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Ayre K, Dutta R, Howard LM. Perinatal self-harm: an overlooked public health issue. Lancet Public Health 2020; 4:e125. [PMID: 30851866 DOI: 10.1016/s2468-2667(19)30020-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 01/18/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Karyn Ayre
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, London, UK.
| | - Rina Dutta
- Academic Department of Psychological Medicine, Psychology and Neuroscience, Kings College London, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, London, UK
| | - Louise Michelle Howard
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, London, UK
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Gupta R, Brown HK, Barker LC, Dennis CL, Vigod SN. Rapid repeat pregnancy in women with schizophrenia. Schizophr Res 2019; 212:86-91. [PMID: 31420202 DOI: 10.1016/j.schres.2019.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/31/2019] [Accepted: 08/03/2019] [Indexed: 01/14/2023]
Abstract
AIM Women with schizophrenia are vulnerable to adverse reproductive health outcomes. Short inter-pregnancy interval, or rapid repeat pregnancy, is associated with maternal and infant complications, and may be preventable. Whether women with schizophrenia are at disproportionate risk for rapid repeat pregnancy is unknown. METHODS This population-based cohort study in Ontario, Canada (2002-2013) compared women with and without schizophrenia on their risk of rapid repeat pregnancy, defined as pregnancy within 12 months of an index live birth. Among women with public drug coverage, those with and without schizophrenia were compared on their use of non-barrier contraception (hormonal and surgical) post-delivery. RESULTS Women with schizophrenia (n = 1565) were at higher risk for rapid repeat pregnancy than women without schizophrenia (n = 924,657) (6.3% vs. 3.9%, adjusted relative risk, aRR 1.31, 95% confidence interval, CI, 1.07-1.59). They had more rapid repeat pregnancies resulting in live births (aRR 1.85, 95% CI 1.26-2.72), but not pregnancy losses (aRR 1.50, 95% CI 0.99-2.29) or induced abortions (aRR 1.07, 95% CI 0.81-1.42). Post-delivery non-barrier contraception use was similar between groups (43.7% vs. 43.6%, aRR 1.06, 95% CI 0.93-1.20), although women with schizophrenia were more likely to use injectable contraception (14.1% vs. 10.1%, aRR 1.67, 95% CI 1.35-2.07). DISCUSSION Women with schizophrenia are at higher risk than their peers for rapid repeat pregnancy, but use non-barrier contraception at similar rates. The postnatal period is an opportune time to initiate targeted interventions designed to optimize planning for any future pregnancies, and contribute to improving maternal and child health in this vulnerable group.
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Affiliation(s)
- Renu Gupta
- Department of Psychiatry, Women's College Hospital, Toronto, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Hilary K Brown
- ICES, Toronto, Canada; Dalla Lana School of Public Health, Interdisciplinary Centre for Health & Society, University of Toronto, Toronto, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Lucy C Barker
- Department of Psychiatry, Women's College Hospital, Toronto, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada; ICES, Toronto, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Cindy-Lee Dennis
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada; Faculty of Nursing, University of Toronto, Toronto, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Simone N Vigod
- Department of Psychiatry, Women's College Hospital, Toronto, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada; ICES, Toronto, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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Harris EL, Frayne J, Allen S, Renganathan K, Nguyen TN. Psychiatric admission during pregnancy in women with schizophrenia who attended a specialist antenatal clinic. J Psychosom Obstet Gynaecol 2019; 40:211-216. [PMID: 29671666 DOI: 10.1080/0167482x.2018.1461832] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Objectives: The mental health and wellbeing of pregnant women with schizophrenia is an area of research interest. We aim to explore this relationship particularly in regards to psychiatric admission rates, timing and their associated contributing factors. Methods: A total of 98 pregnancies to women with schizophrenia, who attended a specialist antenatal clinic and delivered from July 2007 to February 2016, were retrospectively examined. The cohort was divided into two groups based on psychiatric admission. Descriptive data were analyzed using SPSS software. Results: Overall, 40.8% required psychiatric admission during pregnancy. A higher proportion of subjects had their initial psychiatric admission in the first trimester compared to the third trimester (p = .002). Of note, 10.2% were admitted within one month either side of conception. Women with admission also presented later for their first antenatal appointment (p = .04, 95% CI -2.1 to -1.9). Psychiatric admission was associated with substance (p = .014) and alcohol use (p = .001), child protective services involvement (p = .022) and infant being placed in out-of-home care (p = .01), but not with poorer obstetric or neonatal outcomes. Conclusion: High rates of psychiatric admission are evident throughout pregnancy for women with schizophrenia, with a high proportion of first presentations for admission occurring in the first trimester. Psychiatric admission is associated with poorer antenatal care attendance and adverse psychosocial outcomes, highlighting the need for enhanced multidisciplinary pregnancy care for this at risk group. Inpatient psychiatric services should consider pregnancy testing and contraception review for all women of childbearing age, admitted with schizophrenia.
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Affiliation(s)
| | - Jacqueline Frayne
- b Childbirth and Mental Illness Antenatal Clinic , Women's and Newborn Health Service , Perth , Australia.,c School of Medicine, Division of General Practice , University of Western Australia , Perth , Australia
| | - Suzanna Allen
- b Childbirth and Mental Illness Antenatal Clinic , Women's and Newborn Health Service , Perth , Australia
| | - Kanni Renganathan
- b Childbirth and Mental Illness Antenatal Clinic , Women's and Newborn Health Service , Perth , Australia
| | - Thinh Ngoc Nguyen
- d School of Psychiatry and Clinical Neurosciences , University of Western Australia , Perth , Australia.,e Peel and Rockingham Kwinana Mental Health Service , Peel and Rockingham , Australia
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Abstract
BACKGROUND Research suggests that maintaining treatment during pregnancy for women with bipolar affective disorder reduces the risk of relapse. However, one of the key questions for women and clinicians during pregnancy is whether there are implications of exposure to mood stabilizers for longer term child development. Despite these concerns, there are few recent systematic reviews comparing the impact on child developmental outcomes for individual mood-stabilizing agents to inform clinical decisions. OBJECTIVES To examine the strengths and limitations of the existing data on child developmental outcomes following prenatal exposure to mood stabilizers and to explore whether there are any differences between agents for detrimental effects on child development. METHOD Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a rigorous systematic search was carried out of four electronic databases from their respective years of inception to September 2016 to identify studies which examined the effects of mood stabilizers including sodium valproate, carbamazepine, lamotrigine, lithium and second-generation antipsychotics on child developmental outcomes. RESULTS We identified 15 studies for critical review. Of these, 10 examined antiepileptic drugs, 2 studied lithium and 3 studied second-generation antipsychotics. The most consistent finding was a dose-response relationship for valproate with higher doses associated with poorer global cognitive abilities compared to other antiepileptic drugs. The limited data available for lithium found no adverse neurodevelopmental outcomes. The limited second-generation antipsychotic studies included a report of a transient early neurodevelopmental delay which resolved by 12 months of age. CONCLUSION This review found higher neurodevelopmental risk with valproate. While the existing data on lithium and second-generation antipsychotics are reassuring, these data are both limited and lower quality, indicating that further research is required. The information from this review is relevant for patients and clinicians to influence choice of mood-stabilizing agent in childbearing women. This must be balanced against the known risks associated with untreated bipolar affective disorder.
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Affiliation(s)
- Carolyn Haskey
- 1 Peel and Rockingham Kwinana Mental Health Service, Rockingham, WA, Australia
| | - Megan Galbally
- 2 School of Psychology and Exercise Science, Murdoch University, Murdoch, WA, Australia.,3 School of Medicine, The University of Notre Dame Australia, Fremantle, WA, Australia.,4 Fiona Stanley Hospital, Murdoch, WA, Australia
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