Impact of Obstetric Complications in Subjects at Clinical High Risk for Psychosis: A Systematic Review and Meta-Analysis

Abstract

Introduction: Exposure to obstetric complications (OCs) increases the risk of developing psychosis and schizophrenia in offspring. However, studies with subjects at clinical high risk for psychosis (CHR) have reported inconsistent results. We conducted a systematic review and meta-analysis to evaluate the prevalence of OCs among CHR subjects and controls and examine their impact on the transition to psychosis.

Methods: Four databases (Web of Science, PubMed, Latindex, and Dialnet) were systematically searched for articles published between 1995 and June 6, 2024. The risk of bias was assessed using the Newcastle-Ottawa scale. Articles providing data on OCs in CHR subjects were included.

Results: A total of 6037 records were retrieved through systematic and citation searches. Nine articles met the inclusion criteria for our systematic review and provided data for meta-analysis. A total of 555 CHR participants were included. Meta-analysis showed a significantly higher prevalence of OCs in CHR subjects versus controls: RR = 1.45 (95% CI: 1.16, 1.81), (Z = 3.27, p = 0.0011). Data from three longitudinal studies assessed transition to psychosis and our meta-analysis found a trend toward an increased risk of transition in CHR subjects with a history of OCs compared to others: RR = 2.05 (95% CI: 0.98, 4.26), Z = 1.91, p = 0.056.

Conclusions: CHR for psychosis was associated with OCs, though their role in the transition to psychosis requires further study. OCs should be recorded and analyzed in CHR individuals, considering their potential clinical implications.

Keywords: clinical high risk; obstetric complications; outcome; pregnancy and delivery; psychosis risk; psychotic disorder; transition to psychosis.