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

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