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Risk of stillbirth and neonatal death linked with maternal mental illness: a national cohort study
  1. S King-Hele1,
  2. R T Webb1,3,
  3. P B Mortensen2,
  4. L Appleby1,
  5. A Pickles3,
  6. K M Abel1
  1. 1
    Centre for Women’s Mental Health, University of Manchester, Manchester, UK
  2. 2
    National Centre for Register-Based Research, University of Aarhus, Aarhus, Denmark
  3. 3
    Biostatistics/Health Methodology Research Group, University of Manchester, Manchester, UK
  1. Dr K M Abel, Centre for Women’s Mental Health, University of Manchester, 2nd Floor East, University Place, Oxford Road, Manchester M13 9PL, UK. kathryn.abel{at}manchester.ac.uk

Abstract

Background: Babies of mothers with psychotic disorders are known to have higher rates of poor obstetric outcome, including higher mortality rates.

Objective: To estimate risks of stillbirth and neonatal death by specific causes in babies of mothers with histories of severe mental illness, relative to the general population.

Methods: A cohort of 1.45 million live births and 7021 stillbirths during 1973–98 was identified from Danish national registers. These registers were linked to identify babies who were stillborn or died neonatally after exposure to maternal psychiatric illness.

Results: Risks of stillbirth and neonatal death were raised for virtually all causes of death for all of the maternal psychiatric diagnostic categories. For most causes of death, offspring of women with schizophrenia and related disorders had no greater risks of stillbirth or neonatal death than offspring of women with other maternal psychiatric disorders (eg, neonatal death (NND) due to immaturity: relative risks (95% CI) schizophrenia and related disorders: 1.1 (0.4 to 3.5), affective disorders: 2.0 (1.2 to 3.5)). There was a greater risk of fatal congenital malformation associated with a history of maternal affective disorder (stillbirth 2.4 (1.1 to 5.1), NND 2.1 (1.4 to 3.3)) or schizophrenia and related disorders (stillbirth 2.4 (0.8 to 7.6), NND 2.2 (1.1 to 4.1)) than with maternal alcohol/drug-related disorders (stillbirth 1.2 (0.4 to 3.8), NND 1.1 (0.6 to 2.2)).

Conclusions: Higher risk of perinatal loss may be linked to factors associated with maternal psychiatric illness in general, such as insufficient attendance for antenatal care and unhealthy lifestyles rather than the maternal mental illness itself.

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Footnotes

  • Additional tables are published online only at http://adc.bmj.com/content/vol94/issue2

  • Funding: The study was funded by project grant 073935 from the Wellcome Trust, England and by the Stanley Medical Research Institute, Chevy Chase, Maryland.

  • Competing interests: None.

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