Psychiatric admission during pregnancy in women with schizophrenia who attended a specialist antenatal clinic

Abstract

Objectives: The mental health and wellbeing of pregnant women with schizophrenia is an area of research interest. We aim to explore this relationship particularly in regards to psychiatric admission rates, timing and their associated contributing factors.

Methods: A total of 98 pregnancies to women with schizophrenia, who attended a specialist antenatal clinic and delivered from July 2007 to February 2016, were retrospectively examined. The cohort was divided into two groups based on psychiatric admission. Descriptive data were analyzed using SPSS software.

Results: Overall, 40.8% required psychiatric admission during pregnancy. A higher proportion of subjects had their initial psychiatric admission in the first trimester compared to the third trimester (p = .002). Of note, 10.2% were admitted within one month either side of conception. Women with admission also presented later for their first antenatal appointment (p = .04, 95% CI −2.1 to −1.9). Psychiatric admission was associated with substance (p = .014) and alcohol use (p = .001), child protective services involvement (p = .022) and infant being placed in out-of-home care (p = .01), but not with poorer obstetric or neonatal outcomes.

Conclusion: High rates of psychiatric admission are evident throughout pregnancy for women with schizophrenia, with a high proportion of first presentations for admission occurring in the first trimester. Psychiatric admission is associated with poorer antenatal care attendance and adverse psychosocial outcomes, highlighting the need for enhanced multidisciplinary pregnancy care for this at risk group. Inpatient psychiatric services should consider pregnancy testing and contraception review for all women of childbearing age, admitted with schizophrenia.

Keywords:

• Schizophrenia
• pregnancy
• psychiatric admission
• antenatal care
• psychiatry

Disclosure statement

No potential conflict of interest was reported by the authors.

Current knowledge on this subject

1. Women with schizophrenia experience higher rates of unplanned pregnancies, increased prevalence of high-risk sexual practices and more frequent pregnancy health risk behaviors, such as smoking.

2. Pregnant women with schizophrenia are at higher risk of obstetric and neonatal adverse outcomes as well as psychiatric destabilization, than women without schizophrenia.

3. The rate of psychiatric relapses and the potential compounding effect of psychiatric relapse during pregnancy for women with schizophrenia remain understudied.

What this study adds

1. Pregnant women with schizophrenia have a high rate of psychiatric admission in the antenatal period with a high proportion occurring in the first trimester.

2. One in ten pregnant women with schizophrenia had a psychiatric admission periconception (one month either side of conception), highlighting the need for inpatient psychiatric services to be vigilant about pregnancy testing and contraception review.

3. Psychiatric admission for pregnant women with schizophrenia is associated with alcohol and substance use, poorer antenatal care attendance and child protective services involvement.