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For women with schizophrenia, psychiatric emergencies and hospitalization decline during pregnancy and postpartum

Women with schizophrenia had fewer psychiatric emergencies and hospitalizations while pregnant and during the first year after giving birth, than they did in the year before they conceived, a new study found. The research provides important information for women with schizophrenia who are making family planning decisions. 

In the year before they became pregnant, 25 per cent of women with schizophrenia were hospitalized at least once for psychiatric illness, and 20 per cent had at least one psychiatric emergency department visit without being admitted to hospital.

These numbers were halved while the women were pregnant, during which time 12 per cent were hospitalized and 10 per cent used the emergency department.

In the year after giving birth, hospitalizations and emergency visits remained lower than in the year before conception: 19 per cent of the women were hospitalized, and 16 per cent used the emergency department.

The exception to these lowered rates was during the first nine days after giving birth. During this time, women were more than three times as likely to be hospitalized or use the emergency room than in the year before pregnancy. These rates may reflect the many stresses that new mothers feel in the first few days with a new baby. However, this high rate declined over the first month after giving birth, and remained lower the pre-pregnancy rate for the rest of the year.

Incidence of self-harm was also lower during pregnancy and post-partum than it was before conception. In the year before pregnancy, four per cent of the women had an emergency visit related to self-harm. This fell to one per cent during pregnancy and in the year after birth.

“These findings are encouraging for women with schizophrenia who are or who wish to become pregnant about remaining stable during and after pregnancy,” said lead study author Dr. Simone Vigod, an adjunct scientist at the Institute for Clinical Evaluative Sciences (ICES) and a scientist at Women’s College Research Institute. “It is important for us to do more research to understand what supports, services and other resources are useful to ensure that this happens.”

Dr. Vigod and fellow researchers at ICES and Women’s College Hospital used anonymized ICES health records to follow 1,433 Ontario women with schizophrenia who gave birth from 2003 to 2011. They compared the women’s health care use before, during and after pregnancy.

The study authors explain that because about half of women with schizophrenia become mothers, it’s important to know how pregnancy and early motherhood may affect their symptoms. They note several possible reasons why hospitalizations and emergency visits dropped in pregnancy and in the year after. These include the theory that high estrogen levels in pregnancy may protect against schizophrenia symptoms. It’s also possible that the increased support from healthcare providers during pregnancy and following birth may have included increased mental health services and community support. Some women may have been more motivated to follow their treatment plan for schizophrenia during pregnancy and as new mothers. 

The study was published in the Journal of Clinical Psychiatry on March 15, 2016.

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