Adverse obstetric and neonatal outcomes complicated by psychosis among pregnant women in the United States

• Published in: BMC pregnancy and childbirth Vol. 18; no. 1; pp. 120 - 12
• Main Authors: Zhong, Qiu-Yue, Gelaye, Bizu, Fricchione, Gregory L., Avillach, Paul, Karlson, Elizabeth W., Williams, Michelle A.
• Format: Journal Article
• Language: English
• Published: London BioMed Central 02.05.2018; BMC
• Subjects: Abruptio Placentae - epidemiology; Adolescent; Adult; Affective psychosis; Age Distribution; Bipolar disorder; Cesarean section; Cesarean Section - statistics & numerical data; Child; Clinical outcomes; Congenital Abnormalities - epidemiology; Ethnicity; Family income; Female; Fetal Distress - epidemiology; Fetal Growth Retardation - etiology; Fetal Macrosomia - epidemiology; Fetal Membranes, Premature Rupture - epidemiology; Fetuses; Gynecology; Health risk assessment; Hospital Mortality; Hospitals; Humans; Hypertension; Induced labor; Labor, Induced - statistics & numerical data; Maternal and Child Health; Maternal Death - statistics & numerical data; Maternal health and pregnancy; Medicine; Medicine & Public Health; Mental disorders; Metabolism; Middle Aged; National (Nationwide) Inpatient Sample (NIS); Newborn babies; Obstetric and neonatal outcomes; Obstetrics; Postpartum Hemorrhage - epidemiology; Pregnancy; Pregnancy Complications - epidemiology; Premature Birth - epidemiology; Prevalence; Psychosis; Psychotic Disorders - epidemiology; Puerperal Disorders; Reproductive Medicine; Research Article; Risk Assessment; Schizophrenia; Stillbirth - epidemiology; United States - epidemiology; Vitamin D; Vitamin deficiency; Womens health; Young Adult; United States; United States > US; Psychosis; Schizophrenia; National (Nationwide) Inpatient Sample (NIS); Affective psychosis; Obstetric and neonatal outcomes
• ISSN: 1471-2393; 1471-2393
• DOI: 10.1186/s12884-018-1750-0

Background Adverse obstetric and neonatal outcomes among women with psychosis, particularly affective psychosis, has rarely been studied at the population level. We aimed to assess the risk of adverse obstetric and neonatal outcomes among women with psychosis (schizophrenia, affective psychosis, and other psychoses). Methods From the 2007 – 2012 National (Nationwide) Inpatient Sample, 23,507,597 delivery hospitalizations were identified. From the same hospitalization, International Classification of Diseases diagnosis codes were used to identify maternal psychosis and outcomes. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were obtained using logistic regression. Results The prevalence of psychosis at delivery was 698.76 per 100,000 hospitalizations. After adjusting for sociodemographic characteristics, smoking, alcohol/substance abuse, and pregnancy-related hypertension, women with psychosis were at a heightened risk for cesarean delivery (aOR = 1.26; 95% CI: 1.23 - 1.29), induced labor (aOR = 1.05; 95% CI: 1.02 - 1.09), antepartum hemorrhage (aOR = 1.22; 95% CI: 1.14 - 1.31), placental abruption (aOR = 1.22; 95% CI: 1.13 - 1.32), postpartum hemorrhage (aOR = 1.18; 95% CI: 1.10 - 1.27), premature delivery (aOR = 1.40; 95% CI: 1.36 - 1.46), stillbirth (aOR = 1.37; 95% CI: 1.23 - 1.53), premature rupture of membranes (aOR = 1.22; 95% CI: 1.15 - 1.29), fetal abnormalities (aOR = 1.49; 95% CI: 1.38 - 1.61), poor fetal growth (aOR = 1.26; 95% CI: 1.19 - 1.34), and fetal distress (aOR = 1.14; 95% CI: 1.10 - 1.18). Maternal death during hospitalizations (aOR = 1.00; 95% CI: 0.30 - 3.31) and excessive fetal growth (aOR = 1.06; 95% CI: 0.98 - 1.14) were not statistically significantly associated with psychosis. Conclusions Pregnant women with psychosis have elevated risk of several adverse obstetric and neonatal outcomes. Efforts to identify and manage pregnancies complicated by psychosis may contribute to improved outcomes.