Schizophrenia and motherhood

Abstract

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.

Antipsychotic Use During Pregnancy and Risk for Gestational Diabetes: A National Register-Based Cohort Study in Sweden

“…This study also confirmed the slightly increased risk for prematurity suggested by previous studies [37,[49][50][51][52]. There is probably an effect of the underlying disease and lifestyle factors behind the association seen between an increased risk for moderate to late prematurity.…”

Women with Schizophrenia over the Life Span: Health Promotion, Treatment and Outcomes

“…Close liaison between psychiatry and obstetrics will ensure adherence to prenatal directives, important for the prevention of obesity, diabetes and potential complications of pregnancy. Ensuring adequate housing and psychosocial support for pregnant and postpartum women with schizophrenia is a critical element of care [69,70].…”

Neonatal morbidity after fetal exposure to antipsychotics: a national register-based study

“…[7][8][9][10][11][12] Some studies have indicated that schizophrenia itself might be connected to an increased risk of malformations, and discontinuation of drug therapy is not recommended during pregnancy due to the risk of relapse of the underlying condition. [13][14][15][16][17][18] Fetal exposure to antipsychotics has in smaller cohorts been linked to increased risks of prematurity, altered fetal growth, increased admission to neonatal intensive care unit (NICU), low APGAR scores, and neonatal extrapyramidal and respiratory symptoms. These risks seem to increase with increased dosage and with polypharmacy.…”

“…Treatment during pregnancy does not generally seem to increase the risk of malformations 7–12. Some studies have indicated that schizophrenia itself might be connected to an increased risk of malformations, and discontinuation of drug therapy is not recommended during pregnancy due to the risk of relapse of the underlying condition 13–18…”

“…Instead, one of them found a correlation between maternal psychiatric care during pregnancy and infant admission to NICU 22–24. Maternal schizophrenia and bipolar disorders have, independent of drug exposure, been associated with increased risks of prematurity, pre-eclampsia, neonatal morbidity including poor arousal and potential adverse neurodevelopmental effects in the infants 3 14 25–27. Mothers with untreated psychiatric illness are also more likely to engage in high-risk behaviours such as smoking, alcohol and illicit drugs and are less likely to attend to antenatal care 25…”