Obstetric complications in children born to parents with schizophrenia: a meta-analysis of case–control studies

Sacker, Amanda; Done, D.J.; Crow, Timothy J.

doi:10.1017/s003329170003467x

Cited by 123 publications

(77 citation statements)

References 42 publications

(30 reference statements)

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“…Current empirical research increasingly demonstrates the importance of using measures that appropriately reflect the underlying mechanisms linking perinatal complications to psychiatric outcomes (McNeill et al 1994, McNeill 1995, Sacker et al 1996. One such factor is intrauterine growth restriction which is likely to be on the causal pathway that leads to an increased risk of developing social and school problems (Parkinson et al 1981(Parkinson et al , 1986Schothorst and Van Engeland 1996).…”

Section: Discussionmentioning

confidence: 99%

Fetal growth and subsequent mental health problems in children aged 4 to 13 years

Zubrick

Kurinczuk

McDermott

et al. 2000

Develop Med Child Neuro

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To test the hypothesis that children with suboptimal fetal growth have significantly poorer mental health outcomes than those with optimal growth, a population random sample survey of children aged 4 to 16 years in Western Australia in 1993 was conducted. The Child Behavior Checklist (Achenbach 1991a) and the Teacher Report Form (Achenbach 1991b) were used to define mental health morbidity. Survey data for 1775 children aged 4 to 13 years were available for linkage with original birth information. The percentage of expected birth weight (PEBW) was used as the measure of fetal growth. Children below the 2nd centile of PEBW who had achieved only 57% to 72% of their expected birthweight given their gestation at delivery were at significant risk of a mental health morbidity (OR 2.9, 95% CI 1.18, 7.12). In addition, they were more likely to be rated as academically impaired (OR 6.0, 95% CI 2.25, 16.06) and to have poor general health (OR 5.1, 95% CI 1.69, 15.52).

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Section: Discussionmentioning

confidence: 99%

Fetal growth and subsequent mental health problems in children aged 4 to 13 years

Zubrick

Kurinczuk

McDermott

et al. 2000

Develop Med Child Neuro

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“…Women with psychotic disorders are also more likely to abuse substances, smoke and consume alcohol during pregnancy. 11,12 It is clear from a number of systematic reviews that women with psychotic disorders are at increased risk of obstetric complications 12,13 and stillbirths, 3 though these findings may be explained by confounding factors such as smoking, substance misuse, socioeconomic status, genetic susceptibility, poorer antenatal care, or possible effects of psychotropic medication.…”

Section: Risk Of Complications Of Pregnancymentioning

confidence: 99%

Management of women with psychosis during pregnancy

Howard¹,

Seneviratne²

2008

Prog Neurol Psychiatry

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It is increasingly recognised that many women with psychotic disorders have children 1,2 and that pregnancies of these women are high-risk. Psychotic disorders increase the risk of stillbir th and infant mortality 3 and can affect a woman's ability to care for herself and her infant. 4 Although women with psychoses are less fertile than the general population, 5 partly as a result of hyperprolactinaemia secondary to antipsychotic drugs, the increasing use of newer atypical drugs such as clozapine and olanzapine, which do not have this effect, is likely to lead to a rise in fertility, particularly in women with affective psychosis. 5 Women come into contact with many healthcare professionals during pregnancy and there are therefore many potential opportunities for prevention or attenuation of these risks. The challenge for health workers caring for women who are pregnant is how to ensure mental health problems are recognised and adequately treated. The NICE guideline on antenatal and postnatal mental health (2007) 6 recommends that at a women's first contact with services in the antenatal period, healthcare professionals should ask about past or present severe mental illness, previous treatment by a psychiatrist/specialist mental health team, including inpatient care, and a family history of perinatal mental illness.There is evidence from North America that women with psychotic disorders may start antenatal care later than controls and that women with mental health disorders receive poorer prenatal care. 7,8 Good liaison between services is therefore essential; healthcare professionals need to ensure that adequate systems are in place to ensure continuity of care and effective transfer of information. If a patient in contact with psychiatric services becomes pregnant, psychiatric services need to support the patient in engaging with primary care (including health visitors and community midwives) and obstetric services as early as possible in the pregnancy and liaise closely about the multidisciplinary care plan for the pregnancy and postnatal period. Risk of complications of pregnancyAll pregnancies carry risk, particularly to the fetus, with a base rate of obstetric risk and risk of congenital malformation of between 2 and 4 per cent. Patients with schizophrenia are at increased risk of impaired glucose tolerance and incident diabetes, 9 particularly if they are taking cer tain atypical antipsychotic drugs. 10 They are therefore at high risk of gestational diabetes. Women with psychotic disorders are also more likely to abuse substances, smoke and consume alcohol during pregnancy. 11,12 It is clear from a number of systematic reviews that women with psychotic disorders are at increased risk of obstetric complications 12,13 and stillbirths, 3 though these findings may be explained by confounding factors such as smoking, substance misuse, socioeconomic status, genetic susceptibility, poorer antenatal care, or possible effects of psychotropic medication. Risk of relapse during pregnancy and postpartumWhen counsell...

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“…Some women may not engage with antenatal services, although they may be at increased risk of obstetric complications (Goodman & Emory, 1992;Sacker et al, 1996), which may put their genetically susceptible children at further risk of developing a psychotic disorder (Sacker et al, 1996). Post-partum, women with a history of bipolar disorder are at high risk of relapse (Marks et al, 1992) and although women with schizophrenia are at less risk of a relapse in the early post-partum period (Davies et al, 1995) the stress of child care may lead to relapse subsequently.…”

Section: Impact On Patients With a Psychotic Disorder Of Having Childrenmentioning

confidence: 99%

Psychotic disorders and parenting - the relevance of patients' children for general adult psychiatric services

Howard

2000

Psychiatr. bull.

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Patients with psychotic disorders are often assumed to be sub-fertile, and when patients do have children, any child care concerns are usually passed on to social services. The children of patients with psychotic disorders may not, therefore, be of major concern to the responsible medical officer, and community mental health services have not been developed with families in mind. Routine statistics on psychiatric patient episodes do not include information on patients' children – a question covering this issue was included in the pilot draft of the Mental Health Minimum Data Set (approved for England by the Department of Health in September 1999), but was dropped because clinical professionals were reluctant to record this information, as they did not consider it relevant in this context (personal communication, G. Glover, 2000).

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Obstetric complications in children born to parents with schizophrenia: a meta-analysis of case–control studies

Cited by 123 publications

References 42 publications

Fetal growth and subsequent mental health problems in children aged 4 to 13 years

Fetal growth and subsequent mental health problems in children aged 4 to 13 years

Management of women with psychosis during pregnancy

Psychotic disorders and parenting - the relevance of patients' children for general adult psychiatric services

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