Adverse obstetric and neonatal outcomes complicated by psychosis among pregnant women in the United States

Zhong, Qiu‐Yue; Gelaye, Bizu; Fricchione, Gregory L.; Avillach, Paul; Karlson, Elizabeth W.; Williams, Michelle A.

doi:10.1186/s12884-018-1750-0

Cited by 56 publications

(49 citation statements)

References 53 publications

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“…the risk was specifically increased for cardiovascular anomalies. Such studies also found an increased rate of pregnancy complications, including fetal distress and placental abruption …”

Section: Results (Table )mentioning

confidence: 89%

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Schizophrenia and motherhood

Gentile¹,

Fusco²

2019

Psychiatry Clin Neurosci

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The primary aim of this study was to analyze the impact of schizophrenic disorders on pregnancy outcomes. The secondary aim was to briefly analyze the potential role of antipsychotic treatment on influencing pregnancy outcomes in expectant mothers with schizophrenia. We searched the MEDLINE, PsycINFO, and http://Science.gov databases for articles published in English from January 1980 to January 2019. We used the following search terms: ‘schizophrenia’, ‘motherhood’, ‘pregnancy/foetal/neonatal outcomes’, and ‘birth defects’. The reference lists of retrieved articles were also consulted to find additional pertinent studies missed in the electronic search and/or those published before 1980. Data were extracted from articles that provided primary data on the impact of maternal schizophrenia spectrum disorders on obstetrical and perinatal outcomes. After excluding duplicates, 35 articles were identified. Systematic reviews were searched on the same databases to briefly assess the effects of antipsychotics on pregnancy outcomes. The reviewed studies showed several limitations. They were published during a time range from the early 1970s to 2019. During this period, there were significant changes in the diagnostic criteria for schizophrenia. Moreover, such studies showed no homogeneity in the investigation of potential confounders. Most importantly, no research has differentiated the effects of maternal illness on pregnancy, fetal, and neonatal outcomes from those associated with antipsychotic treatments. Thus, it is not surprising that such studies show conflicting results. Despite such limitations, in managing pregnant women with schizophrenia clinicians should consider an integrated approach that includes: antipsychotic treatment, psychological treatment, optimal dietary approaches for prevention of excessive weight gain and gestational diabetes, meticulous gynecologic and obstetric surveillance, and social and occupational support.

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“…the risk was specifically increased for cardiovascular anomalies. Such studies also found an increased rate of pregnancy complications, including fetal distress and placental abruption …”

Section: Results (Table )mentioning

confidence: 89%

“…The second limitation is the lack of homogeneity in the psychiatric diagnoses of the enrolled populations …”

Section: Discussionmentioning

confidence: 99%

Schizophrenia and motherhood

Gentile¹,

Fusco²

2019

Psychiatry Clin Neurosci

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“…Schizophrenia polygenic risk scores appear to mediate less than 20% of the effect of family history 229 . This is likely in part explained by the fact that particularly parental family history also reflects environmental influences, such as higher rates of birth and pregnancy complications 230,231 , growing up in an unfavorable home environment 232 , out-of-home placement 233 , elevated divorce rate, alterations in parental communication 234 , and poor school performance 235 . The sizeable impact of growing up with a parent with severe mental illness on psychological and social development has been recently reviewed 236 .…”

Section: Family Historymentioning

confidence: 99%

The clinical characterization of the patient with primary psychosis aimed at personalization of management

et al. 2021

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The current management of patients with primary psychosis worldwide is often remarkably stereotyped. In almost all cases an antipsychotic medication is prescribed, with second‐generation antipsychotics usually preferred to first‐generation ones. Cognitive behavioral therapy is rarely used in the vast majority of countries, although there is evidence to support its efficacy. Psychosocial interventions are often provided, especially in chronic cases, but those applied are frequently not validated by research. Evidence‐based family interventions and supported employment programs are seldom implemented in ordinary practice. Although the notion that patients with primary psychosis are at increased risk for cardiovascular diseases and diabetes mellitus is widely shared, it is not frequent that appropriate measures be implemented to address this problem. The view that the management of the patient with primary psychosis should be personalized is endorsed by the vast majority of clinicians, but this personalization is lacking or inadequate in most clinical contexts. Although many mental health services would declare themselves “recovery‐oriented”, it is not common that a focus on empowerment, identity, meaning and resilience is ensured in ordinary practice. The present paper aims to address this situation. It describes systematically the salient domains that should be considered in the characterization of the individual patient with primary psychosis aimed at personalization of management. These include positive and negative symptom dimensions, other psychopathological components, onset and course, neurocognition and social cognition, neurodevelopmental indicators; social functioning, quality of life and unmet needs; clinical staging, antecedent and concomitant psychiatric conditions, physical comorbidities, family history, history of obstetric complications, early and recent environmental exposures, protective factors and resilience, and internalized stigma. For each domain, simple assessment instruments are identified that could be considered for use in clinical practice and included in standardized decision tools. A management of primary psychosis is encouraged which takes into account all the available treatment modalities whose efficacy is supported by research evidence, selects and modulates them in the individual patient on the basis of the clinical characterization, addresses the patient’s needs in terms of employment, housing, self‐care, social relationships and education, and offers a focus on identity, meaning and resilience.

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“…Schwerwiegende psychische Erkrankungen in der Schwangerschaft stellen einen relevanten Risikofaktor für Geburtskomplikationen dar. Nach einer aktuellen Registerstudie sind schizophrene und affektive Psychosen während der Schwangerschaft mit einer Vielzahl von mütterlichen, fetalen und neonatalen Komplikationen verbunden [ 28 ]. Neben immanent psychiatrischen Aspekten wie Suizidalität mit ggf.…”

Section: Hintergrundunclassified

“…Letztlich sind die absoluten und relativen Risiken der EKT in der Schwangerschaft nicht exakt bezifferbar, da kontrollierte Studien, die mittels identisch schwer erkrankter Vergleichspopulationen die Effekte der psychiatrischen Störung von denen der Behandlung differenzieren könnten, fehlen. Eine ohne Kausalitätsprüfung vorgenommene Angabe der Häufigkeit unerwünschter Ereignisse bei EKT in der Schwangerschaft wird diese jedoch überschätzen, da die EKT-assoziierten „adverse events“ [ 23 ] qualitativ weitgehend deckungsgleich mit den Risiken einer schwerwiegenden psychischen Erkrankung in der Schwangerschaft [ 14 , 28 ] sind (Tab. 1 ).…”

Section: Diskussionunclassified

Elektrokonvulsionstherapie in der Schwangerschaft: Fallbericht und interdisziplinäre Behandlungsvorschläge

et al. 2020

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Hintergrund Psychische Störungen in der Schwangerschaft sind häufig. Besonders bei schweren affektiven oder psychotischen Störungen mit Notwendigkeit eines raschen Ansprechens kann eine Elektrokonvulsionstherapie (EKT) indiziert sein. Dazu vorliegende Übersichtsartikel unterscheiden sich methodisch stark, was zu unterschiedlichen Schlussfolgerungen hinsichtlich der Anwendung der EKT bei Schwangerschaft führt. Ziel der Arbeit Darstellung eines neuen klinischen Falls sowie interdisziplinärer Behandlungsvorschläge zur sicheren Anwendung der EKT bei Schwangerschaft. Methoden Fallbericht und selektive Literaturübersicht unter besonderer Berücksichtigung der existierenden systematischen Reviews. Ergebnisse und Diskussion Die aktuelle Kasuistik zeigt die potenziell hohe Wirksamkeit sowie die für Mutter und Fetus sichere Anwendung der EKT während der Schwangerschaft. Die in der Literatur beschriebenen unerwünschten Ereignisse entsprechen qualitativ weitgehend den Risiken bei schwerer psychischer Störung in der Schwangerschaft. Zur besseren Nutzen-Risiko-Abwägung wären größere Fall-Kontroll-Studien wünschenswert. Bei sorgfältiger Indikationsstellung, guter interdisziplinärer Abstimmung und Beachtung der Besonderheiten in der praktischen Durchführung ist die EKT auch in der Schwangerschaft eine sinnvolle Behandlungsoption.

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Adverse obstetric and neonatal outcomes complicated by psychosis among pregnant women in the United States

Cited by 56 publications

References 53 publications

Schizophrenia and motherhood

Schizophrenia and motherhood

The clinical characterization of the patient with primary psychosis aimed at personalization of management

Elektrokonvulsionstherapie in der Schwangerschaft: Fallbericht und interdisziplinäre Behandlungsvorschläge

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