Maternity and Psychosis Data-linkage
By analysing routinely collected Scottish maternity care and mental health data we have explored pregnancy outcomes for women with an existing diagnosis of a non-affective psychosis, including schizophrenia.
Psychosis is a complex mental health difficulty, and pregnancy in the context of psychosis requires, sensitive, specialised mental health and physical care, adapted to women’s’ individual health needs. Our research shows that women with a diagnosis of psychosis are less likely to have children compared to the general population. For those women diagnosed with psychosis who do have a pregnancy, their pregnancy care is more complex both in terms of their physical and mental health care needs. Our routine-data linkage also demonstrates that the outcomes for mothers and children in the first month after birth are more complex compared to families where the mother does not have a psychosis diagnosis.
Women with a diagnosis of non-affective psychosis (including schizophrenia) are less likely to have children than women in the general population, although many women diagnosed with psychotic disorders bear children. In addition, children born to mothers with non-affective psychosis are more likely to have low birth weight, which is a risk factor for multiple health problems across the lifespan. However, there is a knowledge gap around how mothers with psychosis experience pregnancy.
The Chief Scientist’s Office of the Scottish Government funded our group to investigate this issue (CSO Grant: CZH/4/951). We used routinely collected healthcare data in the north-east of Scotland (Aberdeen Maternity and Neonatal Databank, NHS Grampian Psychiatric Records) and Greater Glasgow (Psychosis Clinical Information System (PsyCIS) and SMR-02) to link data and explore pregnancy-related outcome for these women.
We found that between 2005-2013, compared to the general population in our study areas, women with a diagnosis of non-affective psychosis have significantly reduced General Fertility Rate (GFR - number of births per annum). Fertility in these women was also lower when and sub-divided by age range in 5-year brackets from 16-45 (Age Specific Fertility Rate - ASFR). The rates for both GFR and ASFR were declining over time, although this was the same for the psychosis group and the general population.
Next we matched women with a diagnosis of non-affective psychosis and at least one pregnancy (n=323) with a comparison group of women with at least one pregnancy who did not have a psychosis (n=869). When we looked at the pregnancy history for each group, women with a psychosis were older, had a higher number of pregnancies in the study period, were more likely to smoke, and more likely to be on psychotropic medication (antipsychotics, antidepressants, mood stabilisers or anxiolytics). They were also more likely to have had a previous miscarriage or a therapeutic abortion than the comparison group. There were no differences between the groups with regard to experience of labour, but babies born to women with schizophrenia were lighter than control babies. Babies born to women with a non-affective psychosis diagnosis were significantly more likely to be admitted to a specialised neonatal unit, and were less likely to be discharged home with mother.
Our results highlight that women with complex mental health difficulties have specific mental and physical health needs in pregnancy. Understanding these needs is key to delivering better care for both these women and their new-born’s.
Dr Angus MacBeth (Lead Investigator, University of Edinburgh)
Dr Sarah Barry (University of Glasgow)
Mrs Paula McSkimming (University of Glasgow)
Dr Alex McConnachie (University of Glasgow)
Professor Andrew Gumley (University of Glasgow)
Mr John Park (NHS Greater Glasgow and Clyde)
Dr Sohinee Bhattacharya (University of Aberdeen)
Professor David St Clair (University of Aberdeen)