Clinical analysis of antipsychotic drug treatment during pregnancy on pregnancy outcomes in women with severe mental illness

doi:10.3877/cma.j.issn.1673-5250.2025.03.008

Objective

To explore the impact of antenatal antipsychotic drug (APD) treatment on pregnancy outcomes in pregnant women with severe mental illness (SMI).

Methods

A total of 51 pregnant women with SMI admitted to Sichuan Mental Health Center and Guangyuan Mental Health Center from January 2021 to December 2023 were selected as research subjects. They were divided into observation group 1 (n=22, receiving continuous APD treatment during pregnancy) and observation group 2 (n=29, receiving APD treatment only when SMI symptoms worsened) based on clinical treatment regimens. A total of 68 healthy pregnant women who underwent prenatal examinations and delivered in the same two hospitals during the same period were included into control group. The Positive and Negative Syndrome Scale (PANSS), Social Disability Screening Schedule (SDSS), Suicide Risk Assessment Scale, and Risk Assessment Scale for Endangering Behavior were used to evaluate the disease symptoms of SMI pregnant women after delivery, and the aggravation/recurrence of SMI was recorded. The scores of disease symptoms and SMI aggravation/recurrence rates between observation group 1 and 2 were compared by independent-samples t test and chi-square test. Statistical analyses were performed on pregnancy complications, pregnancy outcomes, and neonatal outcomes, among the three groups. There were no statistically significant differences in general clinical data, such as age, educational level, residence, and parity between observation groups 1, 2 and the control group (P>0.05). Additionally, no significant differences were found in the course and type of SMI between observation group 1 and 2 (P>0.05). This study complied with the standards formulated by the Ethics Committees of Sichuan Mental Health Center and Guangyuan Mental Health Center, and was approved by the Ethics Committee of Sichuan Mental Health Center (Ethics No. 2021-1).

Results

①There was a statistically significant difference in the overall incidence of gestational diabetes mellitus (GDM) among the three groups (χ²=13.08, P=0.003). Further pairwise comparisons showed that the incidence of GDM in observation group 1 was significantly higher than that in observation group 2 (χ²=6.30, P=0.012) and the control group (χ²=9.78, P=0.002). ②After delivery, the aggravation/recurrence rate of SMI, PANSS score, SDSS score, suicide risk score, and risk score for endangering behavior in observation group 1 were significantly lower than those in observation group 2 (P<0.05). ③There was a statistically significant difference in the proportion of newborns transferred to the neonatal intensive care unit (NICU) among the three groups (P<0.05). Further pairwise comparisons revealed that the proportion in observation group 1 was significantly higher than that in the control group (P=0.008), while no significant differences were found in other pairwise comparisons (P>0.05). No significant differences were observed in neonatal outcomes, such as birth weight, birth length, 5-minute Apgar score, and incidence of preterm birth and congenital malformation between observation group 1 and 2 (P>0.05).

Conclusions

APD treatment for pregnant women with SMI can improve their mental status, reduce the risk of SMI aggravation/recurrence during pregnancy, and does not significantly increase the risk of adverse maternal and neonatal outcomes.

Key words: Mental disorders, severe, Antipsychotic drugs, Pregnancy outcome, Diabetes, gestational, Intensive care units, neonatal, Pregnant women

表1 本研究3组孕妇一般临床资料比较

组别	例数	年龄(岁，±s)	受教育程度[例数(%)]		居住地[例数(%)]		产次[次，M(Q₁，Q₃)]
组别	例数	年龄(岁，±s)	初中及以下	高中及以上	乡镇	城市	产次[次，M(Q₁，Q₃)]
观察组1	22	30.7±4.6	8(36.4)	14(63.6)	10(45.5)	12(54.5)	1(1，2)
观察组2	29	31.1±4.2	10(34.5)	19(65.5)	12(41.4)	17(58.6)	1(1，2)
对照组	68	31.5±4.3	25(36.8)	43(63.2)	29(42.6)	39(57.4)	2(1，2)
统计量		t＝0.25	χ²＝0.05		χ²＝0.09		χ²＝3.51
P值		0.781	0.977		0.957		0.173

表1 本研究3组孕妇一般临床资料比较

组别	例数	年龄(岁，±s)	受教育程度[例数(%)]		居住地[例数(%)]		产次[次，M(Q₁，Q₃)]
组别	例数	年龄(岁，±s)	初中及以下	高中及以上	乡镇	城市	产次[次，M(Q₁，Q₃)]
观察组1	22	30.7±4.6	8(36.4)	14(63.6)	10(45.5)	12(54.5)	1(1，2)
观察组2	29	31.1±4.2	10(34.5)	19(65.5)	12(41.4)	17(58.6)	1(1，2)
对照组	68	31.5±4.3	25(36.8)	43(63.2)	29(42.6)	39(57.4)	2(1，2)
统计量		t＝0.25	χ²＝0.05		χ²＝0.09		χ²＝3.51
P值		0.781	0.977		0.957		0.173

表2 观察组1、2 SMI孕妇SMI病程与类型构成比比较

组别	例数	SMI病程(年，±s)	SMI类型[例数(%)]
组别	例数	SMI病程(年，±s)	精神分裂症	双向情感障碍	其他精神障碍
观察组1	22	8.4±1.7	12(54.5)	7(31.8)	3(13.6)
观察组2	29	8.2±1.7	15(51.7)	10(34.5)	4(13.8)
统计量		t＝0.44	χ²＝0.05
P值		0.665	0.977

表2 观察组1、2 SMI孕妇SMI病程与类型构成比比较

组别	例数	SMI病程(年，±s)	SMI类型[例数(%)]
组别	例数	SMI病程(年，±s)	精神分裂症	双向情感障碍	其他精神障碍
观察组1	22	8.4±1.7	12(54.5)	7(31.8)	3(13.6)
观察组2	29	8.2±1.7	15(51.7)	10(34.5)	4(13.8)
统计量		t＝0.44	χ²＝0.05
P值		0.665	0.977

表3 本研究3组孕妇孕期并发症和母儿妊娠结局比较

组别	例数	分娩孕龄(周，±s)	死胎[例数(%)]	妊娠期高血压疾病[例数(%)]	GDM[例数(%)]	胎膜早破[例数(%)]
观察组1	22	38.2±1.7	1(4.5)	6(27.3)	10(45.5)	5(22.7)
观察组2	29	38.3±1.8	1(3.4)	3(10.3)	4(13.8)	3(10.3)
对照组	68	38.5±1.8	0(0)	7(10.3)	8(11.8)	4(5.9)
统计量		F＝0.36	—^a	χ²＝4.43	χ²＝13.08	χ²＝5.20
P值		0.700	0.182	0.145	0.003	0.077

表3 本研究3组孕妇孕期并发症和母儿妊娠结局比较

组别	例数	分娩孕龄(周，±s)	死胎[例数(%)]	妊娠期高血压疾病[例数(%)]	GDM[例数(%)]	胎膜早破[例数(%)]
观察组1	22	38.2±1.7	1(4.5)	6(27.3)	10(45.5)	5(22.7)
观察组2	29	38.3±1.8	1(3.4)	3(10.3)	4(13.8)	3(10.3)
对照组	68	38.5±1.8	0(0)	7(10.3)	8(11.8)	4(5.9)
统计量		F＝0.36	—^a	χ²＝4.43	χ²＝13.08	χ²＝5.20
P值		0.700	0.182	0.145	0.003	0.077

表4 观察组1、2 SMI孕妇分娩后SMI相关量化指标比较

组别	例数	PANSS评分(分，±s)	SDSS评分(分，±s)	自杀风险评分(分，±s)	肇事、肇祸风险评分(分，±s)	SMI加重/复发[例数(%)]
观察组1	22	8.1±1.6	1.5±0.2	3.3±0.4	0.4±0.1	5(22.7)
观察组2	29	11.4±2.1	2.0±0.3	4.9±0.7	0.7±0.1	16(55.2)
统计量		t＝5.67	t＝5.84	t＝9.60	t＝11.83	χ²＝5.44
P值		<0.001	<0.001	<0.001	<0.001	0.020

表4 观察组1、2 SMI孕妇分娩后SMI相关量化指标比较

组别	例数	PANSS评分(分，±s)	SDSS评分(分，±s)	自杀风险评分(分，±s)	肇事、肇祸风险评分(分，±s)	SMI加重/复发[例数(%)]
观察组1	22	8.1±1.6	1.5±0.2	3.3±0.4	0.4±0.1	5(22.7)
观察组2	29	11.4±2.1	2.0±0.3	4.9±0.7	0.7±0.1	16(55.2)
统计量		t＝5.67	t＝5.84	t＝9.60	t＝11.83	χ²＝5.44
P值		<0.001	<0.001	<0.001	<0.001	0.020

表5 本研究3组孕妇分娩新生儿结局比较

组别	例数	出生体重(kg，±s)	出生身长(cm，±s)	出生后5 min Apgar评分(分，±s)	早产[例数(%)]	转入NICU[例数(%)]	足月低出生体重儿[例数(%)]	足月巨大儿[例数(%)]	性别[例数(%)]
组别	例数	出生体重(kg，±s)	出生身长(cm，±s)	出生后5 min Apgar评分(分，±s)	早产[例数(%)]	转入NICU[例数(%)]	足月低出生体重儿[例数(%)]	足月巨大儿[例数(%)]	男	女
观察组1	22	3.3±0.5	49.1±1.8	8.6±1.5	4(18.2)	3(13.6)	4(18.2)	3(13.6)	10(45.5)	12(54.5)
观察组2	29	3.2±0.4	48.9±1.7	8.6±1.6	3(10.3)	1(3.4)	2(6.9)	1(3.4)	12(41.4)	17(58.6)
对照组	68	3.2±0.4	49.2±1.8	8.7±1.6	4(5.9)	0(0)	3(4.4)	1(1.5)	29(42.6)	39(57.4)
统计量		t＝0.64	t＝0.26	t＝0.07	—^a	—^a	—^a	—^a	χ²＝0.09
P值		0.527	0.768	0.935	0.678	0.023	0.305	0.205	0.957

表5 本研究3组孕妇分娩新生儿结局比较

组别	例数	出生体重(kg，±s)	出生身长(cm，±s)	出生后5 min Apgar评分(分，±s)	早产[例数(%)]	转入NICU[例数(%)]	足月低出生体重儿[例数(%)]	足月巨大儿[例数(%)]	性别[例数(%)]
组别	例数	出生体重(kg，±s)	出生身长(cm，±s)	出生后5 min Apgar评分(分，±s)	早产[例数(%)]	转入NICU[例数(%)]	足月低出生体重儿[例数(%)]	足月巨大儿[例数(%)]	男	女
观察组1	22	3.3±0.5	49.1±1.8	8.6±1.5	4(18.2)	3(13.6)	4(18.2)	3(13.6)	10(45.5)	12(54.5)
观察组2	29	3.2±0.4	48.9±1.7	8.6±1.6	3(10.3)	1(3.4)	2(6.9)	1(3.4)	12(41.4)	17(58.6)
对照组	68	3.2±0.4	49.2±1.8	8.7±1.6	4(5.9)	0(0)	3(4.4)	1(1.5)	29(42.6)	39(57.4)
统计量		t＝0.64	t＝0.26	t＝0.07	—^a	—^a	—^a	—^a	χ²＝0.09
P值		0.527	0.768	0.935	0.678	0.023	0.305	0.205	0.957

表6 本研究3组孕妇分娩新生儿出生后1个月的疼痛评分、神经发育和睡眠状况比较(分，

±s)

组别	例数	N-PASS评分	NBNA评分	SDSC评分
观察组1	22	2.2±0.4	38.0±2.3	61.2±7.5
观察组2	29	2.2±0.4	38.5±2.2	62.0±7.8
对照组	68	2.3±0.3	38.9±2.3	62.6±7.9
F值		0.37	1.18	0.26
P值		0.688	0.310	0.774

表6 本研究3组孕妇分娩新生儿出生后1个月的疼痛评分、神经发育和睡眠状况比较(分，

±s)

组别	例数	N-PASS评分	NBNA评分	SDSC评分
观察组1	22	2.2±0.4	38.0±2.3	61.2±7.5
观察组2	29	2.2±0.4	38.5±2.2	62.0±7.8
对照组	68	2.3±0.3	38.9±2.3	62.6±7.9
F值		0.37	1.18	0.26
P值		0.688	0.310	0.774

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