Obstetric Complications Linked to Greater Symptom Burden in Schizophrenia

Maria Florencia Forte

Credit: Clínic Barcelona

Patients with schizophrenia and related disorders who have a history of obstetric complications face a greater clinical symptom burden than patients without such a history, according to findings from a recent study.¹

Results suggest that obstetric complications impact several outcomes in schizophrenia and related conditions, highlighting a significant correlation between these complications and more severe psychopathological phenotypes in schizophrenia spectrum disorders.¹

“To the best of our knowledge, this is the first systematic review and meta-analysis examining the relationship between obstetric complications and clinical symptomatology in individuals with schizophrenia and associated disorders,” Maria Florencia Forte, a predoctoral researcher in the bipolar and depressive disorders unit at Clínic Barcelona in Spain, and colleagues wrote.¹

According to the World Health Organization, schizophrenia affects approximately 24 million people, or 1 in 300 people (0.32%), worldwide. Although there is no single known cause of schizophrenia, it is thought to be the result of an interaction between genes and a range of environmental and psychosocial factors. Certain pregnancy and birth issues have also been identified as potential risk factors for schizophrenia, and recent research suggests obstetric complications may also exacerbate schizophrenia symptoms.^2,3

To evaluate differences in clinical psychopathology and functioning in schizophrenia and related disorders among individuals with and without exposure to obstetric complications, investigators systematically searched PubMed, PsycINFO, and Scopus from inception to November 8, 2023, for original studies of people diagnosed with schizophrenia and related disorders, including schizoaffective disorder; schizophreniform disorder; delusional disorder; and brief psychotic disorder, based on any edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM) or the International Classification of Diseases (ICD) diagnostic criteria. Of note, cases of first-episode psychosis were also included. Eligible studies were also required to compare patients with and without a history of obstetric complications and assess clinical symptomatology or functioning according to validated instruments.¹

No language or age restrictions were applied, but investigators excluded reviews and meta-analyses; case reports and case series; animal studies; and non-peer-reviewed literature.¹

The initial systematic search yielded 4091 records, 2683 of which were screened after removal of duplicates. Of these, 2597 studies were excluded at the title/abstract level and 75 after the full-text evaluation. In total, 14 studies were included in the systematic review, 12 of which provided enough data to perform a meta-analysis.¹

These 12 studies included 2992 patients with schizophrenia and related disorders. Investigators noted the mean age of these study participants was 30.5 years (standard deviation [SD], 7.7; range of means, 22.7 to 43.5) and 49.4% were male.¹

In total, 10 studies included 2007 (67.1%) people diagnosed with schizophrenia, 3 studies included 361 (12.1%) people experiencing first-episode psychosis, and 1 study included 624 (20.8%) people diagnosed with schizophrenia and schizoaffective disorder. The total number of people with schizophrenia and related disorders and a lifetime history of obstetric complications was 909 compared to 2083 people with the same diagnosis but no history of obstetric complications.¹

Results showed patients with schizophrenia and related disorders with a positive lifetime history of obstetric complications presented higher total scores on psychotic symptoms scales (standardized mean difference [SMD], 0.44; 95% CI, 0.24 to 0.64; P <.001) when compared to patients without a history of obstetric complications. Further analysis of subscales revealed patients with obstetric complications had greater scores for positive (SMD, 0.10; 95% CI, 0.01 to 0.20; P = .03) and general (SMD, 0.37; 95% CI, 0.22 to 0.52; P <.001) symptoms scales, but no differences were observed between the groups for negative symptom scales (SMD, 0.19; 95% CI, -0.01 to 0.38; P = .05).¹

Additionally, investigators noted patients with schizophrenia and related disorders who had a positive lifetime history of obstetric complications also presented with worse depressive symptoms (SMD, 0.47; 95% CI, 0.09-0.84; P = .01). However, no differences were found between the 2 groups in terms of functioning (SMD, -0.01; 95% CI, -0.35 to 0.34; P = .95).¹

Investigators acknowledged multiple limitations to these findings, including the use of data for patients with chronic disorders as well as those with first-episode psychosis; the small sample sizes of some of the included studies and the limited statistical power; differences in the conceptualization of obstetric complications; and the use of different rating scales to assess schizophrenia symptoms.¹

“The findings of the present meta-analysis suggest a consistent correlation between obstetric complications and more severe psychopathological phenotypes in schizophrenia spectrum disorders. Specifically, in comparison to patients without obstetric complications, those with a history of obstetric complications presented greater severity in positive, depressive, and general symptomatology, but not in the negative and functional outcomes,” investigators concluded.¹

References

1. ^{Forte MF, Olvia V, De Prisco M, et al. Obstetric complications and psychopathology in schizophrenia: A systematic review and meta-analysis. Neuroscience and Behavioral Reviews. https://doi.org/10.1016/j.neubiorev.2024.105913}
2. ^{World Health Organization. Schizophrenia. Newsroom. January 10, 2022. Accessed October 9, 2024. https://www.who.int/news-room/fact-sheets/detail/schizophrenia}
3. ^{Mayo Clinic. Schizophrenia. May 18, 2024. Accessed October 9, 2024. https://www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-causes}