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Anti-psychotic medication and pregnancy outcomes
- derek a summerfield (19 October 2008)
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Taking the Spotlight off Schizophrenia
- Kathryn M Abel, Roger Webb: Research Fellow, Centre for Women's Health, University of Manchester and Vera A Morgan: Head Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, University of Western Australia (10 December 2008)
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derek a summerfield, consultant psychiatrist south london & maudsley nhs trust
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derek.summerfield{at}slam.nhs.uk derek a summerfield
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Nillson et al (1) find that offspring with a mother or father with schizophrenia are at increased risk of pre-term birth,low birth weight and of being small for gestational age, and that the risk of infant death is doubled. By examining a number of covariates they conclude that the risk for infant death cannot be explained only by maternal behaviour during pregnancy (eg smoking). But in the second last paragraph they concede that "we were not able to control for the potential confounding of maternal medication during pregnancy". This significantly weakens the paper, surely.I imagine that most or all of the subject mothers were on longterm anti-psychotic medication, or had been. Did the authors feel that the effects of such medication on pregnancy outcomes had already been sufficiently clarified in the psychiatric literature? Peehaps they could comment. 1 Nillson E et al.Schizophrenia and offspring's risk for adverse pregancy outcomes and infant death. Br J Psychiatry 2008; 193:311-315. |
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Kathryn M Abel, Reader and Honorary Consultant Psychiatrist Centre for Women's Mental Health, University of Manchester, Roger Webb: Research Fellow, Centre for Women's Health, University of Manchester and Vera A Morgan: Head Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, University of Western Australia
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kathryn.abel{at}manchester.ac.uk Kathryn M Abel, et al.
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article ID: 193/4/311 --> In this article, Nilsson and authors make reference to a number of our and other colleagues?, papers on the risk of adverse outcome in offspring of mentally ill parents. We should like to bring to readers? attention a key difference between the work of Nilsson et al and that of Jablensky et al (2005) and ourselves (King-Hele et al 2007; Webb et al 2006, 2007, 2008). Nilsson and colleagues restrict their studies to families where parents are suffering from schizophrenia and related disorders and report excess risk of offspring mortality up to a year with either maternal or paternal illness. Although numbers were quite small, Jablensky et al (2005) reported no significant differences in risk of stillbirth, neonatal, postneonatal death, or early childhood death, between mothers with schizophrenia, bipolar or unipolar affective disorder relative to the general population comparison group. Our investigations found that age-specific all-cause mortality rates are higher in children of a mother or father admitted with schizophrenia than the general population. However, these relative risks are comparable to those in offspring of parents admitted for other mental disorders e.g. affective disorder and alcohol/drug-related disorder (Webb et al 2006). Like Nilsson et al., we also looked at cause-specific mortality (King-Hele et al 2007; Webb et al 2007, 2008). Rates of death by natural causes were generally not raised with any parental diagnosis, although fatal birth defect risk was modestly elevated with maternal affective disorder and to a greater degree with maternal schizophrenia. Sudden Infant Death Syndrome rates were elevated with parental schizophrenia and other mental disorders, but the highest SIDS risk was with maternal alcohol/drug- related disorder. Recent Swedish analyses confirm a significantly higher SIDS risk among infants whose mothers and fathers received psychiatric inpatient care with a particularly high risk if both parents were admitted, or if the mother was diagnosed with an alcohol or drug-related disorder. Taken together, we believe that research shows evidence for higher mortality risk in relation to a range of maternal and paternal mental illness. With the exception of fatal birth defects, we conclude that there is no evidence that mortality risk among offspring of parents with schizophrenia and related disorders is significantly higher than that associated with all other parental psychiatric conditions. Therefore, in our view, research highlights the need for greater vigilance and support throughout pregnancy, infancy, childhood and adolescence for families affected by various forms of severe mental illness, and not just schizophrenia. References Jablensky AV, Morgan V, Zubrick SR, Bower C, Yellachich LA. Pregnancy, delivery, and neonatal complications in a population cohort of women with schizophrenia and major affective disorders. Am J Psychiatry 2005; 162: 79?91. King-Hele SA, Abel KM, Webb RT, Mortensen PB, Appleby L, Pickles AR. Risk of sudden infant death syndrome with parental mental illness. Arch Gen Psychiatry 2007; 64: 1323?30. Webb RT, Abel KM, Pickles AR, Appleby L, King-Hele SA, Mortensen PB. Mortality risk among offspring of psychiatric inpatients: a population- based follow-up to early adulthood. Am J Psychiatry 2006; 163: 2170?7. Webb RT, Pickles AR, Appleby L, Mortensen PB, Abel KM. Death by unnatural causes during childhood and early adulthood in offspring of psychiatric inpatients. Archives of General Psychiatry 2007; 64: 345-52. Webb RT, Pickles AR, King-Hele SA, Appleby L, Mortensen PB, Abel KM (2008). Parental mental illness and fatal birth defects in a national birth cohort. Psychological Medicine 38, 1495?1503. The authors have no conflict of interests |
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