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Risk of Stillbirth and Neonatal Death Linked With Maternal Mental Illness: A National Cohort Study

King-Hele, S; Webb, R T.; Mortensen, P B.; Appleby, L; Pickles, A; Abel, K M.

Obstetrical & Gynecological Survey: July 2009 - Volume 64 - Issue 7 - p 439-441
doi: 10.1097/01.ogx.0000351683.93047.9a
Obstetrics: Medical Complications of Pregnancy
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A number of studies of the general US population have provided evidence of increased risks of stillbirth or neonatal death (NND) among the offspring of women with schizophrenia, bipolar or unipolar disorders, or affective psychosis. Other studies, however, have found no increased risk of perinatal death in babies of such women.

In a prior report, the risk of NND appeared to be greater for offspring of mothers with affective or alcohol/drug-related disorders before pregnancy compared to those with schizophrenia and related disorders. This population-based study estimated the risks of stillbirth and NND among the offspring of mothers with psychiatric disorders requiring inpatient treatment, including substance-related disorders, in comparison with the general population. Examination of data from Danish national registers identified a cohort of 1.45 million live births and 7021 stillbirths for the years 1973 to 1998. These data were linked to the Psychiatric Central Register to identify singletons who were stillborn or died neonatally and were offspring of mothers with a history of hospital admission for severe mental illness.

Of the 7021 stillbirths, 188 occurred in babies whose mothers had a history of maternal psychiatric admission for all maternal psychiatric diagnostic categories including schizophrenia-related disorders and affective disorders before delivery. The overall relative risk of stillbirth and NND for these offspring was approximately 2-fold higher than the risk in the Danish general population. There was a significantly increased risk of stillbirth due to complications of delivery among the offspring of women with alcohol and drug-related disorders (RR: 2.3; 95% confidence interval [CI]: 1.2–4.2) and stillbirth due to congenital malformations among the babies of women with affective disorders (RR: 2.4; 95% CI: 1.1–5.1). The risk of NND due to anoxia and birth injury to the brain was similar in the 2 groups of children (maternal alcohol/drug use RR: 3.4; 2.1–5.6 vs. maternal affective disorder RR: 2.6; 1.6–4.3). The risk of NND due to fatal congenital malformation was higher among the children of women with a history of schizophrenia and related disorders ([stillbirth RR: 2.4; 95% CI: 0.8–7.6], [NND RR: 2.2; 95% CI: 1.1–4.1]) and women with affective disorder ([stillbirth RR: 2.4; 95% CI: 1.1–5.1], [NND RR: 2.1; 95% CI: 1.4–3.3]) than among children whose mothers had alcohol/drug-related disorders ([stillbirth: RR, 1.2; 95% CI: 0.4–3.8], [NND: RR, 1.1; 95% CI: 0.6–2.2]).

These findings suggest that maternal psychiatric illnesses is associated with a significantly increased risk of perinatal mortality. The increased risk may be related to poor lifestyle choices by affected women, such as antenatal smoking and drinking, and inadequate attention to prenatal care.

Centre for Women's Mental Health, University of Manchester, Manchester, United Kingdom; National Centre for Register-Based Research, University of Aarhus, Aarhus, Denmark; and Biostatistics/Health Methodology Research Group, University of Manchester, Manchester, United Kingdom

Arch Dis Child Fetal Neonatal 2009;94:F105–F110

© 2009 Lippincott Williams & Wilkins, Inc.