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Espinosa V, Arin-González P, Jiménez-Lafuente A, Pardo N, López-Carrilero R, Birulés I, Barajas A, Pélaez T, Díaz-Cutraro L, Verdaguer-Rodríguez M, Gutiérrez-Zotes A, Palma-Sevillano C, Varela-Casals P, Salas-Sender M, Aznar A, Ayesa-Arriola R, Pousa E, Canal-Rivero M, Garrido-Torres N, Montserrat C, Muñoz-Lorenzo L, Crosas JM, Ochoa S. Family Metacognitive Training (MCT-F): Adapting MCT to Mothers with Psychosis and Their Adolescent Children. Behav Sci (Basel) 2024; 14:97. [PMID: 38392450 PMCID: PMC10885955 DOI: 10.3390/bs14020097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/19/2024] [Accepted: 01/25/2024] [Indexed: 02/24/2024] Open
Abstract
Over half of women with psychosis are mothers. Research suggests that mothers with psychosis face unique challenges affecting both their mental health prognosis and their relationship with their children. Moreover, those children have a higher risk of developing a mental disorder. Notwithstanding, interventions specifically tailored to these families remain largely uncovered. Metacognitive Training (MCT) has demonstrated its efficacy in improving cognitive insight, symptom management, and social cognition in people with psychosis. However, there is no evidence of the efficacy of MCT in a family setting (MCT-F). This study describes the first adaptation of MCT for mothers with psychosis and their adolescent children in an online group setting. The phases (assessment, decision, adaptation, production, topical experts' integration) of the ADAPT-ITT model were systematically applied through a participatory approach (n = 22), including a first-person perspective and involving qualitative (e.g., topical expert literature review and consensus groups, interviews, thematic analyses) and quantitative methods. While MCT's core components were retained, participants guided adaptations both in content and delivery. The findings suggest the importance of community engagement and sharing decision-making processes to demonstrate the acceptability and feasibility of the adapted intervention. Employing a structured approach such as the ADAPT-ITT model ensures readiness of the new training for efficacy trials.
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Affiliation(s)
- Victoria Espinosa
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Fundació Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Etiopatogènia i Tractament dels Trastorns Mentals Greus (MERITT), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
| | | | | | - Nerea Pardo
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Fundació Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Etiopatogènia i Tractament dels Trastorns Mentals Greus (MERITT), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
| | - Raquel López-Carrilero
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Fundació Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Etiopatogènia i Tractament dels Trastorns Mentals Greus (MERITT), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Irene Birulés
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Department of Social and Quantitative Psychology, Faculty of Psychology, University of Barcelona, 08035 Barcelona, Spain
| | - Ana Barajas
- Departament de Psicologia, Facultat de Psicologia Clínica I de la Salut. Serra Húnter Programme, Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallès, Spain
| | - Trinidad Pélaez
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Luciana Díaz-Cutraro
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Fundació Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Etiopatogènia i Tractament dels Trastorns Mentals Greus (MERITT), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Psychology Department, FPCEE Blanquerna, Universitat Ramon Llull, 08022 Barcelona, Spain
| | - Marina Verdaguer-Rodríguez
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Fundació Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Etiopatogènia i Tractament dels Trastorns Mentals Greus (MERITT), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallès, Spain
| | - Alfonso Gutiérrez-Zotes
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Hospital Universitari Institut Pere Mata, Institut d'Investigació Sanitària Pere Virgili-CERCA, Universitat Rovira i Virgili, 43206 Reus, Spain
| | - Carolina Palma-Sevillano
- Psychology Department, FPCEE Blanquerna, Universitat Ramon Llull, 08022 Barcelona, Spain
- Hospital de Mataró, Consorci Sanitari del Maresme, 08301 Mataró, Spain
| | | | | | - Ana Aznar
- Centre d'Higiene Mental Les Corts, 08035 Barcelona, Spain
| | - Rosa Ayesa-Arriola
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL. School of Medicine, University of Cantabria, 39008 Santander, Spain
| | - Esther Pousa
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), 08041 Barcelona, Spain
| | - Manuel Canal-Rivero
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Virgen del Rocío University Hospital, Institute of Biomedicine of Seville (IBiS), University of Seville, First-Episode Psychosis Research Network of Andalusia (Red PEPSur), 41013 Sevilla, Spain
| | - Nathalia Garrido-Torres
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Virgen del Rocío University Hospital, Institute of Biomedicine of Seville (IBiS), University of Seville, First-Episode Psychosis Research Network of Andalusia (Red PEPSur), 41013 Sevilla, Spain
| | - Clara Montserrat
- Hospital del Mar Medical Research Institute (IMIM) of Barcelona, Autonomous University of Barcelona, 08003 Barcelona, Spain
| | - Laura Muñoz-Lorenzo
- Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Josep Maria Crosas
- Department of Mental Health, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, 08208 Sabadell, Spain
| | - Susana Ochoa
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Fundació Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Etiopatogènia i Tractament dels Trastorns Mentals Greus (MERITT), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III, 28029 Madrid, Spain
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Tang W, Zhou LJ, Zhang WQ, Jia YJ, Hu FH, Chen HL. Adverse perinatal pregnancy outcomes in women with schizophrenia: A systematic review and meta-analysis. Schizophr Res 2023; 262:156-167. [PMID: 37979419 DOI: 10.1016/j.schres.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 10/29/2023] [Accepted: 11/04/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION Schizophrenia is a severe mental illness that affects a significant proportion of the global population, particularly those of childbearing age. Several studies have attempted to find an association between schizophrenia and obstetric complications, with varying results. OBJECTIVE The primary objective of this systematic review and meta-analyses was to summarize the relationship between maternal schizophrenia and perinatal pregnancy outcomes. DATA SOURCES PubMed, Web of Science and Ovid EMBASE were searched from January 2001 to September 2022 using keywords related to pregnancy, women, schizophrenia. STUDY SELECTION A total of 23 independent studies across 21,253 individuals with schizophrenia were identified and included in the analysis. DATA EXTRACTION The following data were extracted: author, year of publication, country/continent of data collection, study design, demographic characteristics, diagnoses criteria, related complications. Data were analyzed using random-effects pairwise meta-analysis and were reported as prevalence and odd ratios (OR). Statistical heterogeneity was quantified with the I2 statistic. RESULTS The prevalence of adverse perinatal pregnancy outcomes was represented in descending order: cesarean section (26.0 %); labor induction (24.0 %); small for gestational age (10.5 %); gestational diabetes mellitus (9.2 %); preterm birth (9.1 %); low birth weight (7.8 %); preterm rupture of membranes (6.1 %); 1-Minute Apgar Score < 7 (5.6 %); large for gestational age (5.5 %); birth defect (5.4 %); antepartum hemorrhage (4.4 %);preeclampsia/eclampsia (4.8 %); postpartum hemorrhage (3.9 %); 5-Minute Apgar Score < 7 (3.6 %); gestational hypertension (3.3 %); placental abruption (1.0 %); placenta previa (0.6 %); thromboembolic disease (0.4 %); neonatal mortality (0.3 %) (P ≤ 0.05). There was a higher risk of adverse outcomes including gestational diabetes mellitus, preeclampsia/eclampsia, placental abruption, thromboembolic disease, preterm birth, birth defect, 1-Minute Apgar score < 7, small for gestational age, low birth weight and neonatal mortality compared with non-schizophrenia population (P ≤ 0.05). CONCLUSIONS Women with schizophrenia are at higher risk of adverse perinatal pregnancy outcomes. It is imperative that research efforts continue to focus on the reproductive safety of women with schizophrenia during their childbearing years.
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Affiliation(s)
- Wen Tang
- Master of Medicine, Medical School, Nantong University, Nantong, China
| | - Li-Juan Zhou
- Master of Medicine, Medical School, Nantong University, Nantong, China
| | - Wan-Qing Zhang
- Master of Medicine, Medical School, Nantong University, Nantong, China
| | - Yi-Jie Jia
- Master of Medicine, Medical School, Nantong University, Nantong, China
| | - Fei-Hong Hu
- Master of Medicine, Medical School, Nantong University, Nantong, China
| | - Hong-Lin Chen
- School of Public Health, Nantong University, Nantong, China.
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Review of Male and Female Care Needs in Schizophrenia: A New Specialized Clinical Unit for Women. WOMEN 2023. [DOI: 10.3390/women3010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Women with schizophrenia require health interventions that differ, in many ways, from those of men. The aim of this paper is to review male and female care needs and describe a newly established care unit for the treatment of women with schizophrenia. After reviewing the literature on the differentiated needs of men and women with schizophrenia, we describe the new unit’s assessment, intervention, and evaluation measures. The program consists of (1) individual/group patient/family therapy, (2) therapeutic drug monitoring and adherence checks, (3) perinatal mental health, (4) medical liaison, (5) suicide prevention/intervention, (6) social services with special focus on parenting, domestic abuse, and sexual exploitation, (7) home-based services, (8) peer support, (9) occupational therapies (physical activity and leisure programs), and (10) psychoeducation for both patients and families. Still in the planning stage are quality evaluation of diagnostic assessment, personalized care, drug optimization, health screening (reproductive health, metabolic syndrome, cardiovascular health, cancer, menopausal status), and patient and family satisfaction with services provided. Woman-specific care represents an important resource that promises to deliver state-of-the-art treatment to women and, ideally, prevent mental illness in their offspring.
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Burger M, Einspieler C, Niehaus DJH, Unger M, Jordaan ER. Maternal mental health and infant neurodevelopment at 6 months in a low-income South African cohort. Infant Ment Health J 2022; 43:849-863. [PMID: 36268625 PMCID: PMC9828192 DOI: 10.1002/imhj.22021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 06/13/2022] [Indexed: 01/12/2023]
Abstract
Maternal mental health disorders and the adverse consequences for infant neurodevelopment have received substantial research attention in high-income countries over the past five decades. In Africa, where relatively little work has been done on this topic, researchers have largely focused on infant physical health outcomes. This longitudinal study investigated the neurodevelopment of infants at 6 months post-term with exposure to mothers with a clinical diagnosis of persistent mental health disorders residing in low-income communities in Cape Town, South Africa. Adjusted models revealed no significant differences on the Bayley Scales of Infant and Toddler Development (BSID-III) domains (cognitive, motor, language, socio-emotional, and adaptive behavior) between infants exposed to maternal mental health disorders (n = 62) and the comparison group (n = 35) at 3 and 6 months. Subgroup analyses found no significant differences on the BSID-III domains between infants with exposure to mood disorders (n = 31), as well as infants with exposure to comorbid (i.e., a combination of two or three) mental health disorders (n = 14) and the comparison group. However, infants with exposure to psychotic disorders (n = 14) scored significantly lower on the cognitive and the motor domains and the fine motor subscale. These novel data provide an important contribution to the scientific literature especially in the field of maternal psychotic disorders in Africa.
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Affiliation(s)
- Marlette Burger
- Faculty of Medicine and Health SciencesPhysiotherapy Division, Department of Health and Rehabilitation SciencesStellenbosch UniversityStellenboschSouth Africa
| | - Christa Einspieler
- Research Unit iDN––Interdisciplinary Developmental Neuroscience, Division of PhoniatricsMedical University of GrazGrazAustria
| | - Dana J. H. Niehaus
- Faculty of Medicine and Health SciencesDepartment of Psychiatry, Stellenbosch UniversityStellenboschSouth Africa
| | - Marianne Unger
- Faculty of Medicine and Health SciencesPhysiotherapy Division, Department of Health and Rehabilitation SciencesStellenbosch UniversityStellenboschSouth Africa
| | - Esme R. Jordaan
- Biostatistics UnitSouth African Medical Research CouncilParowSouth Africa,Statistics and Population StudiesUniversity of the Western CapeCape TownSouth Africa
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Law JWY, Chan JKN, Wong CSM, Chen EYH, Chang WC. Antipsychotic utilization patterns in pregnant women with psychotic disorders: a 16-year population-based cohort study. Eur Arch Psychiatry Clin Neurosci 2022:10.1007/s00406-022-01453-1. [PMID: 35792919 DOI: 10.1007/s00406-022-01453-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 06/20/2022] [Indexed: 11/03/2022]
Abstract
Despite growing concern about reproductive safety of antipsychotics, there is a paucity of research specifically assessing prenatal antipsychotic prescribing practices for psychotic disorders. This population-based cohort study identified women aged 15-50 years with diagnosis of psychotic disorders, who delivered their first and singleton child between 2003-2018 in Hong Kong, with an aim to examine temporal trends and predictors of prenatal antipsychotic use as well as antipsychotic utilization patterns before and during pregnancy. Data were retrieved from territory-wide medical-record database of public healthcare services. Of 804 women, 519 (65%) redeemed at least one prescription for antipsychotics during pregnancy. Older age at conception (25-34 years: OR 2.12 [95% CI 1.22-3.67]; 35-50 years: 2.52 [1.38-4.61]; 15-24 years as reference category) and antipsychotic treatment within 12 months pre-pregnancy (24.22 [16.23-36.16]) were significantly associated with prenatal antipsychotic use. Second-generation-antipsychotic (SGA) use during pregnancy increased over 16-year study period, while prenatal first-generation-antipsychotic (FGA) use showed declining trend. Overall antipsychotic and SGA use progressively decreased across pre-pregnancy and trimesters of pregnancy. Further analyses on antipsychotic use trajectories revealed that 87.4% (n = 459) of 529 women receiving antipsychotics in 12-month pre-pregnancy redeemed antipsychotic prescription during pregnancy, and 63.4% (n = 333) continued antipsychotic treatment throughout pregnancy. Only 7.5% of the cohort (n = 60) commenced antipsychotics in pregnancy. This is one of the few studies evaluating real-world prenatal antipsychotic utilization among women with psychotic disorders. Future research delineating risk conferred by illness-related factors and antipsychotic exposure on adverse maternal and fetal outcomes is warranted to facilitate treatment guideline development.
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Affiliation(s)
- Jenny Wai Yiu Law
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Joe Kwun Nam Chan
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Corine Sau Man Wong
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Eric Yu Hai Chen
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
| | - Wing Chung Chang
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China. .,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China.
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Heinonen E, Forsberg L, Nörby U, Wide K, Källén K. Neonatal morbidity after fetal exposure to antipsychotics: a national register-based study. BMJ Open 2022; 12:e061328. [PMID: 35768086 PMCID: PMC9244682 DOI: 10.1136/bmjopen-2022-061328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To investigate the admission rate to neonatal care and neonatal morbidity after maternal use of antipsychotics during pregnancy. DESIGN A population-based register study. SETTING Information on all singleton births between July 2006 and December 2017 in Sweden including data on prescription drugs, deliveries and infants' health was obtained from the Swedish Medical Birth Register, the Prescribed Drug Register and the Swedish Neonatal Quality Register. Exposed infants were compared with unexposed infants and with infants to mothers treated with antipsychotics before or after but not during pregnancy. PARTICIPANTS The cohort comprised a total of 1 307 487 infants, of whom 2677 (0.2%) were exposed to antipsychotics during pregnancy and 34 492 (2.6%) had mothers who were treated before/after the pregnancy. OUTCOME MEASURES The primary outcome was admission rate to neonatal care. Secondary outcomes were the separate neonatal morbidities. RESULTS Of the exposed infants, 516 (19.3%) were admitted to neonatal care compared with 98 976 (7.8%) of the unexposed infants (adjusted risk ratio (aRR): 1.7; 95% CI: 1.6 to 1.8), with a further increased risk after exposure in late pregnancy. The highest relative risks were seen for withdrawal symptoms (aRR: 17.7; 95% CI: 9.6 to 32.6), neurological disorders (aRR: 3.4; 95% CI: 2.4 to 5.7) and persistent pulmonary hypertension (aRR: 2.1; 95% CI: 1.4 to 3.1) when compared with unexposed infants. The absolute risks for these outcomes were however low among the exposed infants, 1.3%, 1.8% and 1.0%, respectively, and the relative risks were lower when compared with infants to mothers treated before/after the pregnancy. CONCLUSION Fetal exposure to antipsychotics was associated with an increased risk of neonatal morbidity. The effects in the exposed infants seem transient and predominantly mild, and these findings do not warrant discontinuation of a necessary treatment but rather increased monitoring of these infants. The increased risk of persistent pulmonary hypertension requires further studies.
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Affiliation(s)
- Essi Heinonen
- Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden
| | - Lisa Forsberg
- Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Ulrika Nörby
- Department of Clinical Sciences, Centre of Reproduction Epidemiology, Tornblad Institute, Lund University, Lund, Sweden
- Health and Medical Care Administration, Region Stockholm, Stockholm, Sweden
| | - Katarina Wide
- Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Karin Källén
- Department of Clinical Sciences, Centre of Reproduction Epidemiology, Tornblad Institute, Lund University, Lund, Sweden
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Heinonen E, Forsberg L, Nörby U, Wide K, Källén K. Antipsychotic Use During Pregnancy and Risk for Gestational Diabetes: A National Register-Based Cohort Study in Sweden. CNS Drugs 2022; 36:529-539. [PMID: 35220525 PMCID: PMC9095513 DOI: 10.1007/s40263-022-00908-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE We aimed to study whether antipsychotic use during pregnancy is associated with gestational diabetes. METHODS This was a Swedish national register-based cohort study on the Medical Birth Register and the Prescribed Drug Register including all 1,307,487 singleton births between July 2006 and December 2017. Antipsychotics were divided into first-generation antipsychotics (n = 728), high-risk metabolic second-generation antipsychotics including olanzapine, clozapine and quetiapine (n = 1710), and other second-generation antipsychotics (n = 541). The risks for gestational diabetes, foetal growth disturbances, pre-eclampsia, caesarean section and preterm labour were assessed. Women treated during pregnancy were compared to women not treated during pregnancy and to women who used antipsychotics before/after but not during pregnancy. RESULTS The crude risk ratio for gestational diabetes for women treated with high-risk metabolic second-generation antipsychotics during pregnancy was 2.2 (95% confidence interval [CI] 1.6-2.9) compared to untreated pregnant women (n = 1,296,539) and 1.8 (95% CI 1.4-2.5) compared to women treated before/after pregnancy (n = 34,492). After adjustment for maternal factors including body mass index, the risk ratios were 1.8 (95% CI 1.3-2.4) and 1.6 (95% CI 1.2-2.1). Exposed infants had an increased risk of being large for gestational age: adjusted risk ratios 1.6 (95% CI 1.3-1.9) and 1.3 (95% CI 1.1-1.6) compared to no maternal antipsychotic use during pregnancy and maternal use before/after the pregnancy. Other antipsychotics were not associated with metabolic risks. CONCLUSIONS Olanzapine, clozapine and quetiapine used during pregnancy were associated with increased risks for gestational diabetes and the infant being large for gestational age. Enhanced metabolic monitoring should be considered for pregnant women using these drugs.
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Affiliation(s)
- Essi Heinonen
- Division of Paediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 14157, Stockholm, Sweden. .,Department of Paediatrics, Unit of Neonatology at Karolinska University Hospital, Stockholm, Sweden.
| | - Lisa Forsberg
- Division of Paediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 14157 Stockholm, Sweden
| | - Ulrika Nörby
- Department of Clinical Sciences, Centre of Reproduction, Epidemiology, Tornblad Institute, Lund University, Lund, Sweden ,Health and Medical Care Administration, Region Stockholm, Stockholm, Sweden
| | - Katarina Wide
- Division of Paediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 14157 Stockholm, Sweden ,Department of Pediatrics, Unit of Emergency Pediatrics at Karolinska University Hospital, Stockholm, Sweden
| | - Karin Källén
- Department of Clinical Sciences, Centre of Reproduction, Epidemiology, Tornblad Institute, Lund University, Lund, Sweden
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Fabre C, Pauly V, Baumstarck K, Etchecopar-Etchart D, Orleans V, Llorca PM, Blanc J, Lancon C, Auquier P, Boyer L, Fond G. Pregnancy, delivery and neonatal complications in women with schizophrenia: a national population-based cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2021; 10:100209. [PMID: 34806069 PMCID: PMC8589714 DOI: 10.1016/j.lanepe.2021.100209] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Existing studies evaluating the association between schizophrenia and complications associated with pregnancy, delivery and neonatal outcomes are based on data prior to 2014 and have reported heterogeneous results. The objective of our study was to determine whether pregnant women with schizophrenia were at increased risk of pregnancy, delivery and neonatal complications compared with women without severe mental disorders. Methods We performed a population-based cohort study of all singleton deliveries in France between Jan. 1, 2015, and Dec. 31, 2019. We divided this population into cases (i.e., women with schizophrenia) and controls (i.e., women without a diagnosis of severe mental disorder). Cases and controls were matched (1:4) inside the same hospital and the same year by age, social deprivation, parity, smoking, alcohol and substance addictions, malnutrition, obesity, and comorbidities. Univariate and multivariate models with odds ratios and 95% confidence intervals (ORs [95% CIs]) were used to estimate the association between schizophrenia and 24 pregnancy, delivery and neonatal outcomes. Findings Over 5 years, 3,667,461 singleton deliveries were identified, of which 3,108 occurred in women with schizophrenia. Compared to controls, women with schizophrenia were found to be older; have more frequent smoking, alcohol and substance addictions; suffer from obesity, diabetes and chronic obstructive pulmonary disease; and often be hospitalized in tertiary maternity hospitals. Compared to matched controls, women with schizophrenia had more pregnancy complications (adjusted OR=1.41[95%CI 1.31-1.51]) (i.e., gestational diabetes, gestational hypertension, genito-urinary infection, intrauterine growth retardation and threatened preterm labour). They had more delivery complications (aOR=1.18[95%CI 1.09 1.29]) with more still births/medical abortions (aOR=2.17[95%CI 1.62-2.90]) and caesarean sections (aOR=1.15[95%CI 1.05-1.25]). Newborns of women with schizophrenia had more neonatal complications (aOR=1.38[95%CI 1.27-1.50]) with more born preterm (aOR=1.64[95%CI1.42 -1.90]), small for gestational age (aOR=1.34[95%CI 1.19-1.50]) and low birth weight (aOR=1.75[95%CI 1.53-2.00]). Interpretation Our results highlight the importance of health disparities between pregnant women with and without schizophrenia, as well as in their newborns. Our study calls for health policy interventions during and before pregnancy, including proportionate intensified care to the level of needs, effective case management and preventive and social determinant approaches. Funding No funding.
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Affiliation(s)
- Cyprien Fabre
- Aix-Marseille Univ., CEReSS - Health Service Research and Quality of Life Center, Marseille, France.,Department of Medical Information, Assistance Publique - Hôpitaux Marseille, Marseille, France.,Department of Epidemiology and Health Economics, Assistance Publique - Hôpitaux Marseille, Marseille, France
| | - Vanessa Pauly
- Aix-Marseille Univ., CEReSS - Health Service Research and Quality of Life Center, Marseille, France.,Department of Medical Information, Assistance Publique - Hôpitaux Marseille, Marseille, France
| | - Karine Baumstarck
- Aix-Marseille Univ., CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | | | - Veronica Orleans
- Department of Medical Information, Assistance Publique - Hôpitaux Marseille, Marseille, France
| | - Pierre-Michel Llorca
- Department of Psychiatry, CHU Clermont-Ferrand, Clermont-Ferrand, France.,FondaMental Fondation, Creteil, France
| | - Julie Blanc
- Aix-Marseille Univ., CEReSS - Health Service Research and Quality of Life Center, Marseille, France.,Department of Obstetrics and Gynaecology, APHM, Nord Hospital, Marseille, France
| | - Christophe Lancon
- Aix-Marseille Univ., CEReSS - Health Service Research and Quality of Life Center, Marseille, France.,Department of Psychiatry, Assistance Publique - Hôpitaux Marseille, Marseille, France
| | - Pascal Auquier
- Aix-Marseille Univ., CEReSS - Health Service Research and Quality of Life Center, Marseille, France.,Department of Epidemiology and Health Economics, Assistance Publique - Hôpitaux Marseille, Marseille, France
| | - Laurent Boyer
- Aix-Marseille Univ., CEReSS - Health Service Research and Quality of Life Center, Marseille, France.,Department of Medical Information, Assistance Publique - Hôpitaux Marseille, Marseille, France.,Department of Epidemiology and Health Economics, Assistance Publique - Hôpitaux Marseille, Marseille, France.,FondaMental Fondation, Creteil, France
| | - Guillaume Fond
- Aix-Marseille Univ., CEReSS - Health Service Research and Quality of Life Center, Marseille, France.,Department of Medical Information, Assistance Publique - Hôpitaux Marseille, Marseille, France.,Department of Epidemiology and Health Economics, Assistance Publique - Hôpitaux Marseille, Marseille, France.,Department of Obstetrics and Gynaecology, APHM, Nord Hospital, Marseille, France.,FondaMental Fondation, Creteil, France
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Abstract
PURPOSE OF REVIEW A diagnosis of schizophrenia has significant implications for women of childbearing age, pregnant or considering a pregnancy, ranging from sexual health, psychopharmacological treatment, to the occurrence of negative pregnancy and foetal outcomes. We provide a short narrative review of recent papers focusing on these issues. RECENT FINDINGS Although pregnancy rates have been increasing in women with a diagnosis of schizophrenia, they also tend to have altogether fewer pregnancies and fewer live births than women without this diagnosis, and also higher rates of induced abortions.Use of antipsychotics in pregnancy has also increased, and evidence suggests lack of significant contraindications for their use in this period. However, drug levels monitoring may be recommended across the three trimesters, as levels may change in relation to pregnancy-related physiology.Monitoring of physical health is an increasingly crucial issue, given higher risk of gestational diabetes, negative obstetric and infant outcomes in these women. SUMMARY There is an urgent need to generate valid and reproducible research that could help implement appropriate treatment protocols and relapse-prevention approaches, and interventions based on strong pharmaceutical targets for the benefit of pregnant women with a diagnosis of schizophrenia, their families and their children.
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Women with Schizophrenia over the Life Span: Health Promotion, Treatment and Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155594. [PMID: 32756418 PMCID: PMC7432627 DOI: 10.3390/ijerph17155594] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/22/2020] [Accepted: 07/30/2020] [Indexed: 02/06/2023]
Abstract
Women with schizophrenia show sex-specific health needs that differ according to stage of life. The aim of this narrative review is to resolve important questions concerning the treatment of women with schizophrenia at different periods of their life—paying special attention to reproductive and post-reproductive stages. Review results suggest that menstrual cycle-dependent treatments may be a useful option for many women and that recommendations re contraceptive options need always to be part of care provision. The pregnancy and the postpartum periods—while constituting vulnerable time periods for the mother—require special attention to antipsychotic effects on the fetus and neonate. Menopause and aging are further vulnerable times, with extra challenges posed by associated health risks. Pregnancy complications, neurodevelopmental difficulties of offspring, cancer risk and cognitive defects are indirect results of the interplay of hormones and antipsychotic treatment of women over the course of the lifespan. The literature recommends that health promotion strategies need to be directed at lifestyle modifications, prevention of medical comorbidities and increased psychosocial support. Careful monitoring of pharmacological treatment has been shown to be critical during periods of hormonal transition. Not only does treatment of women with schizophrenia often need to be different than that of their male peers, but it also needs to vary over the course of life.
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Association Between Gestational Diabetes and Mental Illness. Can J Diabetes 2020; 44:566-571.e3. [PMID: 32792108 DOI: 10.1016/j.jcjd.2020.06.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 12/19/2022]
Abstract
The rates of both gestational diabetes mellitus (GDM) and mental illness in pregnancy are rising. There is an association between type 2 diabetes and major depressive disorder, anxiety and schizophrenia, thus there is a need for greater understanding of the relationship between GDM and mental illness. This review suggests that there is a bidirectional and complex relationship between antenatal depression, gestational diabetes and postpartum depression. The combined effect of both a history of depression and gestational diabetes significantly increases the risk of postpartum depression. There is an association between severe mental illness and GDM; however, it is strongly mediated by antipsychotic medications and psychosocial factors, in addition to the disease itself. Medication has a major role in treating mental illness during pregnancy and is not directly linked with GDM in either depression or psychosis. Health-care providers should be mindful of the association between GDM and mental illness to appropriately screen and treat both disorders.
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