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BMC Psychiatry

, 15:88

Psychotic disorders


BackgroundMost women with psychotic disorders and bipolar disorders have children but their pregnancies are at risk of adverse psychiatric and fetal outcome. The extent of modifiable risk factors – both clinical and socio-demographic – is unclear as most studies have used administrative data or recruited from specialist tertiary referral clinics. We therefore aimed to investigate the socio-demographic and clinical characteristics of an epidemiologically representative cohort of pregnant women with affective and non-affective severe mental illness.

MethodsWomen with severe mental illness were identified from a large electronic mental health case register in south London, and a data linkage with national maternity Hospital Episode Statistics identified pregnancies in 2007–2011. Data were extracted using structured fields, text searching and natural language processing applications.

ResultsOf 456 pregnant women identified, 236 51.7% had schizophrenia and related disorders, 220 48.3% had affective psychosis or bipolar disorder. Women with schizophrenia and related disorders were younger, less likely to have a partner in pregnancy, more likely to be black, to smoke or misuse substances and had significantly more time in the two years before pregnancy in acute care inpatient or intensive home treatment compared with women with affective disorders. Both groups had high levels of domestic abuse in pregnancy recorded in 18.9%, were from relatively deprived backgrounds and had impaired functioning measured by the Health of the Nation Outcome Scale. Women in the affective group were more likely to stop medication in the first trimester 39% versus 25% whereas women with non-affective psychoses were more likely to switch medication.

ConclusionsA significant proportion of women, particularly those with non-affective psychoses, have modifiable risk factors requiring tailored care to optimize pregnancy outcomes. Mental health professionals need to be mindful of the possibility of pregnancy in women of childbearing age and prescribe and address modifiable risk factors accordingly.

KeywordsSchizophrenia Bipolar disorder Pregnancy AbbreviationsSMISevere mental illness

SLaMSouth London and Maudsley NHS Foundation Trust

CRISClinical Record Interactive Search

GATEGeneral Architecture for Text Engineering

HESHospital Episode Statistics

ICDInternational Classification of Diseases

DSMDiagnostic and Statistical Manual of Mental Disorders

HoNOSHealth of the Nation Outcome Scales

UKUnited Kingdom

NOSNot otherwise specified

NICEUK National Institute of Health and Care Excellence

SIGNScottish Intercollegiate Guidelines Network

NHSUK National Health Service

Electronic supplementary materialThe online version of this article doi:10.1186-s12888-015-0451-8 contains supplementary material, which is available to authorized users.

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Autor: Clare L Taylor - Robert Stewart - Jack Ogden - Matthew Broadbent - Dharmintra Pasupathy - Louise M Howard


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