Transtornos mentais maternos graves e risco de malformação congênita do bebê: uma metanálise

Effect of maternal obsessive-compulsive disorder (OCD) on feto-maternal outcomes: A systematic review and meta-analysis

BACKGROUND

Mental health disorders in pregnant women have been related to unfavorable obstetric and neonatal outcomes. Obsessive-compulsive disorder (OCD) significantly distresses mothers and affects the maternal-infant bond.

OBJECTIVES

The present meta-analysis and systematic review aimed to assess the association of maternal OCD with adverse feto-maternal outcomes.

SEARCH STRATEGY

A systematic search was undertaken in the five databases-Cochrane, Embase, ProQuest, Web of Science, and PubMed-on September 5, 2023.

SELECTION CRITERIA

Studies that included pregnant women with OCD in whom the feto-maternal outcomes were reported were included in the systematic review.

DATA COLLECTION AND ANALYSIS

Two pass screening ("title-abstract screening" followed by "full-text review"), and data extraction by two authors independently using the Nested-Knowledge Auto living semi-automated systematic review platform was carried out. The decision for selected studies was reviewed by a third author. Of the 360 studies identified, eight were included for the meta-analysis. Meta-analysis was conducted using R software.

MAIN RESULTS

Of the 24 maternal and neonatal adverse outcomes assessed, 11 were found to be associated with maternal OCD, notably pre-eclampsia (odds ratio [OR] 1.37, 95% confidence interval [CI] 1.19-1.57), antepartum hemorrhage or placental abruption (OR 1.32, 95% CI 1.13-1.54), postpartum hemporrhage (OR 1.19, 95% CI 1.08-1.31), cesarean section delivery (OR 1.32, 95% CI 1.23-1.41), emergency cesarean section (OR 1.22, 95% CI 1.15-1.30), preterm birth (OR 1.41, 95% CI 1.21-1.64), low birth weight (OR 1.41, 95% CI 1.28-1.54), low Apgar score at 5 min (OR 2.37, 95% CI 1.32-4.27), neonatal hypoglycemia (OR 1.37, 95% CI 1.23-1.53), neonatal respiratory distress (OR 1.77, 95% CI 1.44-2.16), and major congenital malformations (OR 1.37, 95% CI 1.08-1.74).

CONCLUSION

OCD in pregnant women might be associated with multiple adverse feto-maternal outcomes.

[Adverse perinatal and infant outcomes among children born to mothers with major mental disorders in a psychiatric hospital in Rio de Janeiro, Brazil]

Adverse perinatal and infant outcomes are the leading causes of infant morbidity and mortality in developing countries like Brazil. Among the risk factors are maternal mental disorders. A retrospective longitudinal study was conducted based on passive follow-up using probabilistic record linkage to estimate the prevalence of adverse perinatal and infant outcomes in children of women admitted to a public psychiatric hospital in Rio de Janeiro, Brazil, and who gave birth from 1999 to 2009. Prevalence rates were: low birth weight (27.6%), prematurity (17.4%), malformations (2.5%), stillbirths (4.8%), and neonatal deaths (3.7%). Associated factors were deficient prenatal care, schizophrenia, and low income. The results corroborate the high prevalence of adverse perinatal and infant outcomes in mothers with major mental disorders, and that screening of psychiatric symptoms and specialized care by mental health professionals are essential throughout prenatal and postpartum care.