Erratum and further analysis: "perinatal conditions and infant development in children with schizophrenic parents"

Schizophrenia and motherhood

The primary aim of this study was to analyze the impact of schizophrenic disorders on pregnancy outcomes. The secondary aim was to briefly analyze the potential role of antipsychotic treatment on influencing pregnancy outcomes in expectant mothers with schizophrenia. We searched the MEDLINE, PsycINFO, and Science.gov databases for articles published in English from January 1980 to January 2019. We used the following search terms: 'schizophrenia', 'motherhood', 'pregnancy/foetal/neonatal outcomes', and 'birth defects'. The reference lists of retrieved articles were also consulted to find additional pertinent studies missed in the electronic search and/or those published before 1980. Data were extracted from articles that provided primary data on the impact of maternal schizophrenia spectrum disorders on obstetrical and perinatal outcomes. After excluding duplicates, 35 articles were identified. Systematic reviews were searched on the same databases to briefly assess the effects of antipsychotics on pregnancy outcomes. The reviewed studies showed several limitations. They were published during a time range from the early 1970s to 2019. During this period, there were significant changes in the diagnostic criteria for schizophrenia. Moreover, such studies showed no homogeneity in the investigation of potential confounders. Most importantly, no research has differentiated the effects of maternal illness on pregnancy, fetal, and neonatal outcomes from those associated with antipsychotic treatments. Thus, it is not surprising that such studies show conflicting results. Despite such limitations, in managing pregnant women with schizophrenia clinicians should consider an integrated approach that includes: antipsychotic treatment, psychological treatment, optimal dietary approaches for prevention of excessive weight gain and gestational diabetes, meticulous gynecologic and obstetric surveillance, and social and occupational support.

Obstetric complications in children born to parents with schizophrenia: a meta-analysis of case-control studies

On the basis of previous findings, we used meta-analyses to consider whether births to parents with schizophrenia have an increased risk of obstetric complications. Meta-analyses were based on published studies satisfying the following selection criteria. The schizophrenic diagnosis could apply to either parent: parents with non-schizophrenic psychoses were not included: only normal controls were accepted. In all, 14 studies provided effect sizes or data from which these could be derived. Studies were identified by data searches through MEDLINE, PSYCLIT and through references of papers relating to the subject. Births to individuals with schizophrenia incur an increased risk of pregnancy and birth complications, low birthweight and poor neonatal condition. However, in each case the effect size is small (mean r = 0.155; 95% CI = 0.057). The risk is greater for mothers with schizophrenia and is not confined to mothers with onset pre-delivery or to the births of the children who become schizophrenic themselves.

Child-care attitudes and development of young children of mentally ill and well mothers

Young children of mentally ill mothers and well mothers were administered the WPPSI. Mother and child were observed in the test situation and mothers were administered the Maternal Attitude Scale and a measure of intelligence. Even partialling out mothers' IQ, scores of mothers who believe in encouraging the child's interaction with the environment correlated with child's IQ. Lower birth weight and greater birth complications were related to maternal attitudes reflecting continuation of the mother-child symbiosis and, among well mothers, more intrusive behavior in the test situation was also related to the belief in the importance of continuing the symbiosis as well as to greater denial of child-rearing concerns.

Maternal Emotionality During Pregnancy and Reproductive Outcome: A Review of the Literature

Empirical studies dealing with the relationship between maternal emotionality during pregnancy and reproductive outcome are critically reviewed. In general, the results of the studies reviewed support the notion of a relationship between maternal emotionality and reproductive outcome. The most methodologically acceptable studies were those linking the emotional state of the expectant mother to habitual abortion, hyperemesis gravidarum, toxemia, deviant infant behavior, and a variety of pregnancy and birth complications. Anxiety is the emotional condition most often studied and implicated in reproductive complications. However, the available data do not permit any conclusions regarding the nature of the relationship between maternal emotionality and obstetric and reproductive outcome. Mediating factors and methodological difficulties are briefly discussed.

Birthweights of male and female schizoprenics' offspring

The live birthweights and the birthweight Z score equivalents based upon state averages of 130 offspring of male and female schizophrenics were compared with state averages and with those of 150 offspring of nonschizophrenic psychiatric patient controls. Offspring of schizophrenics resembled the controls and the state averages with few exceptions. Schizophrenic fathers produced heavier birthweight children and the expected proportion of lower birthweight children. Offspring of schizophrenics born a year or more before onset of the parental disorder were significantly heavier than control offspring, although groups did not differ when birth was near or after breakdown.

Perinatal complications in offspring of psychotic parents

The birth records of 78 subjects born to psychotic parents and 72 subjects born to normal parents were studied. No significant differences in the rates of pregnancy and birth complications (PBCs) were found between the offspring of psychotic parents and normal control parents. There were no differences between offspring born to psychotic mothers compared to psychotic fathers. Neither the onset of the parent's illness, nor the mother's age at delivery, nor the sex of the offspring seemed to influence the rate of PBCs. The offspring of chronic schizophrenic mothers and manic-depressive fathers had lower PBC rates than the offspring of parents of other diagnostic categories. The parents of these two groups, which were of a limited size, did not differ on any variable of significance, excepting the time of their first psychiatric hospital admission.

Some possible childhood indicators of adult schizophrenia inferred from children of schizophrenics

Prospective developmental data on 33 children of consensus diagnosed schizophrenic parents were compared to control samples of children of other psychiatric patients and children of normal parents. Contrary to several reports the children of schizophrenics, observed from birth to age seven, were remarkably normal on a host of pregnancy and delivery variables, neurological examinations, physical growth measures, and psychological tests. However, a combination of three indicators characterized five of the 116 children, and all five were offspring of schizophrenics (17 per cent of the high risk sample), thus matching the expected lifetime risk for schizophrenia previously observed in such samples. Case histories show that all five children have enduring patterns of maladjustment and exhibit behaviours often reported in the premorbid histories of schizophrenics. Most have family histories heavily loaded with schizophrenia. In terms of a diathesis-stress model, these five children appear especially vulnerable to future schizophrenia in the absence of rational methods of prevention.

[The influence of an early brain damage on psychic diseases in adulthood. A study documented by the AMP-system (author's transl)]

The data of 1926 psychiatric in-patients documented by the AMP-system were evaluated with respect to the anamnestic item "early brain damage". There were 82 cases (4.26%). For each patient with an early brain damage a control-case matched for age, sex and diagnosis was selected. Patients with mental handicaps were examined seperately. For methodical reasons the demonstrated frequencies are an underestimation, and subtle differences between index- and controlgroups are not expected to be visible, but those differences which could be found, will be real. The highest frequency for "early brain damage" was found in the diagnostic group which also contained the psychic disturbances in epilepsy. Among neuroses and schizophrenia the item was found with the average-frequency of the total psychiatric population. It was under-represented among affective psychoses and involutional diseases. An early brain damage predisposed to an earlier age of first manifestation, and the psychic disease showed a more chronic course. Hypotheses concerning the uneven distribution over the diagnostic spectrum were discussed with particular emphasis on the fact that hypoxic perinatal disturbances do not lead to diffuse and unspecific consequences, but predominantly to a sensory impairment and possibly to a deficit in the aminergic system. Early brain damage was also discussed as one mode of the transmission of psychic diseases.