The characteristics and health needs of pregnant women with schizophrenia compared with bipolar disorder and affective psychoses

Abstract

BackgroundMost women with psychotic disorders and bipolar disorders have children but their pregnancies are at risk of adverse psychiatric and fetal outcome. The extent of modifiable risk factors – both clinical and socio-demographic – is unclear as most studies have used administrative data or recruited from specialist tertiary referral clinics. We therefore aimed to investigate the socio-demographic and clinical characteristics of an epidemiologically representative cohort of pregnant women with affective and non-affective severe mental illness.MethodsWomen with severe mental illness were identified from a large electronic mental health case register in south London, and a data linkage with national maternity Hospital Episode Statistics identified pregnancies in 2007–2011. Data were extracted using structured fields, text searching and natural language processing applications.ResultsOf 456 pregnant women identified, 236 (51.7%) had schizophrenia and related disorders, 220 (48.3%) had affective psychosis or bipolar disorder. Women with schizophrenia and related disorders were younger, less likely to have a partner in pregnancy, more likely to be black, to smoke or misuse substances and had significantly more time in the two years before pregnancy in acute care (inpatient or intensive home treatment) compared with women with affective disorders. Both groups had high levels of domestic abuse in pregnancy (recorded in 18.9%), were from relatively deprived backgrounds and had impaired functioning measured by the Health of the Nation Outcome Scale. Women in the affective group were more likely to stop medication in the first trimester (39% versus 25%) whereas women with non-affective psychoses were more likely to switch medication.ConclusionsA significant proportion of women, particularly those with non-affective psychoses, have modifiable risk factors requiring tailored care to optimize pregnancy outcomes. Mental health professionals need to be mindful of the possibility of pregnancy in women of childbearing age and prescribe and address modifiable risk factors accordingly.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-015-0451-8) contains supplementary material, which is available to authorized users.

Bipolar disorder in pregnancy and childbirth: a systematic review of outcomes

“…Both of these papers are included in the discussion section only, for noting, as they were published too late to be included in the review. Taylor et al 2015 [53] was excluded, as their description of the characteristics of pregnant women and their use of psychotropic medication was not relevant for this review. The fourth paper, a review and meta-analysis by Wesseloo et al 2016 [54] was also not relevant for inclusion as it included women who had a psychotic or manic episode following childbirth, even if they had never had a diagnosis of BD in pregnancy.…”

Risks and benefits of psychotropic medication in pregnancy: cohort studies based on UK electronic primary care health records

“…We, in keeping with others, found a high prevalence of smokers and individuals with illicit drug problems among women who were prescribed antipsychotics in pregnancy, which may have an inverse impact on pregnancy outcomes. 89 Little is known about adverse developmental effects of antipsychotic exposure in pregnancy. 90 After adjustments for concomitant medication, health and lifestyle factors we found that the association between antipsychotic prescribing in pregnancy and neurodevelopmental disorders attenuated and was not statistically significant.…”

Natural language processing to extract symptoms of severe mental illness from clinical text: the Clinical Record Interactive Search Comprehensive Data Extraction (CRIS-CODE) project

“…This diagnosis information came from structured fields in the source EHR, which are completed by clinicians during the normal course of care by means of selecting an appropriate ICD-10 code; these were supplemented by a separate NLP application33 34 which returns searchable text strings associated with diagnostic statements in text fields. In UK NHS Mental Health Trusts, recording of diagnosis is effectively mandatory, but recorded diagnoses themselves have no financial implications for trusts (eg, are not used for any billing purposes).…”