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. 2018 May 2;18(1):120.
doi: 10.1186/s12884-018-1750-0.

Adverse obstetric and neonatal outcomes complicated by psychosis among pregnant women in the United States

Qiu-Yue Zhong  1 , Bizu Gelaye  2 , Gregory L Fricchione  3 , Paul Avillach  2   4   5 , Elizabeth W Karlson  6 , Michelle A Williams  2
Affiliations
Free PMC article

Adverse obstetric and neonatal outcomes complicated by psychosis among pregnant women in the United States

Qiu-Yue Zhong et al. BMC Pregnancy Childbirth. .
Free PMC article

Abstract

Background: Adverse obstetric and neonatal outcomes among women with psychosis, particularly affective psychosis, has rarely been studied at the population level. We aimed to assess the risk of adverse obstetric and neonatal outcomes among women with psychosis (schizophrenia, affective psychosis, and other psychoses).

Methods: From the 2007 - 2012 National (Nationwide) Inpatient Sample, 23,507,597 delivery hospitalizations were identified. From the same hospitalization, International Classification of Diseases diagnosis codes were used to identify maternal psychosis and outcomes. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were obtained using logistic regression.

Results: The prevalence of psychosis at delivery was 698.76 per 100,000 hospitalizations. After adjusting for sociodemographic characteristics, smoking, alcohol/substance abuse, and pregnancy-related hypertension, women with psychosis were at a heightened risk for cesarean delivery (aOR = 1.26; 95% CI: 1.23 - 1.29), induced labor (aOR = 1.05; 95% CI: 1.02 - 1.09), antepartum hemorrhage (aOR = 1.22; 95% CI: 1.14 - 1.31), placental abruption (aOR = 1.22; 95% CI: 1.13 - 1.32), postpartum hemorrhage (aOR = 1.18; 95% CI: 1.10 - 1.27), premature delivery (aOR = 1.40; 95% CI: 1.36 - 1.46), stillbirth (aOR = 1.37; 95% CI: 1.23 - 1.53), premature rupture of membranes (aOR = 1.22; 95% CI: 1.15 - 1.29), fetal abnormalities (aOR = 1.49; 95% CI: 1.38 - 1.61), poor fetal growth (aOR = 1.26; 95% CI: 1.19 - 1.34), and fetal distress (aOR = 1.14; 95% CI: 1.10 - 1.18). Maternal death during hospitalizations (aOR = 1.00; 95% CI: 0.30 - 3.31) and excessive fetal growth (aOR = 1.06; 95% CI: 0.98 - 1.14) were not statistically significantly associated with psychosis.

Conclusions: Pregnant women with psychosis have elevated risk of several adverse obstetric and neonatal outcomes. Efforts to identify and manage pregnancies complicated by psychosis may contribute to improved outcomes.

Keywords: Affective psychosis; National (Nationwide) Inpatient Sample (NIS); Obstetric and neonatal outcomes; Psychosis; Schizophrenia.

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Conflict of interest statement

Ethics approval and consent to participate

The National (Nationwide) Inpatient Sample has been deemed to be publicly available data sets does not involve “human subjects”, thus not requiring IRB per 45 CFR 46.101 (https://www.hhs.gov/ohrp/regulations-and-policy/regulations/45-cfr-46/index.html). The data contained within these data sets are neither identifiable nor private and thus do not meet the federal definition of “human subject” as defined in 45 CFR 46.102. Therefore, these research projects do not need to be reviewed and approved by the Institutional Review Board.

Competing interests

The authors declare that they have no competing interests.

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