Maternal and newborn outcomes among women with schizophrenia: a retrospective population-based cohort study

Authors

  • SN Vigod,

    Corresponding author
    1. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
    2. Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada
    3. Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada
    • Correspondence: Dr SN Vigod, Women's College Research Institute, and Department of Psychiatry, University of Toronto, 76 Grenville Street, Rm. 7234, Toronto, Ontario, M5S 1B2, Canada. Email simone.vigod@wchospital.ca

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  • PA Kurdyak,

    1. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
    2. Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada
    3. Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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  • CL Dennis,

    1. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
    2. Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada
    3. Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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  • A Gruneir,

    1. Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada
    2. Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada
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  • A Newman,

    1. Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada
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  • MV Seeman,

    1. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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  • PA Rochon,

    1. Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada
    2. Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada
    3. Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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  • GM Anderson,

    1. Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada
    2. Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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  • S Grigoriadis,

    1. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
    2. Sunnybrook Research Institute, Toronto, Ontario, Canada
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  • JG Ray

    1. Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada
    2. Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
    3. Keenan Research Centre, St. Michael's Hospital, Toronto, Ontario, Canada
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Abstract

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.

Design

Retrospective cohort study.

Setting

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

Population

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

Methods

Women with schizophrenia (= 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.

Main outcome measures

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.

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