Main Article Content
Background: Obstetric complications tend to affect the immature brain which may cause or predispose to neurological or psychiatric disorder(s) in childhood or adolescence.
Aim: To determine the pattern and prevalence of childhood and adolescent neuropsychiatric disorders associated with obstetric complications in UPTH.
Methodology: This is a multi-design study, a descriptive cross sectional for assessing psychiatric illness in childhood and adolescence at the time of presentation in the outpatient clinic and this was followed by a retrospective design for mothers to recall cases associated with obstetric complications. Therefore, all cases of childhood psychiatric disorders with established and reliable history of obstetric complications as volunteered by either or both parents of affected children from January, 2013-December, 2019 were included in the study. Diagnoses were made by consultant neuropsychiatrists using the Diagnostic Statistical Manual version 5 (DSM IV) criteria. All cases with family history of mental illness were excluded from the study. A study questionnaire was also administered to the mothers of affected children. The results were analysed using GraphPad Prism statistical software.
Results: In all, 2182 cases of various childhood psychiatric disorders were seen within the period under study. Out of this figure, 408 (18.7%) were associated with history of obstetric complications. The most prevalent neuropsychiatric disorder was substance abuse with 17.3%, followed by depression 16.2% and then anxiety disorder 14.8%.
Conclusion: Obstetric complications have become important in childhood and adolescent neuropsychiatric disorders and is therefore important to pay more attention to steps that are necessary to prevent obstetric complications in pregnancy, labour, delivery as well as the immediate post partum.
Madhu A, Deegan A, Cawthorpe D. Correlation between pregnancy and childbirth complications and the mental health of the children born. European Psychiatry. 2015;30(Supplement 1):194.
Thornhon, Guendelmans D, Hosang N. Obstetric complications in women with diagnosed mental illness: The relative cancers of California’s country mental Health disoders. Ifeaw Serv. Res. 2010;45(1):248-264.
Bherman RE, Kliegman RM, Arvin AM. Nelson textbook of pediatrics. 15th Ed. Philadelphia, Pa WB Saunders Co.; 1996.
Buka SL, Tsuang MT, Torrey EF, Klebanoff MA, Wagner RL, Yolken RH. Maternal cytokine levels during pregnancy and adult psychosis. Brain Behav Immun. 2001;15:411–420.
Kotlicka-Antczak M, Pawełczyk A, Rabe-Jabłońska J, Smigielski J, Pawełczyk T. Obstetrical complications and Apgar score in subjects at risk of psychosis. J. Psychiatr. Res. 2014;48:79–85.
Mittal VA, Ellman LM, Cannon TD. Gene-environment interaction and covariation in schizophrenia: The role of obstetric complications. Schizophr. Bull. 2008;34:1083–1094.
Sorensen HJ, Mortensen EL, Reinisch JM, Mednick SA. Association between prenatal exposure to bacterial infection and risk of schizophrenia. Schizophr Bull. 2009;35:631–637.
Lukkari S, Hakko H, Herva A, Pouta A, Riala K, Räsänen P. Exposure to obstetric complications in relation to subsequent psychiatric disorders of adolescent inpatients: Specific focus on gender differences. Psychopathology. 2012;45:317–326.
Nosarti C, Reichenberg A, Murray RM, Cnattingius S, Lambe MP, Yin L, MacCabe J, Rifkin L, Hultman CM. Preterm birth and psychiatric disorders in young adult life. Arch. Gen. Psychiatry. 2012;69:E1–E8.
Schmitt A, Malchow B, Hasan A, Falkai P. The impact of environmental factors in severe psychiatric disorders. Front. Neurosci. 2014;8:19.
Rosso IM, Cannon TD, Huttunen T, Huttunen MO, Lönnqvist J, Gasperoni TL. Obstetric risk factors for early-onset schizophrenia in a Finnish birth cohort. Am J Psychiatry. 2000;157:801–807.
Martelon M, Wilens TE, Anderson JP, Morrison NR, Wozniak J. Are obstetrical, perinatal and infantile difficulties associated with pediatric bipolar disorder? Bipolar Disord. 2012;14:507–514.
Freed RD, Tompson MC, Otto MW, Nierenberg AA, Hirshfeld-Becker D, Wang CH, Henin A. Early risk factors for psychopathology in offspring of parents with bipolar disorder: The role of obstetric complications and maternal comorbid anxiety. Depress. Anxiety. 2014;31:583–590.
Bouli M, Bertino V, Caldiroli A, Dobrea C, Serati M, et al. Are obstetric complications really involved in the etiology and course of schizophrenia and mood disorders? J. Psychiatry Research. 2016;05:014.
Yun Y, Phillips LJ, Cotton S, Yung AR, Francey SM, Yuen HP, McGorry PD. Obstetric complications and transition to psychosis in an “ultra” high risk sample. Aust. N. Z. J. Psychiatry. 2005;39:460–466.
Cannon TD, van Erp TG, Rosso IM, et al. Fetal hypoxia and structural brain abnormalities in schizophrenic patients, their siblings and controls. Arch Gen Psychiatry. 2002;59:35–41.
Niemi LT, Suvisaari JM, Haukka JK, Wrede G, Lönnqvist JK. Cumulative incidence of mental disorders among offspring of mothers with psychotic disorder. Results from the Helsinki high-risk study. Br J Psychiatry. 2004;185:11–17.
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.
Jaana, MS, Virpi Taxell-Lassas, Maiju Pankakoski, Jari KH, Jouko KL, Laura TH. Obstetric complications as risk factors for schizophrenia spectrum psychoses in offspring of mothers with psychotic disorder schizophrenia. Bulletin. 2013;39(5):1056–1066.
Warner R. Time trends in schizophrenia: Changes in obstetric risk factors with industrialization. Schizophr. Bull. 1995;21:483–500.
Hultman CM, Sparén P, Takei N, Murray RM, Cnattingius S. Prenatal and perinatal risk factors for schizophrenia, affective psychosis and reactive psychosis of early onset: case-control study. BMJ. 1999;318:421–426.
Brown AS, Derkits EJ. Prenatal infection and schizophrenia: A review of epidemiologic and translational studies. Am J Psychiatry. 2010;167:261–280.
Bonnin A, Goeden N, Chen K, et al. A transient placental source of serotonin for the fetal forebrain. Nature. 2011;472:347–350.
Byrne M, Browne R, Mulryan N, Scully A, Morris M, Kinsella A, Takei N, McNeil T, Walsh D, O’Callaghan E. Labour and delivery complications and schizophrenia. Case-control study using contemporaneous labour ward records. Br. J. Psychiatry. 2000;176:531–536.
Preti A, Cardascia L, Zen T, Marchetti M, Favaretto G, Miotto P. Risk for obstetric complications and schizophrenia. Psychiatry Res. 2000;96:127–139.
Patton GC, Coffey C, Carlin JB, Olsson CA, Morley R. Prematurity at birth and adolescent depressive disorder. Br. J. Psychiatry. 2004;184:446–447.
Byrne M, Agerbo E, Bennedsen B, Eaton WW, Mortensen PB. Obstetric conditions and risk of first admission with schizophrenia: A Danish national register based study. Schizophr Res. 2007;97:51–59.
Chudal R, Sourander A, Polo-Kantola P, Hinkka-Yli-Salomäki S, Lehti V, Sucksdorff D, Gissler M, Brown AS. Perinatal factors and the risk of bipolar disorder in Finland. J. Affect. Disord. 2014;155:75–80.
Räikkönen K, Pesonen AK, Kajantie E, Heinonen K, Forsén T, Phillips DI, Osmond C, Barker DJ, Eriksson JG. Length of gestation and depressive symptoms at age 60 years. Br. J. Psychiatry. 2007;190:469–474.
Altamura AC, Buoli M, Caldiroli A, Caron L, CumerlatoMelter C, Dobrea C, Cigliobianco M, ZanelliQuarantini F. Misdiagnosis, duration of untreated illness (DUI) and outcome in bipolar patients with psychotic symptoms: A naturalistic study. J. Affect. Disord. 2015;182:70–75.
Guth C, Jones P, Murray R. Familial psychiatric illness and obstetric complications in early-onset affective disorder. A case-control study. Br. J. Psychiatry. 1993;163:492–498.
Kotlicka-Antczak M, Gmitrowicz A, Sobów TM, Rabe-Jabłonska J. Obstetric complications and Apgar score in early-onset schizophrenic patients with prominent positive and prominent negative symptoms. J. Psychiatr. Res. 2001;35:249–257.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Revision (DSM-5). American Psychiatric Press, Washington DC; 2013.
Dalma C, Allebeck P, Cullberg J. Obstetric complications and the risk of schizophrenia: A longitudinal study of a national birth cohort. Arch Gen Psychiatry. 1999;56(3):234-240.
Kneeland RE, Fatemi SH. Viral infection, inflammation and schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry; 2012.
Dalman C, Thomas HV, David AS, Gentz J, Lewis G, Allebeck P. Signs of asphyxia at birth and risk of schizophrenia. Population-based case-control study. Br J Psychiatry. 2001;179:403–408.
Ellman LM, Huttunen M, Lönnqvist J, Cannon TD. The effects of genetic liability for schizophrenia and maternal smoking during pregnancy on obstetric complications. Schizophr Res. 2007;93:229–236.
Verdoux H, Geddes JR, Takei N, Lawrie SM, Bovet P, Eagles JM, Heun R, McCreadie RG, McNeil TF, O'Callaghan E, Stöber G, Willinger MU, Wright P, Murray RM. Obstetric complications and age at onset in schizophrenia: An international collaborative meta-analysis of individual patient data. Am J Psychiatry. 1997;1541220-1227.
Verdoux H, Bourgeois M. A comparative study of obstetric history in schizophrenics, bipolar patients and normal subjects. Schizophr Res.1993;967-69.
O'Dwyer JM. Schizophrenia in people with intellectual disability: The role of pregnancy and birth complications. J Intellect Disabil Res.1997;41238-251.
Brown AS. The environment and susceptibility to schizophrenia. Prog Neurobiol. 2011;93:23–58.
Buka SL, Tsuang MT, Lipsitt LP. Pregnancy/delivery complications and psychiatric diagnosis: A prospective study. Arch Gen Psychiatry. 1993;50:151–156.
Kendell RE, Juszczack E, Cole SK. Obstetric complications and schizophrenia: A case-control study based on standardised obstetric records. Br J Psychiatry. 1996;168:556–561.
Zornberg GL, Buka SL, Tsuang MT. Hypoxic-ischemia-related fetal/ neonatal complications and risk of schizophrenia and other nonaffective psychoses: A 19-year longitudinal study. Am J Psychiatry. 2000;157:196–202.
Günther-Genta F, Bovet P, Hohlfeld P. Obstetric complications and schizophrenia: A case-control study. Br J Psychiatry. 1994;164165-170.
Ballon JS, Seeber K, Cadenhead KS. Obstetrical complications in people at risk for developing schizophrenia. Schizophr. Res. 2008;98:307–311.
Alvir JM, Woerner MG, Gunduz H, Degreef G, Lieberman JA. Obstetric complications predict treatment response in first-episode schizophrenia. Psychol. Med. 1999;29:621–627.
Cannon M, Jones PB, Murray RM. Obstetric complications and schizophrenia: Historical and meta-analytic review. Am. J. Psychiatry. 2002;159:1080–1092.
Tuovinen S, Räikkönen K, Pesonen AK, et al. Hypertensive disorders in pregnancy and risk of severe mental disorders in the offspring in adulthood: The Helsinki birth cohort study. J Psychiatr Res. 2012;46:303–310.
Scott J, McNeill Y, Cavanagh J, Cannon M, Murray R. Exposure to obstetric complications and subsequent development of bipolar disorder: Systematic review. Br. J. Psychiatry. 2006;189:3–11.
O'Callaghan E, Givson T, Colohan HA, Buckley P, Walshe DG, Larkin C, Waddington JL. Risk of schizophrenia in adults born after obstetric complications and their association with early onset of illness: A controlled study. BMJ. 1992;305:1256-1259.
Lewis SW, Murray RM. Obstetric complications, neurodevelopmental deviance and risk of schizophrenia. J. Psychiatr. Res. 1987;21:413–421.
Lewis SW, Owen MJ, Murray RM. Obstetric complications and schizophrenia: Methodology and mechanisms. Schulz SCTamminga CAeds. Schizophrenia Scientific Progress New York, NY Oxford University Press Inc. 1989;56-68.
Done DJ, Johnstone EC, Frith CD, Golding J, Shepherd, PM, Crow TJ. Complications of pregnancy and delivery in relation to psychosis in adult life: Data from the British Perinatal Mortality Survey sample. BMJ. 1991;3021576-1580.
Kirov G, Jones PB, Harvey I, Lewis SW, Toone BK, Rifkin L, Sham P, Murray RM. Do obstetric complications cause the earlier age at onset in male than female schizophrenics? Schizophr Res. 2011;7-124.
Sacker A, Done DJ, Crow TJ, Golding J. Antecedents of schizophrenia and affective illness. Obstetric complications. Br J Psychiatry. 1995;166:734–741.
Lewis SW, Stewart A. Complications of pregnancy and delivery and psychosis in adult life. BMJ. 1991;303582.
Brown AS, Hooton J, Schaefer CA, et al. Elevated maternal interleukin-8 levels and risk of schizophrenia in adult offspring. Am J Psychiatry. 2004;161:889–895.
Morales P, Bustamante D, Espina-Marchant P, Neira-Peña T, Gutiérrez-Hernández MA, Allende-Castro C, Rojas-Mancilla E. Pathophysiology of perinatal asphyxia: Can we predict and improve individual outcomes? EPMA J. 2011;2:211–230.
Murray RM, Sham P, Van Os J, Zanelli J, Cannon M, McDonald C. A developmental model for similarities and dissimilarities between schizophrenia and bipolar disorder. Schizophr. Res. 2004;71:405–416.
Brown AS, Schaefer CA, Wyatt RJ, et al. Maternal exposure to respiratory infections and adult schizophrenia spectrum disorders: A prospective birth cohort study. Schizophr Bull. 2000;26:287–295.
Alvarez MD, Villamil M, Keyes G. Predictive factors in the genesis of intraventricular hemorrhage in premature infants. P R Health Sci J. 1994;13:251-254.
Haukvik UK, Schaer M, Nesvåg R, McNeil T, Hartberg CB, Jönsson EG, Eliez S, Agartz I. Cortical folding in Broca’s area relates to obstetric complications in schizophrenia patients and healthy controls. Psychol. Med. 2012;42:1329–1337.