Maternal schizophrenia and adverse birth outcomes: what mediates the risk?

PURPOSE: Maternal schizophrenia is associated with adverse birth outcomes, but the reasons for this remain unclear. In a population-based cohort of infants born to women with schizophrenia, we determined the occurrence of key perinatal outcomes and explored whether factors identifiable in our datasets explained any elevated risk. METHODS: Using population-level health administrative data linked to clinical birth-registry data in Ontario, Canada (2006-2011), we examined the relative risk (RR) of preterm birth (< 37 weeks), small for gestational age (SGA), and Apgar scores < 8 in infants of women with schizophrenia (n = 4279) versus infants of unaffected women (n = 286,147). Generalized estimating equations determined whether reproductive history, maternal health conditions, pregnancy exposures, and complications explained elevated RRs. RESULTS: Among infants of women with schizophrenia, risk was higher for prematurity (11.4% vs. 6.9%, aRR 1.64, 95% CI 1.51-1.79), SGA (3.5% vs. 2.5%, aRR 1.40, 95% CI 1.20-1.64), and Apgar score < 8 at 1 (19.0% vs. 12.8%, aRR 1.49, 95% CI 1.40-1.59) and 5 min (5.6% vs. 3.0%, aRR 1.90, 95% CI 1.68-2.16). Smoking, fourfold more common among women with schizophrenia, was the variable that explained the greatest proportion of the elevated aRR for prematurity (9.9%), SGA (28.7%), and Apgar < 8 at 1 and 5 min (9.8%, 5.6%). Illicit substance use, certain reproductive history variables, and pregnancy complications also contributed to the elevated aRR for preterm birth. CONCLUSIONS: Elevated risks of preterm birth, SGA, and low Apgar scores in infants of women with schizophrenia are partly explained by potentially modifiable factors such as smoking and illicit drug use, suggesting opportunities for targeted intervention.

Prospective study of depression among dialysis patients in Saudi Arabia.

OBJECTIVES: The purpose was to determine the short-term course of depression among dialysis patients in Saudi Arabia and identify baseline characteristics that may influence course. METHODS: Thirty-nine dialysis patients in Jeddah, SA, were identified with subthreshold, minor, or major depressive disorders using the Structured Clinical Interview for Depression (SCID) and followed up at 6 and 12 weeks using the Longitudinal Interview and Follow-up Evaluation (LIFE) schedule. Depressive symptoms were tracked using the Hamilton Depression Rating Scale (HDRS). Patient characteristics measured at baseline included demographic, psychosocial, physical health, and treatment factors. RESULTS: Of the 20 patients with major or minor depressive disorder, eight (40 %) fully remitted by 6 weeks and an additional three patients remitted over the next 6 weeks, leaving 45 % with significant depressive symptoms persisting beyond 12 weeks. Subthreshold disorders followed a similar course (42 % with persistent symptoms). Few patients received treatment for depression. Those with more education, severe health problems, poorer psychological function, more severe depressive symptoms, or a family psychiatric history were less likely to remit. Similar factors predicted change in depressive symptoms assessed by HDRS, especially high medical co-morbidity, severe illness, and overall poor psychological functioning. CONCLUSIONS: Nearly one-half of depressed dialysis patients in Saudi Arabia continue to have significant symptoms beyond 12 weeks of follow-up, few of whom were treated. Specific characteristics at baseline identify depressed dialysis patients at greater risk of persistent symptoms who need treatment.