ncreased morbidity and mortality trends in patients with severe mental illness (SMI), coupled with suboptimal access to health provision, 1 highlights the need for comprehensive yet individualised care. Pregnant women with SMI and their babies appear to be a particularly vulnerable group, due to increased risks for obstetric and neonatal complications. 2-4 In a Western Australian population study, 3 women with schizophrenia and major affective disorders were more likely to experience placental abnormalities and fetal distress. Women with schizophrenia were also more likely to have newborns in the lowest weight/growth decile and have a neonatal narcotic antagonist administered. Pregnant women with bipolar disorder have been found to be at increased risk of preterm and low-birthweight infants. 5,6 Mothers with SMI present with poor maternal condition, 7 which is reflected by late presentation to obstetric services and fewer appointments, 8,9 poor nutrition, more likelihood of smoking, illicit substance use, and less support. 10,11 Additional concerns include antipsychotic exposure during pregnancy, which has been associated with fetal malformation; 12 infant growth disruption; increased or decreased birthweight; 12,13 and neonatal adjustment difficulties. 14 Pregnant women with SMI should be designated as a health disparity population, 15 and every effort should be made to improve their access to obstetric care. Within this context, the Childbirth and Mental Illness Antenatal Clinic (CAMI clinic) at King Edward Memorial Hospital (KEMH) was established in 2007. The weekly antenatal clinic comprises a multidisciplinary team of designated obstetrics, midwifery, psychiatry, mental health nursing and social work staff who provide care for pregnant women, in liaison with their treating psychiatrists. This approach has the potential to increase attendance at antenatal care for pregnant women with SMI. 16 We report on the obstetric and neonatal outcomes of pregnant women with SMI who attended the CAMI clinic between 2007 and 2011. Method A retrospective file audit was made of all pregnant women with SMI who attended the CAMI clinic and gave birth between December 2007 and April 2011. Psychiatric diagnoses were grouped into schizophrenia and related disorders, bipolar disorders, and non-psychotic disorders with significant functional impairment. Diagnoses were made by community mental health services, private psychiatrists or a consultant psychiatrist at KEMH using ICD-10 criteria. 17 Data audited from case notes were based on the Western Australian Midwives' Notification System. The purpose-designed database also included psychiatric diagnoses, detailed demographic information, attendance at the CAMI clinic (including the number of antenatal appointments), psychotropic medication use, and psychosocial outcomes, including psychiatric admissions and statutory welfare agency involvement. The KEMH Ethics Committee approved the study. Statistical analysis CAMI clinic data (summary data from all women combined) were compared wit...

Neuritin 1 (NRN1), an activity-regulated gene with multiple roles in neurodevelopment and synaptic plasticity, is located within the 6p24-p25 interval on chromosome 6, previously identified as linked to a subtype of schizophrenia (SZ) characterized by pervasive cognitive deficit (CD). We have tested the effect of NRN1 sequence variation on susceptibility to SZ and on general cognitive ability in patients and non-psychiatric control subjects by re-sequencing the coding regions of NRN1 and its flanking sequences, and genotyping 19 single-nucleotide polymorphisms (SNPs) in 336 SZ patients and 172 healthy control individuals. All participants completed comprehensive neurocognitive assessment, including tests estimating premorbid/prior IQ and current IQ. Logistic regression analyses found no significant association for any of the 19 SNPs with SZ or its CD subtype. However, linear regression analysis gave significant association (P = 0.024 and P = 0.027 after correction for multiple testing) for polymorphisms rs1475157 and rs9405890 with current IQ in the patient group. In SZ, the rs1475157-rs9405890 haplotypes revealed a highly significant association with the abstraction component of current ("fluid") intelligence (P = 0.0014), and with percentage loss of IQ points between premorbid and current intelligence (P = 0.0041). Results in the control group were not significant after correction. This is the first analysis of association between variation in NRN1 and SZ. The findings suggest a role of NRN1 as a modifier of cognitive functioning in SZ, with implications for future research into the impact of the environment on the development and maintenance of "fluid" intelligence.

Our purpose was to explore the pregnancy experiences of Australian women attending a specialized childbirth and mental illness (CAMI) antenatal clinic. A qualitative exploratory design was selected to give voice to women with severe mental illness receiving antenatal care. Telephone interviews with 41 women, 24 primiparous and 17 multiparous, were analyzed using thematic analysis. Three themes emerged: "building relationships," "acknowledging me as a person with special needs," and "respecting and understanding without stigma." Findings offer insight into care experiences possible within a multidisciplinary model developed to address psychiatric and obstetric needs of pregnant women with severe mental illness.

Objective: To evaluate the obstetric and neonatal outcomes of pregnant women with severe mental illness (SMI) who attended a specialist multidisciplinary antenatal clinic in Perth, Western Australia. Design, setting and participants: A retrospective case‐note audit of outcomes from the Childbirth and Mental Illness Antenatal Clinic (CAMI clinic) at King Edward Memorial Hospital for pregnant women with severe mental illness (SMI), aged 18–41 years, who gave birth between December 2007 and April 2011, and their babies. Main outcome measures: Obstetric and neonatal outcomes for 138 women and newborns from singleton live births. Data were compared between three diagnostic groups (schizophrenia, bipolar and non‐psychotic SMI), and with WA obstetric and perinatal statistics for 2008. Results: 44 women with schizophrenia, 56 with bipolar disorder and 38 with non‐psychotic SMI attended antenatal care for an average of 7.7 (SD, 3.3) visits. The proportion of women who smoked tobacco was significantly higher than that in the WA antenatal population (46% v 15%; P < 0.0001). Alcohol use, illicit substance use and psychotropic medication exposure during pregnancy were high. The women were at increased risk of developing gestational diabetes mellitus (15% v 4%; P < 0.0001) and pre‐eclampsia (9% v 3%; P < 0.0001), and birth complications were more common. Babies born to CAMI clinic women were less likely to have Apgar scores ≥ 8 at 1 minute and 5 minutes. Pregnant women with schizophrenia had more psychiatric relapses during pregnancy, and had more statutory child welfare involvement. Gestational age at birth and infant birth weights were similar for the pregnant women with SMI and the WA population in 2008. Conclusions: Women attending our specialist clinic had increased rates of obstetric and neonatal complications compared with the general population, and were exposed to a cluster of risk factors. We report encouraging trends in antenatal attendance, gestational age at birth, and birth weights. Managing pregnant women with SMI will require a comprehensive approach aimed at early detection of obstetric complications and psychosocial difficulties, as well as neonatal monitoring. Optimising prepregnancy maternal health and welfare may also be of benefit.

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