Maternal bipolar disorder increases low birthweight and preterm births: a nationwide population-based study. J Affect Disord 121: 100-105

Taipei Medical University-Shuang Ho Hospital, Department of Psychiatry & Sleep Center, Taipei, Taiwan.
Journal of Affective Disorders (Impact Factor: 3.38). 07/2009; 121(1-2):100-5. DOI: 10.1016/j.jad.2009.05.019
Source: PubMed


To investigate pregnancy outcomes, including low birthweight, preterm births, and small-for-gestational-age (SGA) among women with bipolar disorder, schizophrenia compared with women with no history of mental illness using nationwide population-based data.
This study linked the Taiwan National Health Insurance Research Dataset with the national birth certificate registry. A total of 528,398 singleton births between 2001 and 2003 were included; 337 were diagnosed with bipolar disorder. Multivariate logistic regression analyses were carried out to examine the relationship between maternal bipolar disorder, schizophrenia and the odds of low birthweight, preterm births, and SGA, after adjusting for characteristics of infant, mother and father.
It shows that pregnant women with bipolar disorder were more likely to have LBW infants (9.8% vs. 5.7%), preterm births (14.2% vs. 6.9%) and SGA (22.3% vs. 15.7%) than pregnant women with no history of mental illness. The adjusted odds of low birthweight for women with bipolar disorder was 1.66 times (95% CI, 1.16-2.38) that of women with no history of mental illness. In terms of preterm births and SGA, the adjusted odds ratios were 2.08 (95% CI, 1.53-2.83) and 1.47 (95% CI, 1.14-1.91) respectively, for women with bipolar disorder, compared to their counterparts with no history of mental illness.
We conclude that women with bipolar disorder had increased risk of low birthweight, preterm births, and SGA than women without a history of mental illness. More active monitoring and early intervention to counter potential adverse pregnancy outcomes for pregnant women with bipolar disorder should be initiated.

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    • "Women with schizophrenia have also been shown to be at greater risk of interventions such as cesarean section, vaginal assisted delivery, and pharmacological stimulation of labor (Bennedsen et al., 2001). Women with bipolar disorder have an increased risk of preterm birth (MacCabe et al., 2007; Lee and Lin, 2010) and small or growth retarded babies (MacCabe et al., 2007; Lee and Lin, 2010; Bodén et al., 2012) as well as increased risk of placenta previa and antepartum hemorrhage (Jablensky et al., 2005). Studies have also shown that pregnancy outcomes are worse for women with schizophrenia than those with bipolar disorder (Verdoux and Bourgeois, 1993; Jablensky et al., 2005). "
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    ABSTRACT: Background: Women with schizophrenia and bipolar disorder are at a higher risk of obstetric and neonatal complications. The aim of this study was to better understand the factors that may influence these adverse outcomes. Method: We examined obstetric and neonatal outcomes of pregnant women with schizophrenia and bipolar disorder and factors possibly influencing these outcomes. A retrospective review of the medical history of 112 women with a DSM-IV diagnosis of schizophrenia or bipolar disorder was undertaken. Data for controls were extracted from the hospital's electronic birth record data. Results: Women with schizophrenia and bipolar disorder presented later for their first antenatal visit and had higher rates of smoking and illicit drug use than the control group. They also had higher rates of pre-eclampsia and gestational diabetes. Their infants were less likely to have Apgar scores 8-10 at both 1 and 5minutes and were more likely to be admitted to special care/neonatal intensive care nursery than the infants of controls. The rate of pre-term birth was significantly increased in the women with schizophrenia and bipolar disorder. Pre-term birth and admission to special care/neonatal intensive care were predicted by smoking and illicit drug use. Conclusion: These data point to potentially modifiable factors as significant contributors to the high rate of adverse obstetric and neonatal outcomes in women with mental illness. Comprehensive management of women with mental illness prior to, during pregnancy and in the postnatal period may have long-term benefits for their offspring.
    Schizophrenia Research 06/2014; 157(1-3). DOI:10.1016/j.schres.2014.05.030 · 3.92 Impact Factor
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    • "Multiple reviews have highlighted the lack of evidence regarding antipsychotic use in pregnancy and breastfeeding [19]–[24]. Whether antipsychotics exacerbate or mitigate the increased rate of stillbirth, prematurity, and obstetric complications seen in mothers with severe mental illness is unknown [25]–[27]. "
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    ABSTRACT: Many women diagnosed with varying psychiatric disorders take antipsychotic medications during pregnancy. The safety of antipsychotic medications in pregnancy is largely unknown. We established the National Register of Antipsychotic Medications in Pregnancy in 2005. Women who are pregnant and taking an antipsychotic medication are interviewed every 6 weeks during pregnancy and then followed until their babies are one year old. The baby's progress is closely followed for the first year of life. As of April 18 2012, 147 pregnancies had been followed through to completion. There were 142 live births and data is available for 100 one year old babies. 18% of babies were born preterm, with a higher dose of antipsychotic medication correlating to an increased likelihood of premature delivery; 43% of babies required special care nursery or intensive care after birth; 37% had any degree of respiratory distress and 15% of babies developed withdrawal symptoms. Congenital anomalies were seen in eight babies. Most pregnancies resulted in the birth of live, healthy babies. The use of mood stabilisers or higher doses of antipsychotics during pregnancy increased the likelihood of babies experiencing respiratory distress or admission to Special Care Nursery or Neonatal Intensive Care Units. There is a great need for safety and efficacy information about the use of antipsychotic medications in pregnancy. Live, healthy babies are the most common outcome following the use of antipsychotic medication in pregnancy, but clinicians should be particularly mindful of neonatal problems such as respiratory distress.
    PLoS ONE 05/2014; 9(5):e94788. DOI:10.1371/journal.pone.0094788 · 3.23 Impact Factor
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    • "Even fertility rates were lower compared to levels for the general population, at least with respect to the first or second child, in a population-based study from Denmark (Laursen and Munk-Olsen, 2010). BD increased the risk of low birth-weight and pre-term births in a nation-wide Taiwanese study (Lee and Lin, 2010). Since both genetic predisposition and familial environment may influence onset of psychiatric conditions (Faraone et al., 2003; Wamboldt and Reiss, 2006), herein we conducted a case–control study of women with and without BD. "
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    ABSTRACT: INTRODUCTION: Bipolar disorder (BD) is a highly incapacitating disease typically associated with high rates of familial dysfunction. Despite recent literature suggesting that maternal care is an important environmental factor in the development of behavioral disorders, it is unclear how much maternal care is dysfunctional in BD subjects. OBJECTIVE: The objective of this study was to characterize maternal care in DSM-IV/SCID diagnosed BD type I subjects compared to healthy controls with (PD) and without (NPD) other psychiatric diagnoses. MATERIALS AND METHODS: Thirty-four BD mothers and 106 controls underwent an interview about family planning and maternal care, obstetrical complications, and mother-child interactions. K-SADS-PL questions about violence exposure were used to ascertain domestic violence and physical/sexual abuse. RESULTS: BD mothers were less likely to have stable unions (45.5%; p<0.01) or to live with the biological father of their children (33.3%; p<0.01), but had higher educational level and higher rates of social security use/retirement. They also had fewer children and used less contraceptive methods than controls. Children of BD women had higher rates of neonatal anoxia, and reported more physical abuse (16.1%; p=0.02) than offspring of NPD mothers. Due to BD mothers' symptoms, 33.3% of offspring suffered physical and/or psychological abuse. LIMITATIONS: Post hoc analysis, and the use of questions as a surrogate of symptoms as opposed to validated instruments. CONCLUSION: This is one of few reports confirming that maternal care given by BD women is dysfunctional. BD psychopathology can lead to poor maternal care and both should be considered important environmental risk factors in BD, suggesting that BD psychoeducation should include maternal care orientation.
    Journal of Affective Disorders 08/2012; 143(1-3). DOI:10.1016/j.jad.2012.05.050 · 3.38 Impact Factor
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