Obstetric and Perinatal Complications in Childhood Schizophrenia: A Preliminary Case-Control Study

Background: Numerous case-control studies have found an increased frequency of obstetric and perinatal complications in the histories of patients with schizophrenia. Prospective studies have demonstrated that although the great majority of individuals born with such complications do not develop schizophrenia during their lifetime, the risk is increased compared to matched controls. Obstetric and perinatal complications have been associated to a greater degree with onset of the illness before age 22 years. In most studies, the association is more pronounced in males.

Objective: To examine whether there is an increased incidence of obstetric and perinatal complications in the histories of patients hospitalized with the diagnosis of schizophrenia on the Inpatient Ward of the University Psychiatric Department at "Aghia Sophia" Children's Hospital in Athens.

Methods: Obstetric and perinatal complications were recorded according to the Lewis and Murray Scale from the standard health booklets of 26 patients, 11 boys and 15 girls, hospitalized in our department with an ICD-10 diagnosis of schizophrenia during the period ...... . Their mean age was 12.6 years ( range 9-14 years). Each psychiatric patient was matched with three controls of the same age and sex who presented to National Health System services for medical problems.

Results: Overall, in 19/26 (73%) patients with schizophrenia there was at least one obstetric or perinatal complication. In 19/78 (24%) controls there was at least one such complication (2 p<0.001).

The following individual complications were significantly increased in the subjects with schizophrenia: maternal bleeding during pregnancy (2 p<0.001), duration of gestation <37 weeks (2 p< 0.01) and neonatal hyperbilirubinemia >15 mg/dl (2 p<0.05).

Among the psychiatric patients, 10/11 boys and 9/15 girls had a history of complications. Among controls, 7/33 boys and 12/45 girls had a history of complications. The odds ratio of having a positive history was 37.3 (95% CL 4.01-170.37) for boys and 3.32 (95% CL 0.36-15.27) for girls with schizophrenia.

Conclusions: Our findings indicate an excess of obstetric and perinatal complications in the histories of children with schizophrenia, particularly in boys. A similar gender effect has been described in the literature. Among individual complications, the strongest association was noted with maternal bleeding during pregnancy and duration of gestation less than 37 weeks. In previous research, these are among the most frequently cited complications in schizophrenia patients. Our finding of a weaker association with neonatal hyperbilirubinemia is not mentioned by most authors.

It would be premature to characterize these associations as etiological, and they do not minimize the importance of genetic and environmental factors. There is a need for ongoing research with larger study samples and further differentiation of the subjects, such as those with positive or negative family history. Children born with obstetric and perinatal problems are at increased risk for various behavioral and developmental problems which have been extensively described. Our preliminary results add to the evidence supporting existing recommendations for vigilant developmental monitoring of children with such a history by their pediatricians.

Key words: Childhood schizophrenia, obstetric complications.