Volume 121, Issue 5 p. 566-574
Original Article

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

SN Vigod

Corresponding Author

SN Vigod

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

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 [email protected]Search for more papers by this author
PA Kurdyak

PA Kurdyak

Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada

Centre for Addiction and Mental Health, Toronto, Ontario, Canada

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CL Dennis

CL Dennis

Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada

Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada

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A Gruneir

A Gruneir

Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada

Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada

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A Newman

A Newman

Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada

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MV Seeman

MV Seeman

Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

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PA Rochon

PA Rochon

Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada

Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada

Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

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GM Anderson

GM Anderson

Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada

Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

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S Grigoriadis

S Grigoriadis

Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

Sunnybrook Research Institute, Toronto, Ontario, Canada

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JG Ray

JG Ray

Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada

Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

Keenan Research Centre, St. Michael's Hospital, Toronto, Ontario, Canada

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First published: 21 January 2014
Citations: 97

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.