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.
Highlights
Most women with psychotic disorders and bipolar disorders have children but their pregnancies are at risk of adverse psychiatric and fetal outcome
Socio-demographic and clinical characteristics We identified 456 women with severe mental illnesses (SMI) with 539 pregnancies during the study period 2007–2011 (Figure 1); 68 women had more than one pregnancy in the study period
Using diagnoses recorded closest to the beginning of the first pregnancy, there were 236 (51.7%) women with schizophrenia and related disorders, and 220 (48.3%) women with affective SMI (165 bipolar affective disorder, 48 psychotic depression, and 7 with a history of postpartum psychosis only)
Summary
Most women with psychotic disorders and bipolar disorders have children but their pregnancies are at risk of adverse psychiatric and fetal outcome. Most women with severe mental illnesses (SMI; i.e. schizophrenia and related delusional disorders, and bipolar disorder and affective psychoses) have children [1], and with the use of newer antipsychotic medications that do not raise prolactin, fertility in women with SMI is increasing [2,3]. The prevalence of these modifiable risk factors in these women is unclear as most studies have used clinical data from specialist services with limited generalizability, or have small clinical samples with limited statistical power to investigate differences between the groups [17], or have used administrative data of population cohorts with little detail on clinical characteristics. It is not clear to what extent these risk factors differ in pregnant women with schizophrenia and related delusional disorders compared with women with bipolar disorder or affective psychoses
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
