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Fertility rates are rising in women with schizophrenia

Sept. 24, 2012

By Patricia Nicholson

Results of a new study show that women with schizophrenia are now having more babies than they have in the past.

Historically, women with schizophrenia tended to have a lower birth rate than women in the general population. However, new research shows that gap has narrowed in many age groups. That means more women with schizophrenia need preconception, prenatal and postpartum care for themselves and their children. Earlier research has suggested that women with schizophrenia may be at greater risk for pregnancy, birth and neonatal complications than women in the general population.

“The health of women with schizophrenia in pregnancy and postpartum is an important issue,” says Women’s College Hospital psychiatrist Dr. Simone Vigod, lead author of the study. “We need to be looking at what will optimize the health of these women and their children.”

In recent years, many experts have come to believe that women with schizophrenia now have more opportunities to become pregnant, for a number of reasons. This was partly because fewer women with schizophrenia are living in institutions and more are receiving community-based care, giving them more opportunities to engage in relationships. Also, there is a trend toward aggressive treatment of schizophrenia in young patients.  There have also been changes in the types of medications used. Older schizophrenia medications elevated a hormone called prolactin, which made women less likely to be fertile. In newer drugs, this side-effect is either temporary or only occurs in higher doses.

“Most second-generation antipsychotic drugs do not elevate prolactin to the same extent as the other drugs,” Dr. Vigod explains. “Meaning that these women might not just have more opportunities, but might actually be more fertile.”

However, there was no research supporting the observation that more women with schizophrenia were giving birth. To find out if fertility rates were in fact rising, Dr. Vigod led a study using population-based databases to look at fertility rates in women with schizophrenia and in the general population in Ontario from 1996 to 2009. The study was published in the journal Schizophrenia Research in August 2012.

“What the study found was that indeed on a population level there has been a small but significant increase in births among women with schizophrenia in Ontario,” says Dr. Vigod. “It’s not a huge dramatic increase, but to see even an incremental increase in birth rates at a population level is fairly significant.”

Overall, there was a 16 per cent increase in the general fertility rate for women with schizophrenia over the study period. The results for women ages 20 to 24 were particularly interesting. In the early years of the study, women with schizophrenia in this age group had lower birth rates than the general population. However, by the last few years of the study their birth rate was similar to that of the general population. The study doesn’t show the reasons for the increase, but the changes do coincide with changes in how schizophrenia is treated in young women.

“There’s been a lot of push around treatment of first-episode psychosis, treatment of younger people with psychosis: getting them better faster and more functional faster. That’s really been a change over the last number of years,” Dr. Vigod says. “Could this be reflecting that young women with schizophrenia are actually coming back and living less impaired lives than they might have been 20 years ago? The study doesn’t tell us that, but those are the things that we wonder about.”

The study results are important because they call attention to the health needs of women with schizophrenia and their babies. Dr. Vigod notes that part of the reason for doing the study was to highlight those needs, and make it clear that a significant number of women with schizophrenia are giving birth.

“There’s quite a bit of evidence that women with schizophrenia, when their parenting is supported, they can do very well as mothers,” says Dr. Vigod. “Knowing that there are more women who are becoming pregnant and having children, it’s important for us to think – on a health level and a public policy level – about how we are going to help these women have the healthiest pregnancies and children and parenting experiences that we can.”

Dr. Vigod also sees an anti-stigma message in the study results.

“We can help these women and we should – we shouldn’t just sweep this under the table,” she says. “There’s an anti-stigma message that women with schizophrenia are capable of becoming pregnant and being mothers, and we as health-care providers and the health-care system have an obligation to help support them.”

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