Skip to main content Accessibility help
×
Home

Schizophrenia and offspring's risk for adverse pregnancy outcomes and infant death

  • Emma Nilsson (a1), Christina M. Hultman (a2), Sven Cnattingius (a3), Petra Otterblad Olausson (a4), Camilla Björk (a3) and Paul Lichtenstein (a5)...

Abstract

Background

Women with schizophrenia are at increased risk for adverse pregnancy outcomes. It is not known whether offspring born to fathers with schizophrenia also have an increased risk.

Aims

To evaluate paternal and maternal influences on the association between schizophrenia and pregnancy outcomes.

Method

A record linkage including 2 million births was made using Swedish population-based registers. The risk for adverse pregnancy outcomes was evaluated through logistic regression.

Results

Offspring with a mother or father with schizophrenia faced a doubled risk of infant mortality, which could not be explained by maternal behaviour alone during pregnancy. Excess infant death risk was largely attributable to post-neonatal death. Maternal factors (e.g. smoking) explained most of the other risks of adverse pregnancy outcomes among both mothers and fathers with schizophrenia.

Conclusions

The risks to offspring whose fathers had schizophrenia suggest that, in addition to maternal risk behaviour, nonoptimal social and/or parenting circumstances are of importance.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Schizophrenia and offspring's risk for adverse pregnancy outcomes and infant death
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Schizophrenia and offspring's risk for adverse pregnancy outcomes and infant death
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Schizophrenia and offspring's risk for adverse pregnancy outcomes and infant death
      Available formats
      ×

Copyright

Corresponding author

Emma Nilsson, Centre for Epidemiology, National Board of Health and Welfare, SE-106 30 Stockholm, Sweden. Email: Emma.Nilsson@Socialstyrelsen.se

References

Hide All
1 Jablensky, AV, Morgan, V, Zubrick, SR, Bower, C, Yellachich, LA. Pregnancy, delivery, and neonatal complications in a population cohort of women with schizophrenia and major affective disorders. Am J Psychiatry 2005; 162: 7991.
2 Sacker, A, Done, DJ, Crow, TJ. Obstetric complications in children born to parents with schizophrenia: a meta-analysis of case-control studies. Psychol Med 1996; 26: 279–87.
3 Webb, R, Abel, K, Pickles, A, Appleby, L. Mortality in offspring of parents with psychotic disorders: a critical review and meta-analysis. Am J Psychiatry 2005; 162: 1045–56.
4 Bennedsen, BE, Mortensen, PB, Olesen, AV, Henriksen, TB, Frydenberg, M. Obstetric complications in women with schizophrenia. Schizophr Res 2001; 47: 167–75.
5 Nilsson, E, Lichtenstein, P, Cnattingius, S, Murray, RM, Hultman, CM. Women with schizophrenia: pregnancy outcome and infant death among their offspring. Schizophr Res 2002; 58: 221–9.
6 King-Hele, SA, Abel, KM, Webb, RT, Mortensen, PB, Appleby, L, Pickles, AR. Risk of sudden infant death syndrome with parental mental illness. Arch Gen Psychiatry 2007; 64: 1323–30.
7 Webb, RT, Abel, KM, Pickles, AR, Appleby, L, King-Hele, SA, Mortensen, PB. Mortality risk among offspring of psychiatric inpatients: a population-based follow-up to early adulthood. Am J Psychiatry 2006; 163: 2170–7.
8 Statistics Sweden. Educational attainment of the population 2001. Official statistics of Sweden UF 37 SM 0101, 2001: (http://www.scb.se/templates/Publikation_44633.asp).
9 Cnattingius, S, Ericson, A, Gunnarskog, J, Kallen, B. A quality study of a medical birth registry. Scand J Soc Med 1990; 18: 143–8.
10 Centre for Epidemiology. The Swedish Medical Birth Register – A Summary of Content and Quality. Research Report 2003. (http://www.socialstyrelsen.se/NR/rdonlyres/E9BE4DDE-95EE-4E3F-A56F-36CA5125CA8C/1132/20031123.pdf).
11 Centre for Epidemiology. The Swedish Hospital Discharge Register. 2005. (http://www.socialstyrelsen.se/en/Statistics/statsbysubject/The+Swedish+Hospital+Discharge+Register.htm)).
12 World Health Organization. International Classification of Diseases: Manual of the International Statistical Classification of Diseases, Injuries and Causes of Death (ICD–8). WHO, 1967.
13 World Health Organization. International Classification of Diseases: Manual of the International Statistical Classification of Diseases, Injuries and Causes of Death (ICD–9). WHO, 1978.
14 World Health Organization. International Classification of Diseases: Manual of the International Statistical Classification of Diseases, Injuries and Causes of Death (ICD–10). WHO, 1992.
15 Lunde, AS, Lundeborg, S, Lettenstrom, GS, Thygesen, L, Huebner, J. The person-number systems of Sweden, Norway, Denmark, and Israel. Vital Health Stat 1980; 2: 159.
16 Cole, S, Hartford, RB, Bergsjo, P, McCarthy, B. International collaborative effort (ICE) on birth weight, plurality, perinatal, and infant mortality. III: a method of grouping underlying causes of infant death to aid international comparisons. Acta Obstet Gynecol Scand 1989; 68: 113–7.
17 Marsal, K, Persson, PH, Larsen, T, Lilja, H, Selbing, A, Sultan, B. Intrauterine growth curves based on ultrasonically estimated foetal weights. Acta Paediatr 1996; 85: 843–8.
18 Bennedsen, BE, Mortensen, PB, Olesen, AV, Henriksen, TB. Preterm birth and intra-uterine growth retardation among children of women with schizophrenia. Br J Psychiatry 1999; 175: 239–45.
19 Cnattingius, S. The epidemiology of smoking during pregnancy: smoking prevalence, maternal characteristics, and pregnancy outcomes. Nicotine Tob Res 2004; 6 (suppl 2): S12540.
20 Goldenberg, RL, Culhane, JF, Iams, JD, Romero, R. Epidemiology and causes of preterm birth. Lancet 2008; 371: 7584.
21 Bennedsen, BE, Mortensen, PB, Olesen, AV, Henriksen, TB. Congenital malformations, stillbirths, and infant deaths among children of women with schizophrenia. Arch Gen Psychiatry 2001; 58: 674–9.
22 McNeil, TF. Perinatal risk factors and schizophrenia: selective review and methodological concerns. Epidemiol Rev 1995; 17: 107–12.
23 Ekholm, B, Ekholm, A, Adolfsson, R, Vares, M, Osby, U, Sedvall, GC, Jonsson, EG. Evaluation of diagnostic procedures in Swedish patients with schizophrenia and related psychoses. Nordic J Psychiatry 2005; 59: 457–64.
Type Description Title
PDF
Supplementary materials

Nilsson et al. supplementary material
Appendix 1

 PDF (32 KB)
32 KB
UNKNOWN
Supplementary materials

Nilsson et al. supplementary material
Supplementary Material

 Unknown (522 bytes)
522 bytes

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Schizophrenia and offspring's risk for adverse pregnancy outcomes and infant death

  • Emma Nilsson (a1), Christina M. Hultman (a2), Sven Cnattingius (a3), Petra Otterblad Olausson (a4), Camilla Björk (a3) and Paul Lichtenstein (a5)...
Submit a response

eLetters

Taking the Spotlight off Schizophrenia

Kathryn M Abel, Reader and Honorary Consultant Psychiatrist
10 December 2008

article ID: 193/4/311 -->

In this article, Nilsson and authors make reference to a number of our and other colleagues?, papers on the risk of adverse outcome in offspring of mentally ill parents. We should like to bring to readers?attention a key difference between the work of Nilsson et al and that of Jablensky et al (2005) and ourselves (King-Hele et al 2007; Webb et al 2006, 2007, 2008). Nilsson and colleagues restrict their studies to families where parents are suffering from schizophrenia and related disorders and report excess risk of offspring mortality up to a year with either maternal or paternal illness.

Although numbers were quite small, Jablensky et al (2005) reported nosignificant differences in risk of stillbirth, neonatal, postneonatal death, or early childhood death, between mothers with schizophrenia, bipolar or unipolar affective disorder relative to the general population comparison group.

Our investigations found that age-specific all-cause mortality rates are higher in children of a mother or father admitted with schizophrenia than the general population. However, these relative risks are comparable to those in offspring of parents admitted for other mental disorders e.g.affective disorder and alcohol/drug-related disorder (Webb et al 2006).Like Nilsson et al., we also looked at cause-specific mortality (King-Heleet al 2007; Webb et al 2007, 2008). Rates of death by natural causes were generally not raised with any parental diagnosis, although fatal birth defect risk was modestly elevated with maternal affective disorder and to a greater degree with maternal schizophrenia. Sudden Infant Death Syndromerates were elevated with parental schizophrenia and other mental disorders, but the highest SIDS risk was with maternal alcohol/drug- related disorder. Recent Swedish analyses confirm a significantly higher SIDS risk among infants whose mothers and fathers received psychiatric inpatient care with a particularly high risk if both parents were admitted, or if the mother was diagnosed with an alcohol or drug-related disorder.

Taken together, we believe that research shows evidence for higher mortality risk in relation to a range of maternal and paternal mental illness. With the exception of fatal birth defects, we conclude that thereis no evidence that mortality risk among offspring of parents with schizophrenia and related disorders is significantly higher than that associated with all other parental psychiatric conditions. Therefore, in our view, research highlights the need for greater vigilance and support throughout pregnancy, infancy, childhood and adolescence for families affected by various forms of severe mental illness, and not just schizophrenia.

References

Jablensky AV, Morgan V, Zubrick SR, Bower C, Yellachich LA.Pregnancy, delivery, and neonatal complications in a population cohort of women with schizophrenia and major affective disorders. Am J Psychiatry 2005; 162: 79?91.

King-Hele SA, Abel KM, Webb RT, Mortensen PB, Appleby L, Pickles AR.Risk of sudden infant death syndrome with parental mental illness. Arch Gen Psychiatry 2007; 64: 1323?30.

Webb RT, Abel KM, Pickles AR, Appleby L, King-Hele SA, Mortensen PB.Mortality risk among offspring of psychiatric inpatients: a population- based follow-up to early adulthood. Am J Psychiatry 2006; 163: 2170?7.

Webb RT, Pickles AR, Appleby L, Mortensen PB, Abel KM. Death by unnatural causes during childhood and early adulthood in offspring of psychiatric inpatients. Archives of General Psychiatry 2007; 64: 345-52.

Webb RT, Pickles AR, King-Hele SA, Appleby L, Mortensen PB, Abel KM (2008). Parental mental illness and fatal birth defects in a national birth cohort. Psychological Medicine 38, 1495?1503.

The authors have no conflict of interests
... More

Conflict of interest: None Declared

Write a reply

Anti-psychotic medication and pregnancy outcomes

derek a summerfield, consultant psychiatrist
20 October 2008

Nillson et al (1) find that offspring with a mother or father with schizophrenia are at increased risk of pre-term birth,low birth weight andof being small for gestational age, and that the risk of infant death is doubled. By examining a number of covariates they conclude that the risk for infant death cannot be explained only by maternal behaviour during pregnancy (eg smoking).

But in the second last paragraph they concede that "we were not able to control for the potential confounding of maternal medication during pregnancy". This significantly weakens the paper, surely.I imagine that most or all of the subject mothers were on longterm anti-psychotic medication, or had been. Did the authors feel that the effects of such medication on pregnancy outcomes had already been sufficiently clarified in the psychiatric literature? Peehaps they could comment.

1 Nillson E et al.Schizophrenia and offspring's risk for adverse pregancy outcomes and infant death. Br J Psychiatry 2008; 193:311-315.
... More

Conflict of interest: None Declared

Write a reply

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *