Risk of stillbirth and neonatal death linked with maternal mental illness: A national cohort study

Abstract

Background: Babies of mothers with psychotic disorders are known to have higher rates of poor obstetric outcome, including higher mortality rates. This population-based study investigates risks of cause-specific perinatal death linked to a range of maternal psychiatric illness.

Aims: To estimate risks of stillbirth and neonatal death by specific causes in babies of mothers with histories of severe mental illness, relative to the general population.

Methods: We identified a cohort of 1.45 million live births and 7,021 stillbirths during 1973-1998 from Danish national registers. These registers were linked to identify babies who were stillborn or died neonatally following exposure to maternal psychiatric illness. Results: Risks of stillbirth and neonatal death were raised for virtually all causes of death, in relation to all maternal psychiatric illnesses. For most causes of death, offspring of women with schizophrenia and related disorders had no greater risks of stillbirth or neonatal death compared with other maternal disorders (e.g. stillbirth due to immaturity: relative risks (95%confidence interval) schizophrenia and related disorders: 1.1(0.4-3.5), affective disorders: 2.0(1.2-3.5)). There was a stronger elevation in risk of fatal congenital malformation associated with a history of maternal affective disorder (stillbirth 2.4(1.1-5.1), neonatal death (NND) 2.2(1.4-3.3)) or schizophrenia and related disorders (stillbirth 2.4(0.8-7.6), NND 2.2(1.1-4.1)) than with maternal alcohol/drug-related disorders (stillbirth 1.2(0.4-3.8), NND 1.1(0.6-2.2)).

Conclusions: Higher risk of perinatal loss may be linked to factors associated with maternal psychiatric illness in general such as insufficient attendance for antenatal care and unhealthy lifestyles rather than maternal mental illness per se.