Implications for practice and research

• Higher rates of preterm delivery and small for gestational age (SGA) babies in schizophrenic mothers confirm previous findings in the context of newer antipsychotic drugs and treatment practices.

• Women with schizophrenia should be counselled about increased risks and followed by a provider specialising in high-risk pregnancies.

• Strategies to address modifiable risk factors during pregnancy and the perinatal period are necessary. Special attention should be given to smoking cessation and control of blood pressure.

• Novel findings include increased rates of thromboembolic disease in pregnancy and large for gestational age (LGA) infants in births involving schizophrenic mothers. Further studies should assess whether potential confounding factors such as body mass index (BMI), alcohol, tobacco and drug use, and the type of antipsychotic medications used, affect the novel findings reported.

Context

A documented rise in fertility rates among schizophrenic women warrants improved understanding of these women's reproductive outcomes.1 Much of the existing literature examining the relationship between schizophrenia and pregnancy outcomes was completed prior to newer antipsychotic drugs and updated treatment protocols, and is likely to be confounded by factors such as smoking and socioeconomic components.2 As such, an up-to-date study exploring maternal and fetal outcomes for schizophrenic women is needed.

Findings

Women with schizophrenia had increased rates of pre-eclampsia/eclampsia, gestational diabetes and venous thromboembolism. The study also documented increased rates of gestational hypertension, but this finding did not persist following adjustment for covariates.

Schizophrenic mothers were also more likely to suffer from septic shock and placental abruption, to be transferred to an intensive care unit, undergo labour induction or caesarean section, and to be readmitted following discharge. The risks for infants born to schizophrenic mothers included increased rates of SGA, LGA and preterm birth.

Commentary

Overall, women with schizophrenia and their infants were found, in concordance with previous literature, to have increased rates of several risk factors.3–6 The importance of this study is that it re-examined reproductive outcomes of women with schizophrenia in the present-day setting where newer antipsychotic drugs, better understanding of mental illness and increased patient access to mental health services exists. Areas not assessed, but of interest for future examination, include patient reception (or otherwise) of mental health treatment, and types of antipsychotic medication prescribed during pregnancy.

As the authors noted, there were limitations related to standard variables captured by the health databases. It is difficult to determine the confounding effect of medical and social determinants such as alcohol, tobacco and drug abuse, periods of homelessness, medication use and BMI. An additional question to be considered when interpreting data on secondary maternal outcomes is whether medical providers perceive schizophrenic mothers to be higher risk than the general population. If so, such pregnancies may be subject to more aggressive intervention regardless of the actual risk profile of the patient.

The study captured several unique factors, including an increased risk of LGA infants, pregnancy-induced hypertension and thromboembolic disease in pregnancy. Owing to potential confounding factors, further studies are needed to elucidate whether this trend will persist.