Schizophrenia and Pregnancy

Schizophrenia and Pregnancy
Though a significant proportion of postpartum psychosis has been linked to underlying diagnosis of bipolar spectrum illness, women with non-affective psychotic illness (i.e. schizophrenia) represent an important proportion of women who experience an exacerbation of symptoms in the perinatal period. There is a relative paucity of literature on the course of psychosis during pregnancy and the postpartum
period, possibly due to a historic resistance to seeing women with chronic
psychotic illness as mothers themselves. As mental health care evolves, so does our understanding of the reproductive lives of the women we treat, their potential as parents, and their unique needs as patients.
Early studies found low fertility in women with schizophrenia, when compared with rates in the general population.More recent and methodologically rigorous studies show no difference in fertility between women with schizophrenia and controls .It is posited that an increase in
fertility rates in women with chronic psychosis came with the decrease in ovulatory suppression seen with atypical antipsychotics relative to first generation neuroleptics .Women with psychotic illnesses tend to have
fewer children than nonpsychotic counterparts, yet it is estimated that up to 60 % of women in inpatient psychiatric settings are mothers.
Schizophrenia is linked to behaviors that increase pregnancy-related risks. Smoking and other substance use disorders carry a 47 % lifetime prevalence in people with schizophrenia, and a 1996 retrospective study showed that up to 78 % of women admitted to substance use during their pregnancies . In fact, in pregnant women with schizophrenia, poor self-care, poor nutrition, prenatal care, risks of substance use, poor judgment, and fetal abuse/injury have all been linked to adverse infant outcomes .A 2001 study showed that children of women with schizophrenia had increased risk of postneonatal death, generally attributed to an increased risk of sudden infant death syndrome. A large 2002 study found significantly increased risks for stillbirth, infant death, preterm delivery and low birth weight, and small-for-gestational age among the offsprings of women with schizophrenia, even when controlling for adverse health behaviors. A recent study linked schizophrenia in mothers to complicated
obstetrical outcomes such as preeclampsia and Eclampsia, gestational diabetes, venous thromboembolism, operative deliveries, and postpartum medical complications.Children of women with schizophrenia had a
marginally statistically significant increase in the risk of congenital malformations, though no control was made for smoking or other adverse pregnancy risks.Such findings underscore the value and need for multifaceted and intensive supports. Intensive community and treatment team supports thoroughout the reproductive years.
Psychotic symptoms can alter women’s perceptions of bodily processes, leading to late detection of pregnancy and delayed postnatal care.In
rare cases, a psychotic denial of pregnancy can occur, particularly in women with diagnoses of chronic schizophrenia with previous custody loss and associated anticipated separation from the baby they were carrying .Miller suggests that treatment for such patients should take place in a setting that integrates comprehensive psychiatric and obstetrical care and may include pharmacotherapy,
supportive psychotherapy, and evaluation of the patient’s parenting skills and support network to assess and optimize continued custody.More commonly, in the postnatal period, hallucinations, paranoia, and other
perceputal symptoms can interfere with the mother’s ability to detect and respond to nuanced cues from the baby and require supervision or help from others.Likewise, the negative symptoms of chronic psychosis may interfere with a mother’s ability to read her baby’s nonverbal cues and may reduce capacity to communicate with and appropriately stimulate the baby.The disturbances in object constancy observed in children of women hospitalized early in their infancy has lead researchers to follow the social and cognitive development of children of women with schizophrenia .Though it is unclear that such disturbances affect later cognitive or social functioning. Early studies link impairments in object constancy to an elevated risk of development of psychosis later in life .Caretakers and kin should receive guidance to be sure that the infant’s needs are being met and that appropriate bonding with mother or another caretaker is provided.