Obstetric and neonatal outcomes in women with schizophrenia and the impact of psychiatric admission during pregnancy

Introduction Women with schizophrenia are known to have poor obstetric and neonatal outcomes. This study aims to determine these outcomes, along with psychiatric admission rates during pregnancy and the impact of this on outcomes. Method A cohort sample of 98 singleton pregnancies to women with schizophrenia managed in a specialised antenatal clinic in Western Australia (WA) from 2008-2016 was retrospectively examined. Data collected included demographic, psychosocial, obstetric, neonatal and psychiatric relapse. This was compared to the WA Mother and Baby perinatal data 2012. Descriptive data was analysed using SPPS software. Results The cohort demographic data was comparable to the WA perinatal population, with an over representation of Indigenous (24.5% cf 4.9%, p<0.001), smokers (58.2% cf 11.6%, p<0.001) and obese women (38.8% cf 23.1%, p<0.001). There were statistically significant higher rates of pre-existing medical comorbidities, antenatal and delivery complications, and women were less likely to achieve a normal vaginal birth (p=0.005). Neonatal outcomes demonstrated lower Apgar scores at 1 and 5 minutes (p<0.001), significantly higher rates of small-for-gestational-age infants (10.3% cf 5.3%, p=0.02) and special care nursery admission (p<0.001), but not preterm birth. Overall, 40.8% required psychiatric admission during pregnancy, with no significant trend regarding trimester timing, although 50% of these occurred in the first trimester. Psychiatric admission was associated with substance use (57%, p=0.01), but not significantly associated with poorer obstetric or neonatal outcomes. Conclusion Women with schizophrenia are a high risk population in pregnancy. Psychiatric admission does not appear to increase this risk further with specialised antenatal care management.