Factors associated with postpartum psychiatric admission in a population‐based cohort of women with schizophrenia

Vigod, Simone N.; Rochon-Terry, Geneviève; Fung, Kinwah; Gruneir, Andrea; Dennis, Cindy‐Lee; Grigoriadis, Sophie; Kurdyak, Paul; Ray, Joel G.; Rochon, Paula A.; Seeman, Mary V.

doi:10.1111/acps.12622

Cited by 12 publications

(10 citation statements)

References 50 publications

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“…With respect to the risk of relapse during the postpartum period, the magnitude of risk may differ according to several sociodemographic and clinical factors [62]. Universally, however, the production of estrogens abruptly declines [63]. The balance among interrelated hormones, drug metabolism and other pharmacokinetic factors all change in the postnatal period [64].…”

Section: Treatment Of Schizophrenia During the Perinatal Periodmentioning

confidence: 99%

Women with Schizophrenia over the Life Span: Health Promotion, Treatment and Outcomes

González-Rodríguez

Guàrdia²,

Pedrero

et al. 2020

IJERPH

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Women with schizophrenia show sex-specific health needs that differ according to stage of life. The aim of this narrative review is to resolve important questions concerning the treatment of women with schizophrenia at different periods of their life—paying special attention to reproductive and post-reproductive stages. Review results suggest that menstrual cycle-dependent treatments may be a useful option for many women and that recommendations re contraceptive options need always to be part of care provision. The pregnancy and the postpartum periods—while constituting vulnerable time periods for the mother—require special attention to antipsychotic effects on the fetus and neonate. Menopause and aging are further vulnerable times, with extra challenges posed by associated health risks. Pregnancy complications, neurodevelopmental difficulties of offspring, cancer risk and cognitive defects are indirect results of the interplay of hormones and antipsychotic treatment of women over the course of the lifespan. The literature recommends that health promotion strategies need to be directed at lifestyle modifications, prevention of medical comorbidities and increased psychosocial support. Careful monitoring of pharmacological treatment has been shown to be critical during periods of hormonal transition. Not only does treatment of women with schizophrenia often need to be different than that of their male peers, but it also needs to vary over the course of life.

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Section: Treatment Of Schizophrenia During the Perinatal Periodmentioning

confidence: 99%

Women with Schizophrenia over the Life Span: Health Promotion, Treatment and Outcomes

González-Rodríguez

Guàrdia²,

Pedrero

et al. 2020

IJERPH

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“…Reproductive health includes sexual health (libido, sexual function, the ability to establish and maintain sexual relationships)[ 99 , 164 , 165 ], menstrual health[ 47 , 125 , 166 ], the preservation of fertility[ 167 , 168 ], contraception[ 12 ], prenatal care[ 122 ], pregnancy[ 18 , 169 ], postpartum care[ 170 ] and lactation support[ 171 ], parenting support and training groups, home visiting, peer support, respite care[ 111 , 112 , 172 , 173 ], and menopausal care[ 49 , 50 , 83 , 174 ].…”

Section: Reproductive Healthmentioning

confidence: 99%

Women who suffer from schizophrenia: Critical issues

Seeman

2018

WJP

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Many brain diseases, including schizophrenia, affect men and women unequally - either more or less frequently, or at different times in the life cycle, or to varied degrees of severity. With updates from recent findings, this paper reviews the work of my research group over the last 40 years and underscores issues that remain critical to the optimal care of women with schizophrenia, issues that overlap with, but are not identical to, the cares and concerns of men with the same diagnosis. Clinicians need to be alert not only to the overarching needs of diagnostic groups, but also to the often unique needs of women and men.

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“…In Canada, Denmark and the UK, our teams have also shown that markers of the severity of the psychiatric disorder such as number and recency of previous admissions are predictive of admissions in the perinatal period. 37 , 43 , 44 Interestingly, in a Canadian study, having a consistent mental healthcare provider in pregnancy (either a primary care provider or a psychiatrist) was associated with a lower likelihood of requiring psychiatric admission in the postpartum. Other predictors of postpartum psychiatric admission were age >34, low income, not having an ultrasound before 20 weeks’ gestation as well as psychiatric comorbidity and prior psychiatric hospitalizations.…”

Section: Resultsmentioning

confidence: 99%

“…Other predictors of postpartum psychiatric admission were age >34, low income, not having an ultrasound before 20 weeks’ gestation as well as psychiatric comorbidity and prior psychiatric hospitalizations. 44 …”

Section: Resultsmentioning

confidence: 99%

“…Other predictors of postpartum psychiatric admission were age >34, low income, not having an ultrasound before 20 weeks' gestation as well as psychiatric comorbidity and prior psychiatric hospitalizations. 44 Conducting longitudinal research relying on clinical studies prospectively collecting data across years would be very costly and at high risk of substantial loss to follow-up across the course of pregnancy and postpartum. These resources of prospective routinely collected healthcare data include more women with longer followup periods, minimising attrition, and can include otherwise hard to reach women too unwell to take part in a clinical study.…”

Section: Longitudinal Follow-upmentioning

confidence: 99%

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Schizophrenia around the time of pregnancy: leveraging population-based health data and electronic health record data to fill knowledge gaps

et al. 2020

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Background Research in schizophrenia and pregnancy has traditionally been conducted in small samples. More recently, secondary analysis of routine healthcare data has facilitated access to data on large numbers of women with schizophrenia. Aims To discuss four scientific advances using data from Canada, Denmark and the UK from population-level health registers and clinical data sources. Method Narrative review of research from these three countries to illustrate key advances in the area of schizophrenia and pregnancy. Results Health administrative and clinical data from electronic medical records have been used to identify population-level and clinical cohorts of women with schizophrenia, and follow them longitudinally along with their children. These data have demonstrated that fertility rates in women with schizophrenia have increased over time and have enabled documentation of the course of illness in relation with pregnancy, showing the early postpartum as the time of highest risk. As a result of large sample sizes, we have been able to understand the prevalence of and risk factors for rare outcomes that would be difficult to study in clinical research. Advanced pharmaco-epidemiological methods have been used to address confounding in studies of antipsychotic medications in pregnancy, to provide data about the benefits and risks of treatment for women and their care providers. Conclusions Use of these data has advanced the field of research in schizophrenia and pregnancy. Future developments in use of electronic health records include access to richer data sources and use of modern technical advances such as machine learning and supporting team science.

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Factors associated with postpartum psychiatric admission in a population‐based cohort of women with schizophrenia

Abstract: Certain subgroups of women with schizophrenia may benefit from targeted intervention to mitigate risk for postpartum admission.

Cited by 12 publications

References 50 publications

Women with Schizophrenia over the Life Span: Health Promotion, Treatment and Outcomes

Women with Schizophrenia over the Life Span: Health Promotion, Treatment and Outcomes

Women who suffer from schizophrenia: Critical issues

Schizophrenia around the time of pregnancy: leveraging population-based health data and electronic health record data to fill knowledge gaps

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