attachment. JAMA 289:1701

    Article  PubMed  Google Scholar 

  47. Schneid-Kofman N, Sheiner E, Levy A (2008) Psychiatric illness and adverse pregnancy outcome. Int J Gynecol Obstet 101(1):53–56

    Article  Google Scholar 

  48. Schubert EW, Blennow G, McNeil TF (1996) Wakefulness and arousal in neonates born to women with schizophrenia: diminished arousal and its association with neurological deviations. Schizophr Res 22(1):49–59

    Article  CAS  PubMed  Google Scholar 

  49. Spinelli MG (2004) Maternal infanticide associated with mental illness: prevention and the promise of saved lives. Am J Psychiatry 161:1548–1557

    Article  PubMed  Google Scholar 

  50. Susser ES, Gorman JM, Brown AS (1999) Prenatal exposures in schizophrenia, vol 56, Hardcover, American Psychiatric Publishing

  51. Tsai-Ching L, Chin-Shyan C, Chung Ping AL (2009) Do children of parents with mental illness have lower survival rate? A population-based study. Comprehensive psychiatry (in press)

  52. Van Bogaert LJ (2006) Rights of and duties to non-consenting patients—informed refusal in the developing world. Develop World Bioethics 6(1):13–22

    Article  Google Scholar 

  53. Wan MW, Moulton S, Abel KM (2008) A review of mother–child relational interventions and their usefulness for mothers with schizophrenia. Arch Womens Mental Health 11(3):171–179

    Article  Google Scholar 

  54. Yaeger D, Smith HG, Altshuler LL (2006) Atypical antipsychotics in the treatment of schizophrenia during pregnancy and the postpartum. Am J Psychiatry 163:2064–2070

    Article  PubMed  Google Scholar 

  55. Yarcheski A, Mahon NE, Yarcheski TJ et al (2009) A meta-analytic study of predictors of maternal-fetal attachment. Int J Nurs Studies 46(5):708–715

    Google Scholar 

  56. Yaris F, Yaris E, Kadioglu M et al (2004) Use of polypharmacotherapy in pregnancy: a prospective outcome in a case. Prog Neuropsychopharmacol Biol Psychiatry 28(3):603–605

    Article  PubMed  Google Scholar 

  57. Yun Y, Phillips LJ, Cotton S et al (2005) Obstetric complications and transition to psychosis in an ‘ultra’ high risk sample. Aust N Zealand J Psychiatry 39(6):460–466

    Google Scholar 

  58. Zammit S, Allebeck P, Dalman C et al (2003) Paternal age and risk for schizophrenia. Br J Psychiatry 183:405–408

    Article  PubMed  Google Scholar 

  59. Zammit S, Lewis S, Gunnell D (2007) Schizophrenia and neural tube defects: comparisons from an epidemiological perspective. Schizophr Bull 33(4):853–858

    Article  PubMed  Google Scholar 

  60. Zax M, Sameroff AJ, Babijian HM (1977) Birth outcomes in the offspring of mentally disordered women. Am J Orthopsychiatry 47(2):218–230

    Article  CAS  PubMed  Google Scholar 

  61. Zimerman A, Doan H, McK (2003) Prenatal attachment and other feelings and thoughts during pregnancy in three groups of pregnant women. J Prenatal Perinatal Psychol Health 18(2):131–148

    Google Scholar 

  62. Zipursky RB, Schulz SC (1987) Seasonality of birth and CT findings in schizophrenia. Biol Psychiatry 22(10):1288–1292

    Article  CAS  PubMed  Google Scholar 

  63. Zornberg GL, Buka SL, Tsuang MT (2000) The problem of obstetrical complications and schizophrenia. Schizophr Bull 26(2):249–256

    CAS  PubMed  Google Scholar 

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Correspondence to Naira Roland Matevosyan.

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Matevosyan, N.R. Pregnancy and postpartum specifics in women with schizophrenia: a meta-study. Arch Gynecol Obstet 283, 141–147 (2011). https://doi.org/10.1007/s00404-010-1706-8

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  • DOI: https://doi.org/10.1007/s00404-010-1706-8

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