Maternal schizophrenia and pregnancy outcome: Does the use of antipsychotics make a difference?

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Abstract

Objective

This study compared the risk of adverse pregnancy outcome—including preterm births, low birth weight (LBW), large-gestational-age (LGA), and small-gestational-age (SGA)—among mothers with schizophrenia receiving typical, atypical, and no antipsychotics during pregnancy. They were all compared with control subjects.

Methods

We used population-based data from the Taiwan National Health Insurance Research Database and birth certificate registry covering the years 2001 to 2003. In total, 696 mothers with schizophrenia and 3480 matched unaffected mothers were included for analysis. After adjusting for characteristics of mother, father, and infants, multivariate logistic regression analyses were performed to examine the risk of LBW, preterm gestation, SGA, and LGA, comparing mothers with schizophrenia and unaffected mothers.

Results

After adjusting for potential confounders, the odds of LBW and SGA for unaffected mothers respectively were 0.72 (95% CI = 0.50–0.88) and 0.81 (95% CI = 0.64–0.92) times those of mothers with schizophrenia who had not receiving antipsychotics during pregnancy. There was no significant difference in the risk of LBW, preterm births, LGA, and SGA babies compared to mothers with schizophrenia receiving atypical antipsychotics during pregnancy and those not receiving antipsychotics. However, mothers with schizophrenia receiving typical antipsychotics during pregnancy had higher odds of preterm birth (OR = 2.46, 95% CI = 1.50–4.11) compared to those not receiving antipsychotics.

Conclusions

The data suggest that the risks for LBW and SGA among mothers with schizophrenia are not affected by antipsychotic use. Women who receive treatment with typical antipsychotics during pregnancy are at slightly higher risk of preterm birth.

Introduction

The effect of antipsychotics on pregnant women has drawn much attention during the past few years. In terms of pregnancy outcome for women with schizophrenia however, the safety of antipsychotics remains unclear. Pregnant women with schizophrenia who discontinue antipsychotics are more likely to experience relapse. This could put them and their babies at greater risk, outweighing risks associated with antipsychotics use (Newport et al., 2007). Therefore, treating expectant mothers with schizophrenia poses a challenge for patients, their families, and doctors, since the most common onset of schizophrenia is during childbearing ages (Miller, 1997).

Previous studies have attempted to document the impact of antipsychotics on pregnancy outcome, but have yielded inconsistent findings. A study by Newham et al. (2008) reported that in utero exposure to atypical antipsychotics may increase infant birth weight and incidences of babies large for gestational age (LGA). A study by Reis and Kallen (2008) found that the maternal use of antipsychotics was not associated with preterm births, low birth weight (LBW), or SGA. McKenna et al. (2005) concluded that women exposed to atypical antipsychotics had significantly higher rates of low birth weight (LBW) infants than those in the comparison group (10% vs. 2%). However, the above studies not only look at different sets of outcome, all analyses fail to take the disorder itself into consideration. A plethora of studies have consistently demonstrated the relationship between schizophrenia and adverse pregnancy outcome. Therefore, studies of the effect of antipsychotics on pregnancy outcome based on samples that mixed patients with diverse types of mental disorders or other chronic disorders may confound the findings.

Using a nationwide population-based dataset from Taiwan, the objective of this study was to compare the risk of adverse pregnancy outcome including preterm birth, LBW, LGA, and SGA among mothers with schizophrenia receiving typical, atypical, and no antipsychotics during pregnancy and comparison subjects after adjusting for the characteristics of mother, father, and infant. We hypothesized that the risk of adverse birth outcome increased among women with schizophrenia, as compared to those without a psychiatric illness. The maternal use of physician-approved antipsychotic medication during pregnancy would possess minimal excess risk to the pregnancy outcome. These findings may help clinicians understand the possible impact of antipsychotics on pregnancy outcome and indicate a better treatment choice for optimal control of schizophrenic symptoms during pregnancy.

Section snippets

Database

For this study, we linked two nationwide population-based datasets. The first dataset was sourced from the Taiwan National Health Insurance Research Dataset (NHIRD), covering the years 1996 to 2003. Taiwan inaugurated its National Health Insurance (NHI) program in 1995 as a means of financing healthcare for all Taiwanese citizens. The NHI has the following characteristics: universal health insurance coverage, a single-payer system with the government as the sole insurer and payer, comprehensive

Results

A total of 696 mothers with schizophrenia during the study period were identified. In 242 pregnancies, mothers received antipsychotics for treatment of schizophrenia. The mean duration of antipsychotics use was 164 days (standard deviation = 113 days). In 194 of these pregnancies, the women received typical antipsychotics. The distribution of antipsychotics used during pregnancy is listed in Table 1. Table 2 shows the study and comparison cohort distributions of the infant, mother, and father

Discussion

In this nationwide, population-based retrospective study, women with schizophrenia, regardless of whether they had received antipsychotics during pregnancy, had an increased risk of delivering babies with LBW and SGA than the comparison cohort. As shown by an earlier meta-analytic study, women with schizophrenia were at higher risk for obstetric complications, including LBW and poor neonatal conditions, than the general population (Sacker et al., 1996). Several recent studies have provided more

Role of funding source

None.

Contributors

Authors Herng-Ching Lin and I-Ju Chen designed the study and wrote the draft. Authors Dr. Yi-Hua Chen, Hsin-Chien Lee, I-Ju Chen and Fang-Jen Wu managed the literature searches and analyses. Authors Herng-Ching Lin, Yi-Hua Chen and Hsin-Chien Lee undertook the statistical analysis. All authors contributed to and have approved the final manuscript.

Conflict of interest

None.

Acknowledgements

This study is based in part on the data from the National Health Insurance Research Database provided by the Bureau of National Health Insurance, Department of Health and managed by the National Health Research Institutes, Taiwan. The interpretations and conclusions contained herein do not represent those of the Bureau of National Health Insurance, Department of Health, or the National Health Research Institutes.

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