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Maternal schizophrenia and adverse birth outcomes: what mediates the risk?

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Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

Maternal schizophrenia is associated with adverse birth outcomes, but the reasons for this remain unclear. In a population-based cohort of infants born to women with schizophrenia, we determined the occurrence of key perinatal outcomes and explored whether factors identifiable in our datasets explained any elevated risk.

Methods

Using population-level health administrative data linked to clinical birth-registry data in Ontario, Canada (2006–2011), we examined the relative risk (RR) of preterm birth (< 37 weeks), small for gestational age (SGA), and Apgar scores < 8 in infants of women with schizophrenia (n = 4279) versus infants of unaffected women (n = 286,147). Generalized estimating equations determined whether reproductive history, maternal health conditions, pregnancy exposures, and complications explained elevated RRs.

Results

Among infants of women with schizophrenia, risk was higher for prematurity (11.4% vs. 6.9%, aRR 1.64, 95% CI 1.51–1.79), SGA (3.5% vs. 2.5%, aRR 1.40, 95% CI 1.20–1.64), and Apgar score < 8 at 1 (19.0% vs. 12.8%, aRR 1.49, 95% CI 1.40–1.59) and 5 min (5.6% vs. 3.0%, aRR 1.90, 95% CI 1.68–2.16). Smoking, fourfold more common among women with schizophrenia, was the variable that explained the greatest proportion of the elevated aRR for prematurity (9.9%), SGA (28.7%), and Apgar < 8 at 1 and 5 min (9.8%, 5.6%). Illicit substance use, certain reproductive history variables, and pregnancy complications also contributed to the elevated aRR for preterm birth.

Conclusions

Elevated risks of preterm birth, SGA, and low Apgar scores in infants of women with schizophrenia are partly explained by potentially modifiable factors such as smoking and illicit drug use, suggesting opportunities for targeted intervention.

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Acknowledgements

We thank the Ontario Ministry of Health and Long-Term Care for their data. Parts of this material are based on data and/or information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions, and statements expressed herein are those of the authors and not necessarily those of the CIHI. This study is based in part on data provided by Better Outcomes Registry and Network (“BORN”), part of the Children’s Hospital of Eastern Ontario. The interpretation and conclusions contained herein do not necessarily represent those of BORN Ontario.

Funding

This work was supported by the ICES, which is funded by an annual Grant from the MOHLTC. It was also supported by the Mental Health and Addictions Scorecard and Evaluation Framework Grant from the MOHLTC (Grant number 04601A14-19). The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred.

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Authors and Affiliations

  1. Women’s College Hospital and Research Institute, 76 Grenville Street Rm. 6336, Toronto, ON, M5S 1B2, Canada

    Simone N. Vigod, Lucy C. Barker & Hilary K. Brown

  2. University of Toronto, Toronto, ON, Canada

    Simone N. Vigod, Emily Bartsch, Reema Felemban, Natasha Saunders, Astrid Guttmann, Maria Chiu, Lucy C. Barker, Paul Kurdyak & Hilary K. Brown

  3. ICES, Toronto, ON, Canada

    Simone N. Vigod, Kinwah Fung, Abigail Amartey, Natasha Saunders, Astrid Guttmann, Maria Chiu, Lucy C. Barker, Paul Kurdyak & Hilary K. Brown

  4. Hospital for Sick Children, Toronto, ON, Canada

    Natasha Saunders & Astrid Guttmann

  5. Centre for Addiction and Mental Health, Toronto, ON, Canada

    Paul Kurdyak

Authors
  1. Simone N. Vigod
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  2. Kinwah Fung
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  3. Abigail Amartey
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Correspondence to Simone N. Vigod.

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Conflict of interest

In terms of author disclosures, Dr. Vigod receives royalties for authorship of chapters related to depression and pregnancy from UpToDate Inc. The other authors have declared that there are no conflicts of interest in relation to the subject of this study.

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Vigod, S.N., Fung, K., Amartey, A. et al. Maternal schizophrenia and adverse birth outcomes: what mediates the risk?. Soc Psychiatry Psychiatr Epidemiol 55, 561–570 (2020). https://doi.org/10.1007/s00127-019-01814-7

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  • DOI: https://doi.org/10.1007/s00127-019-01814-7

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