Pregnancy Among Women With Schizophrenia

It was not so long ago that women with schizophrenia were known to have quite low birth rates. This circumstance may have been partly due to a history of institutionalization, generating few opportunities for pregnancy, and also due to the fertility-impairing properties of the typical or first-generation antipsychotic medications (the newer second-generation medications do not suppress prolactin to the same extent). Over the last couple of decades, however, birth rates among women with schizophrenia have increased, and it is estimated that around half of women with schizophrenia become mothers. In fact, among young women (aged 20–24 years), no significant difference in birth rates exists between those with and without schizophrenia. As such, there has been a resurgence of interest in research into how to ensure optimal mental and physical health outcomes for this group of women and their children.

In a research study published in The Journal of Clinical Psychiatry in April 2016, my colleagues and I examined the health care records of 1,433 women with schizophrenia from 1 year before pregnancy to 1 year after delivery of a live infant. We found that these women were less likely to be hospitalized for psychiatric reasons during pregnancy and the postpartum period compared with the year prior to pregnancy. The only exception to this decrease was during the first 9 days postpartum, when the rate of psychiatric admission was over 3 times higher than the pre-pregnancy admission rate. These findings are in keeping with research that suggests that, while the early postpartum period is a time of acute risk (probably related to the biological impact of rapid estrogen withdrawal on the brain), the potential exists for women with schizophrenia to have enhanced psychiatric stability in the perinatal period.

Engagement with community supports and services has been shown to reduce hospitalization risk for individuals with schizophrenia in general. During the perinatal period, women may have additional motivation to engage in strategies that enhance stability, such as medication adherence and service engagement, so as to be able to have meaningful parenting relationships with, and hopefully retain custody of, their children. Because most women are in contact with the health care system for their antenatal care, this service opportunity may represent an ideal time for solidifying women’s relationships with the mental health supports and services that help to ensure longer term recovery and assist them in the transition to parenthood.

That being said, 1 in 5 women with schizophrenia in our study did require hospitalization in the 1-year postpartum period. This finding suggests that there is still room to improve the psychiatric stability of these women around the time of pregnancy. Our future research will focus on identifying risk factors for perinatal psychiatric hospitalization among women with schizophrenia and on developing interventions targeted to women’s individual needs and circumstances around this time.

Financial disclosure:Dr Vigod had no relevant personal financial relationships to report. ​