Clinical analysis of pregnancy outcomes of psychotic pregnant women with severe mental disorders

doi:10.3877/cma.j.issn.1673-5250.2022.06.016

Objective

To investigate the effects of antipsychotic medication during pregnancy in pregnant women complicated with severe mental illness (SMI) on maternal outcomes, pregnancy condition changes, and perinatal outcomes.

Methods

The clinical data of 154 pregnant women combined with SMI who delivered in the Renmin Hospital of Wuhan University from January 2017 to December 2021 were selected as research subjects. They were divided into experimental group (n=70, regular antipsychotics during pregnancy) and control group (n=84, without psychotropic medication) according to whether they used antipsychotics during pregnancy. The general clinical data, pregnancy outcomes, complications and perinatal outcomes of the two groups were retrospectively analyzed. The study was conducted in accordance with World Medical Association Declaration of Helsinki revised in 2013. All subjects informed consent and signed the informed consent forms for the clinical study.

Results

① There were statistically significant differences between two groups in the terms of educational level, the course of SMI, the percentage of exacerbation/relapse during pregnancy and the percentage of pre-pregnancy psychotropic medication (P<0.05). ② The prevalence of gestational diabetes mellitus (GDM) in pregnant women of experimental group was 28.6% (20/70), which was significantly higher than that in control group (6.0%, 5/84), and the difference was statistically significant (χ²=14.36, P<0.001). ③The birth weight and body length of newborns of experimental group were (3 247.1± 497.5) g and (49.3±1.6)cm, respectively, which were significantly higher or longer than those in control group (2 991.9±456.9) g and (48.7±1.8)cm, and both the differences were statistically significant (t=3.22, 2.04; P=0.002、0.043).

Conclusions

Regular antipsychotics medication in pregnancy complicated with SMI can reduce the incidence of aggravation or recurrence during pregnancy and is beneficial to maintain the stability of the condition. It has no obvious effects on maternal and perinatal outcomes, but the incidence of gestational diabetes increased, we should pay more attention to early screening of GDM and develop individualized management for the population.

Key words: Serious Mental illness, Antipsychotic agents, Gestational diabetes mellitus, Pregnancy outcome, Maternal outcomes, Pregnant women

表1 2组SMI孕妇一般临床资料比较

组别	例数	年龄(岁，±s)	文化水平[例数(%)]		居住地[例数(%)]		孕次[次，M(Q₁，Q₃)]	产次(次，±s)
组别	例数	年龄(岁，±s)	初中及以下	高中及以上	乡镇	城市	孕次[次，M(Q₁，Q₃)]	产次(次，±s)
研究组	70	30.9±3.9	23(32.9)	47(67.1)	31(44.3)	39(55.7)	1(1，2)	1.2±0.4
对照组	84	29.9±4.4	42(50.0)	42(50.0)	39(46.4)	45(53.6)	1(1，2)	1.3±0.5
统计量		t＝1.37	χ²＝4.60		χ²＝0.07		Z＝－0.05	t＝－1.96
P值		0.172	0.032		0.791		0.959	0.052
组别	例数	流产次数[次，M(Q₁，Q₃)]	剖宫产术分娩史[例数(%)]	SMI病程[年，M(Q₁，Q₃)]	SMI类型[例数(%)]			SMI加重/复发[例数(%)]	孕前采取APD治疗[例数(%)]
组别	例数	流产次数[次，M(Q₁，Q₃)]	剖宫产术分娩史[例数(%)]	SMI病程[年，M(Q₁，Q₃)]	精神分裂症	双相情感障碍	其他精神障碍	SMI加重/复发[例数(%)]	孕前采取APD治疗[例数(%)]
研究组	70	0(0，1)	5(7.1)	8.5(4.0，10.0)	47(67.1)	4(5.7)	19(27.1)	13(18.6)	65(92.9)
对照组	84	0(0，1)	15(17.9)	5.0(2.0，10.0)	49(58.3)	7(8.3)	28(33.3)	54(64.3)	36(42.9)
统计量		Z＝－1.22	χ²＝4.96	Z＝－3.00	χ²＝1.32			χ²＝32.95	χ²＝42.29
P值		0.220	0.084	0.003	0.516			<0.001	<0.001

表1 2组SMI孕妇一般临床资料比较

组别	例数	年龄(岁，±s)	文化水平[例数(%)]		居住地[例数(%)]		孕次[次，M(Q₁，Q₃)]	产次(次，±s)
组别	例数	年龄(岁，±s)	初中及以下	高中及以上	乡镇	城市	孕次[次，M(Q₁，Q₃)]	产次(次，±s)
研究组	70	30.9±3.9	23(32.9)	47(67.1)	31(44.3)	39(55.7)	1(1，2)	1.2±0.4
对照组	84	29.9±4.4	42(50.0)	42(50.0)	39(46.4)	45(53.6)	1(1，2)	1.3±0.5
统计量		t＝1.37	χ²＝4.60		χ²＝0.07		Z＝－0.05	t＝－1.96
P值		0.172	0.032		0.791		0.959	0.052
组别	例数	流产次数[次，M(Q₁，Q₃)]	剖宫产术分娩史[例数(%)]	SMI病程[年，M(Q₁，Q₃)]	SMI类型[例数(%)]			SMI加重/复发[例数(%)]	孕前采取APD治疗[例数(%)]
组别	例数	流产次数[次，M(Q₁，Q₃)]	剖宫产术分娩史[例数(%)]	SMI病程[年，M(Q₁，Q₃)]	精神分裂症	双相情感障碍	其他精神障碍	SMI加重/复发[例数(%)]	孕前采取APD治疗[例数(%)]
研究组	70	0(0，1)	5(7.1)	8.5(4.0，10.0)	47(67.1)	4(5.7)	19(27.1)	13(18.6)	65(92.9)
对照组	84	0(0，1)	15(17.9)	5.0(2.0，10.0)	49(58.3)	7(8.3)	28(33.3)	54(64.3)	36(42.9)
统计量		Z＝－1.22	χ²＝4.96	Z＝－3.00	χ²＝1.32			χ²＝32.95	χ²＝42.29
P值		0.220	0.084	0.003	0.516			<0.001	<0.001

表2 2组SMI孕妇妊娠结局及孕期并发症发生率比较

组别	例数	分娩孕龄(周，±s)	分娩方式[例数(%)]		死胎[例数(%)]	妊娠期高血压疾病[例数(%)]	GDM[例数(%)]	胎膜早破[例数(%)]
组别	例数	分娩孕龄(周，±s)	阴道分娩	剖宫产术分娩	死胎[例数(%)]	妊娠期高血压疾病[例数(%)]	GDM[例数(%)]	胎膜早破[例数(%)]
研究组	70	38.3±1.7	16(22.9)	54(77.1)	2(2.9)	11(15.7)	20(28.6)	9(12.9)
对照组	84	38.2±1.8	29(34.5)	55(65.5)	7(8.3)	7(8.3)	5(6.0)	15(17.9)
统计量		t＝0.45	χ²＝2.51		χ²＝1.20^a	χ²＝2.02	χ²＝14.36	χ²＝0.73
P值		0.654	0.113		0.272	0.156	<0.001	0.394

表2 2组SMI孕妇妊娠结局及孕期并发症发生率比较

组别	例数	分娩孕龄(周，±s)	分娩方式[例数(%)]		死胎[例数(%)]	妊娠期高血压疾病[例数(%)]	GDM[例数(%)]	胎膜早破[例数(%)]
组别	例数	分娩孕龄(周，±s)	阴道分娩	剖宫产术分娩	死胎[例数(%)]	妊娠期高血压疾病[例数(%)]	GDM[例数(%)]	胎膜早破[例数(%)]
研究组	70	38.3±1.7	16(22.9)	54(77.1)	2(2.9)	11(15.7)	20(28.6)	9(12.9)
对照组	84	38.2±1.8	29(34.5)	55(65.5)	7(8.3)	7(8.3)	5(6.0)	15(17.9)
统计量		t＝0.45	χ²＝2.51		χ²＝1.20^a	χ²＝2.02	χ²＝14.36	χ²＝0.73
P值		0.654	0.113		0.272	0.156	<0.001	0.394

表3 2组SMI孕妇所分娩新生儿结局比较

组别	例数	出生体重(g，±s)	出生身长(cm，±s)	生后1 min Apgar评分[例数(%)]	生后5 min Apgar评分[例数(%)]	早产[例数(%)]
研究组	68	3 247.1±497.5	49.3±1.6	0(0)	0(0)	9(13.2)
对照组	77	2 991.9±456.9	48.7±1.8	3(3.9)	1(1.3)	11(14.3)
统计量		t＝3.22	t＝2.04	χ²＝3.85	χ²＝2.70	χ²＝0.03
P值		0.002	0.043	0.248	0.259	0.855
组别	例数	新生儿畸形[例数(%)]	转入NICU[例数(%)]	足月低出生体重儿[%(n/n′)]^a	足月巨大儿[%(n/n′)]^b	性别[例数(%)]
组别	例数	新生儿畸形[例数(%)]	转入NICU[例数(%)]	足月低出生体重儿[%(n/n′)]^a	足月巨大儿[%(n/n′)]^b	男	女
研究组	68	1(1.5)	4(5.9)	3.4(2/59)	10.2(6/59)	34(50.0)	34(50.0)
对照组	77	0(0)	9(11.7)	6.1(4/66)	3.0(2/66)	41(53.2)	36(46.8)
统计量		χ²＝1.52	χ²＝1.49	χ²＝0.49	χ²＝2.65	χ²＝0.15
P值		0.217	0.222	0.486	0.104	0.696

表3 2组SMI孕妇所分娩新生儿结局比较

组别	例数	出生体重(g，±s)	出生身长(cm，±s)	生后1 min Apgar评分[例数(%)]	生后5 min Apgar评分[例数(%)]	早产[例数(%)]
研究组	68	3 247.1±497.5	49.3±1.6	0(0)	0(0)	9(13.2)
对照组	77	2 991.9±456.9	48.7±1.8	3(3.9)	1(1.3)	11(14.3)
统计量		t＝3.22	t＝2.04	χ²＝3.85	χ²＝2.70	χ²＝0.03
P值		0.002	0.043	0.248	0.259	0.855
组别	例数	新生儿畸形[例数(%)]	转入NICU[例数(%)]	足月低出生体重儿[%(n/n′)]^a	足月巨大儿[%(n/n′)]^b	性别[例数(%)]
组别	例数	新生儿畸形[例数(%)]	转入NICU[例数(%)]	足月低出生体重儿[%(n/n′)]^a	足月巨大儿[%(n/n′)]^b	男	女
研究组	68	1(1.5)	4(5.9)	3.4(2/59)	10.2(6/59)	34(50.0)	34(50.0)
对照组	77	0(0)	9(11.7)	6.1(4/66)	3.0(2/66)	41(53.2)	36(46.8)
统计量		χ²＝1.52	χ²＝1.49	χ²＝0.49	χ²＝2.65	χ²＝0.15
P值		0.217	0.222	0.486	0.104	0.696

[1]	国家卫生健康委. 卫生健康委关于印发严重精神障碍管理治疗工作规范(2018年版)的通知[EB/OL]. (2018-05-28)[2022-01-09]. URL
[2]	Zhou M, Wang H, Zeng X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017[J]. Lancet, 2019, 394(10204): 1145-1158. DOI: 10.1016/S0140-6736(19)30427-1.
[3]	张五芳，马宁，王勋，等. 2020年全国严重精神障碍患者管理治疗现状分析[J]. 中华精神科杂志，2022, 55(2): 122-128.
[4]	Raimondi A, Sheiner E. Pregnant women with schizophrenia are at higher risk of pre-eclampsia, venous thromboembolism and adverse neonatal outcomes[J]. Evid Based Nurs, 2015, 18(2): 39-40. DOI: 10.1136/eb-2014-101902.
[5]	Mota NP, Chartier M, Ekuma O, et al. Mental disorders and suicide attempts in the pregnancy and postpartum periods compared with non-pregnancy: a population-based study[J]. Can J Psychiatry, 2019, 64(7): 482-491. DOI: 10.1177/0706743719838784.
[6]	Raffi ER, Nonacs R, Cohen LS. Safety of psychotropic medications during pregnancy[J]. Clin Perinatol, 2019, 46(2): 215-234. DOI: 10.1016/j.clp.2019.02.004.
[7]	Alexander GC, Gallagher SA, Mascola A, et al. Increasing off-label use of antipsychotic medications in the United States, 1995-2008[J]. Pharmacoepidemiol Drug Saf, 2011, 20(2): 177-184. DOI: 10.1002/pds.2082.
[8]	王瀚，苏允爱，李继涛，等. 孕期使用抗精神病药对子代神经发育影响的研究进展[J]. 中华精神科杂志，2020, 53(4): 347-350. DOI：10.3760/cma.j.cn113661-20190726-00247.
[9]	卢逃涛. 非典型抗精神病药在孕期的用药安全性[D]. 重庆：重庆医科大学，2016.
[10]	廖雪梅，苏允爱，司天梅. 孕期服用抗精神病药安全性的临床研究[J]. 中华精神科杂志，2013，46(2): 122-124. DOI: 10.3760/cma.j.issn.1006-7884.2013.02.019.
[11]	Edvardsson K, Hughes E, Copnell B, et al. Severe mental illness and pregnancy outcomes in Australia. A population-based study of 595 792 singleton births 2009-2016[J]. PLoS One, 2022, 17(2): e264512. DOI: 10.1371/journal.pone.0264512.
[12]	Damkier P, Videbech P. The safety of second-generation antipsychotics during pregnancy: a clinically focused review[J]. CNS Drugs, 2018, 32(4): 351-366. DOI: 10.1007/s40263-018-0517-5.
[13]	Gilbert PL, Harris MJ, McAdams LA, et al. Neuroleptic withdrawal in schizophrenic patients. A review of the literature[J]. Arch Gen Psychiatry, 1995, 52(3): 173-188. DOI: 10.1001/archpsyc.1995.03950150005001.
[14]	Viguera AC, Whitfield T, Baldessarini RJ, et al. Risk of recurrence in women with bipolar disorder during pregnancy: prospective study of mood stabilizer discontinuation[J]. Am J Psychiatry, 2007, 164(12): 1817-1824, 1923. DOI: 10.1176/appi.ajp.2007.06101639.
[15]	Wakil L, Perea E, Penaskovic K, et al. Exacerbation of psychotic disorder during pregnancy in the context of medication discontinuation[J]. Psychosomatics, 2013, 54(3): 290-293.DOI: 10.1016/j.psym.2012.07.003.
[16]	Petersen I, McCrea RL, Osborn DJ, et al. Discontinuation of antipsychotic medication in pregnancy: a cohort study[J]. Schizophr Res, 2014, 159(1): 218-225. DOI: 10.1016/j.schres.2014.07.034.
[17]	Larsen ER, Saric K. Pregnancy and bipolar disorder: the risk of recurrence when discontinuing treatment with mood stabilisers: a systematic review[J]. Acta Neuropsychiatr, 2017, 29(5): 259-266. DOI: 10.1017/neu.2016.60.
[18]	Jenkins JA, Kontos N. The maudsley prescribing guidelines in psychiatry, 12th edition[J]. J Clin Psychiatry, 2016, 77(4): e469.
[19]	Ellfolk M, Leinonen MK, Gissler M, et al. Second-generation antipsychotics and pregnancy complications[J]. Eur J Clin Pharmacol, 2020, 76(1): 107-115. DOI: 10.1007/s00228-019-02769-z.
[20]	Bellet F, Beyens MN, Bernard N, et al. Exposure to aripiprazole during embryogenesis: a prospective multicenter cohort study[J]. Pharmacoepidemiol Drug Saf, 2015, 24(4): 368-380. DOI: 10.1002/pds.3749.
[21]	Sutter-Dallay AL, Bales M, Pambrun E, et al. Impact of prenatal exposure to psychotropic drugs on neonatal outcome in infants of mothers with serious psychiatric illnesses[J]. J Clin Psychiatry, 2015, 76(7): 967-973. DOI: 10.4088/JCP.14m09070.
[22]	Sadowski A, Todorow M, Yazdani BP, et al. Pregnancy outcomes following maternal exposure to second-generation antipsychotics given with other psychotropic drugs: a cohort study[J]. BMJ Open, 2013, 3(7)．DOI: 10.1136/bmjopen-2013-003062.
[23]	Reutfors J, Cesta CE, Cohen JM, et al. Antipsychotic drug use in pregnancy: a multinational study from ten countries[J]. Schizophr Res, 2020, 220: 106-115. DOI: 10.1016/j.schres.2020.03.048.
[24]	Petersen I, Sammon CJ, McCrea RL, et al. Risks associated with antipsychotic treatment in pregnancy: comparative cohort studies based on electronic health records[J]. Schizophr Res, 2016, 176(2-3): 349-356. DOI: 10.1016/j.schres.2016.07.023.
[25]	Vigod SN, Gomes T, Wilton AS, et al. Antipsychotic drug use in pregnancy: high dimensional, propensity matched, population based cohort study[J]. BMJ, 2015, 350: h2298. DOI: 10.1136/bmj.h2298.
[26]	Bodén R, Lundgren M, Brandt L, et al. Antipsychotics during pregnancy: relation to fetal and maternal metabolic effects[J]. Arch Gen Psychiatry, 2012, 69(7): 715-721. DOI: 10.1001/archgenpsychiatry.2011.1870.
[27]	Vigod SN, Kurdyak PA, Dennis CL, et al. Maternal and newborn outcomes among women with schizophrenia: a retrospective population-based cohort study[J]. BJOG, 2014, 121(5): 566-574. DOI: 10.1111/1471-0528.12567.
[28]	Park Y, Huybrechts KF, Cohen JM, et al. Antipsychotic medication use among publicly insured pregnant women in the United States[J]. Psychiatr Serv, 2017, 68(11): 1112-1119. DOI: 10.1176/appi.ps.201600408.
[29]	Park Y, Hernandez-Diaz S, Bateman BT, et al. Continuation of atypical antipsychotic medication during early pregnancy and the risk of gestational diabetes[J]. Am J Psychiatry, 2018, 175(6): 564-574. DOI: 10.1176/appi.ajp.2018.17040393.
[30]	Chen J, Huang XF, X Shao R, et al. Molecular mechanisms of antipsychotic drug-induced diabetes[J]. Front Neurosci, 2017, 11: 643. DOI: 10.3389/fnins.2017.00643.

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