Maternal and newborn outcomes among women with schizophrenia: a retrospective population-based cohort study

ObjectiveMore women with schizophrenia are becoming pregnant, such that contemporary data are needed about maternal and newborn outcomes in this potentially vulnerable group. We aimed to quantify maternal and newborn health outcomes among women with schizophrenia. DesignRetrospective cohort study. SettingPopulation based in Ontario, Canada, from 2002 to 2011. PopulationOntario women aged 15-49years who gave birth to a liveborn or stillborn singleton infant. MethodsWomen with schizophrenia (n=1391) were identified based on either an inpatient diagnosis or two or more outpatient physician service claims for schizophrenia within 5years prior to conception. The reference group comprised 432358 women without diagnosed mental illness within the 5years preceding conception in the index pregnancy. Main outcome measuresThe primary maternal outcomes were gestational diabetes mellitus, gestational hypertension, pre-eclampsia/eclampsia, and venous thromboembolism. The primary neonatal outcomes were preterm birth, and small and large birthweight for gestational age (SGA and LGA). Secondary outcomes included additional key perinatal health indicators. ResultsSchizophrenia was associated with a higher risk of pre-eclampsia (adjusted odds ratio, aOR 1.84; 95% confidence interval, 95% CI 1.28-2.66), venous thromboembolism (aOR 1.72, 95% CI 1.04-2.85), preterm birth (aOR 1.75, 95% CI 1.46-2.08), SGA (aOR 1.49, 95% CI 1.19-1.86), and LGA (aOR 1.53, 95% CI 1.17-1.99). Women with schizophrenia also required more intensive hospital resources, including operative delivery and admission to a maternal intensive care unit, paralleled by higher neonatal morbidity. ConclusionsWomen with schizophrenia are at higher risk of multiple adverse pregnancy outcomes, paralleled by higher neonatal morbidity. Attention should focus on interventions to reduce the identified health disparities.