Schizophrenia and pregnancy: a national register-based follow-up study among Finnish women born between 1965 and 1980.

To assess psychosocial and somatic risk factors related to pregnancy, and pregnancy-related complications or disorders in women with schizophrenia compared to population controls. In this register-based cohort study, we identified all Finnish women who were born in 1965-1980 and diagnosed with schizophrenia in psychiatric care before 31 December 2013. For each case, five age- and place-of-birth matched controls were randomly selected. They were followed from the day when the disorder was diagnosed in specialized health care till the end of 2013. The mean follow-up time was 14.0 + 6.91 vs. 14.3 + 6.89 years. Altogether, 1162 singleton pregnancies were found among affected women and 4683 among controls. Affected women were significantly older and more often single; their body mass index before pregnancy was significantly higher, and they smoked significantly more often both in the beginning of pregnancy and after the first trimester than controls. They showed a significantly higher odds for pathologic oral glucose tolerance test (odds ratio (OR) 1.66, 95% confidence interval (95% CI) 1.27-2.17), initiation of insulin treatment (OR 1.84, 95% CI 1.15-2.93), fast fetal growth (OR 1.62, 95% CI 1.03-2.52), premature contractions (OR 2.42, 95% CI 1.31-4.49), hypertension (OR 1.81, 95% CI 1.01-3.27), and pregnancy-related hospitalizations (OR 1.97, 95% CI 1.66-2.33). Suspected damage to the fetus from alcohol/drugs was significantly more common among affected women than controls. Women with schizophrenia have higher prevalence of psychosocial and somatic risk factors related to pregnancy, as well as pregnancy-related complications and disorders than non-affected women.

Partners of nulliparous women with severe fear of childbirth: A longitudinal study of psychological well-being.

BACKGROUND: Little is known about the psychological status of partners of women with severe fear of childbirth (FOC). In this longitudinal study from Helsinki University Central Hospital, we investigated FOC, depression, and posttraumatic stress in the partners of women with severe FOC, and possible effects of group psychoeducation and mode of birth. METHODS: During pregnancy, 250 partners of nulliparous women with severe FOC participated, 93 in the intervention group and 157 in the control group. At 3 months postpartum, 52 partners in the intervention group and 93 in the control group participated. Both the partners and the childbearing women filled in the Wijma Delivery Expectancy/Experience Questionnaire and the Edinburgh Postnatal Depression Scale mid-pregnancy as well as 3 months postpartum, when they also filled in the Traumatic Event Scale. RESULTS: Partners of women with severe FOC reported less antenatal and postnatal FOC and fewer depressive symptoms than the childbearing women. No partner reached the threshold of severe FOC. No partner reported a possible posttraumatic stress disorder. Group psychoeducation with relaxation was not associated with better or worse psychological well-being of the partners. An emergency cesarean delivery was associated with a more fearful delivery experience in the partners. CONCLUSION: Partners of nulliparous women with severe FOC neither seem to suffer from severe FOC nor reported posttraumatic stress symptoms after childbirth. They reported better psychological well-being than the mothers both during pregnancy and after delivery. An unexpected cesarean may be a negative experience even for partners of childbearing women.

Persistent Pain After Cesarean Delivery and Vaginal Delivery: A Prospective Cohort Study.

BACKGROUND: Persistent pain after cesarean delivery and vaginal delivery has been the subject of only a few research articles. The primary outcome of our prospective study was the incidence of persistent pain and its association to mode of delivery. We also studied the nature and intensity of pain after delivery. METHODS: A questionnaire was distributed on postpartum day 2 to 1052 women who had given birth vaginally and to 502 who had undergone cesarean delivery in a tertiary maternity hospital in Helsinki, Finland, in 2010. A second questionnaire was mailed to the women 1 year later. We recorded the women's health history, obstetric history and previous pain history, details of cesarean delivery or vaginal delivery, and description of pain, if present. RESULTS: The incidence of persistent pain at 1 year after delivery was greater after cesarean delivery (85/379 [22%]) than after vaginal delivery (58/713 [8%]: P < .001, relative risk 2.8, 95% confidence interval 2.0-3.8). Because of initial differences in the groups, we performed logistic regression analysis with persistent pain as a dependent factor that confirmed the mode of delivery as a predictor of persistent pain. The incidence of persistent pain graded as moderate or more severe (25/379 [7%] vs 25/713 [4%]: P = .022, relative risk 1.9, 95% confidence interval 1.1-3.2) was also greater after cesarean delivery than vaginal delivery. The incidence of persistent pain was significantly more common in women with a history of previous pain and among primiparous women in logistic regression analysis. The women with persistent pain had experienced more pain the day after cesarean delivery (P = .023) and during vaginal delivery (P = .030) than those who did not report persistent pain. Complications such as perineal trauma, episiotomy, vacuum extraction, endometritis, wound infection, or ante- or postpartum depression did not predispose women to persistent pain. Dyspareunia was reported by 41% of women after vaginal delivery and by 2% after cesarean delivery among women with persistent pain at 1 year. CONCLUSIONS: The incidence of persistent pain at 1 year is greater after cesarean delivery than after vaginal delivery. Pain shortly after cesarean delivery and during vaginal delivery correlated with persistent pain.

Monitoring the condition of the fetus during delivery.

Uterine contractions during delivery increase the resistance to flow in the blood vessels of the placenta and decreases placental blood circulation, possibly subjecting the fetus to hypoxia. Several methods have been developed for monitoring the condition of the fetus during delivery. Cardiotocography is used to monitor the fetus's heart rate and variability in relation to the mother's contractions. A change in cardiotocography recording due to stimulation of the presenting part is an indication of a healthy fetus. ST analysis of fetal ECG depicts the oxygenation of fetal cardiac muscle during delivery. In addition to cardiotocography and ST analysis, analysis of blood gases and lactate determination are used in assessing the condition of the fetus.

[Pregnancy and maternity of a schizophrenic patient]. / Skitsofreniapotilaan raskaus ja äitiys.

Aspects to be taken into consideration in the total care of women of reproductive age and affected with schizophrenia include possible contraception, pharmacological therapy during pregnancy and need for support in parenthood. Compared with other pregnant women, those affected with schizophrenia are older, are more frequently smokers during pregnancy and more often neglect health monitoring during pregnancy. Schizophrenia predisposes for preterm delivery, miscarriage and lower Apgar score of the infant. In regard to parenthood, the effects of the illness itself or the prescribed medication on the interactive mother-child relationship may emerge as problematic issues.

Life satisfaction, general well-being and costs of treatment for severe fear of childbirth in nulliparous women by psychoeducative group or conventional care attendance.

OBJECTIVE: Fear of childbirth is a common reason for seeking cesarean section. It is important to consider outcomes and costs associated with alternative treatment and delivery mode. We compared well-being and costs of group psychoeducation and conventional care for fear of childbirth. DESIGN: Randomized controlled trial. POPULATION: A total of 371 nulliparous women scoring over the 95th centile in the Wijma Delivery Expectancy Questionnaire (W-DEQ) during the first trimester. SETTING: Finland, data from obstetrical patient records and questionnaires. METHODS: Randomization to group psychoeducation with relaxation (six sessions during pregnancy, one after childbirth, n = 131), or surveillance and referral on demand (n = 240). MAIN OUTCOME MEASURES: All costs in maternity care during pregnancy, delivery and postnatally according to Diagnoses Related Groups. Life satisfaction and general well-being 3 months after childbirth (by a Satisfaction with Life Scale and Well-being Visual Analogue Scale). RESULTS: The groups did not differ in total direct costs (€3786/woman in psychoeducative group and €3830/woman in control group), nor in life satisfaction or general well-being. Although only 76 (30%) of the women assigned to the surveillance were referred to special maternity care and 36 (15%) attended advanced prenatal classes, costs in the psychoeducation group did not exceed the costs of the controls, mostly because of the greater number of uncomplicated vaginal deliveries (63% vs. 47%, p = 0.005). CONCLUSIONS: Through an association with safer childbirth and equal well-being after delivery, psychoeducative group treatment for nulliparous women with fear of childbirth can be a recommended choice for the same overall costs as conventional treatment.

Diagnosis and treatment of severe hemolytic disease of the fetus and newborn: a 10-year nationwide retrospective study.

OBJECTIVE: Outcome after intrauterine transfusions due to severe hemolytic disease of the fetus and newborn. DESIGN: Nationwide population-based retrospective cohort study. SETTING: All women treated with intrauterine transfusions for hemolytic disease of the fetus and newborn in Finland in 2003-2012. POPULATION: 339 intrauterine transfusions, performed in 104 pregnancies of 84 women. METHODS: Information on antenatal screening of red cell antibodies and red cell units issued for intrauterine transfusion was obtained from the Finnish Red Cross Blood Service database, and obstetric and neonatal data from hospital records. MAIN OUTCOME MEASURES: Procedure-related complications, perinatal mortality, neonatal morbidity. RESULTS: Overall survival was 94.2% (95% confidence interval 89.7-98.7). There were four fetal and two neonatal deaths. Procedure-related fetal loss rate was 1.2% (95% confidence interval 0.04-2.4) per procedure and 3.8% (95% confidence interval 0.1-7.5) per pregnancy. Of the four procedure-related losses, three were due to technically difficult intrauterine transfusions causing infection and preterm birth. Of the live born infants, 19% (95% confidence interval 11.3-26.7) were born before 32 weeks' gestation. The incidence of severe neonatal morbidity (respiratory distress syndrome, severe cerebral injury, sepsis) was 22.2% (95% confidence interval 13.4-30.2). Poor outcome (death, severe neonatal morbidity) was negatively associated with gestational age at first transfusion (p = 0.001) and at birth (p = 0.00006). Follow-up of the infants was too incomplete to assess the neurodevelopmental outcome. CONCLUSIONS: Although overall survival is comparable with previous studies, our concern is procedure-related infections and preterm births. Close collaboration between the university hospitals is needed to ensure timely treatment, operator skills and systematic follow-up of the children.

Intravenous sulprostone infusion in the treatment of retained placenta.

OBJECTIVE: To analyze the effectiveness of intravenous sulprostone infusion for the treatment of retained placenta without massive primary hemorrhage among women at an university hospital over a three-year period. DESIGN: Retrospective observational study. SETTING: University teaching hospital. POPULATION: 126 consecutive women with placental retention and intravenous sulprostone infusion as primary treatment performed from October 2007 up to December 2011. METHODS: Hospital records of women who received sulprostone infusion to attempt placental expulsion were reviewed. MAIN OUTCOME MEASURES: Primary endpoints of the study were expulsion of placenta and the total amount of blood loss during delivery. RESULTS: The placenta was successfully expelled in 39.7% of cases, whereas 60.3% of women underwent manual removal of placenta. Blood loss was significantly lower in women with successful placental expulsion than in women who had manual removal of the placenta (582 ± 431 ml vs. 1275 ± 721 ml, p < 0.0001). Sulprostone infusion did not cause adverse effects or significant postpartum morbidity. CONCLUSIONS: Intravenous sulprostone infusion is safe and reduces both blood loss and the need for manual removal of the placenta.

Alcohol and substance abuse identified during pregnancy: maternal morbidity, child morbidity and welfare interventions.

AIM: To study the relations between postnatal maternal morbidity, child morbidity and welfare interventions in families with prenatal alcohol or substance abuse. METHODS: A register-based longitudinal retrospective cohort study. The exposed cohort included 638 children born to 524 women followed-up during pregnancy for alcohol or substance abuse 1992-2001. Non-exposed children (n = 1914) born to control women were matched for maternal age, parity, number of foetuses, month of birth and delivery hospital of the index child. Perinatal and follow-up data of both cohorts were collected from national registers until 2007. RESULTS: Postnatal maternal abuse-related healthcare utilization and use of medication were associated with child out-of-home care. Significant differences were in particular observed in the categories of maternal mental and behavioural disorders caused by psychoactive substance use as well as injury and poisoning. Maternal inpatient care for mental and behavioural disorders peaked at the time of child out-of-home care. Maternal abuse-related healthcare utilization was associated with early child healthcare utilization and use of medication for mental and behavioural disorders. These associations were largely explained by the association with child out-of-home care. CONCLUSIONS: Postnatal maternal abuse-related morbidity is associated with significant early child morbidity, use of medication and timing of out-of-home care.

[Cancer diagnosed during pregnancy]. / Kun syöpä todetaan raskausaikana.

The risk of contracting cancer is approximately 1 out of 1,000 pregnancies. The most common types of cancer include melanoma, cervical cancer and breast cancer. Utilization of MRI studies for radiological examination of cancer during pregnancy is recommended. Mammography and chest radiography are also allowed. Computed tomographic scanning of the abdominal region should be avoided. The prognosis during pregnancy is dependent on the extent and histologic type of the cancer. Chemotherapy can be started after the first trimester of pregnancy and terminated about one month before delivery.

Early healthcare utilization and welfare interventions among children of mothers with alcohol and substance abuse: a retrospective cohort study.

AIM: Early childhood healthcare utilization, mortality and welfare interventions were studied among children of mothers with identified gestational alcohol and/or substance abuse. METHODS: Register-based retrospective cohort study. The exposed cohort consisted of 638 children born to 524 women followed up antenatally 1992-2001 at special outpatient clinics in the capital area of Finland. Nonexposed children (n = 1914) born to control women were matched for maternal age, parity, number of foetuses, month of birth and delivery hospital of the index child. Postnatal data of both cohorts were collected from national registers until 2007. RESULTS: The exposed cohort displayed twice the amount of in- and outpatient hospital care episodes compared with nonexposed children. Differences attributable to exposure were found in categories of conditions originating in the perinatal period, mental and behavioural disorders, and nonspecific factors influencing health status and contact with health services. This was reflected in amounts of reimbursements for drugs of the central nervous system, as well as special care allowances and rehabilitation for mental and behavioural disorders. The highest degree of healthcare utilization was observed among exposed children placed in out-of-home care. One-third of these children received outpatient care and one-tenth required inpatient care for a mental and behavioural disorder. No significant differences were found in early mortality. CONCLUSION: The exposed children displayed significant neonatal and early mental and behavioural healthcare utilization, and need for significant psychosocial support during their first decade of life.

Broad-spectrum drug screening of meconium by liquid chromatography with tandem mass spectrometry and time-of-flight mass spectrometry.

Analysis of the major drugs of abuse in meconium has been established in clinical practice for detecting fetal exposure to illicit drugs, particularly for the ready availability of the sample and ease of collection from diapers, compared with neonatal hair and urine. Very little is known about the occurrence and detection possibilities of therapeutic and licit drugs in meconium. Meconium specimens (n = 209) were collected in delivery hospitals, from infants of mothers who were suspected to be drug abusers. A targeted analysis method by liquid chromatography-triple quadrupole mass spectrometry (LC-MS/MS) was developed for abused drugs: amphetamine, methamphetamine, 3,4-methylenedioxyamphetamine, 3,4-methylenedioxymethamphetamine, morphine, codeine, 6-monoacetylmorphine, oxycodone, methadone, tramadol, buprenorphine, and norbuprenorphine. A separate LC-MS/MS method was developed for 11-nor-∆(9)-tetrahydrocannabinol-9-carboxylic acid. A screening method based on LC coupled to time-of-flight MS was applied to a broad spectrum of drugs. As a result, a total of 77 different compounds were found. The main drug findings in meconium were as follows: local anesthetics 82.5% (n = 172), nicotine or its metabolites 61.5% (n = 129), opioids 48.5% (n = 101), stimulants 21.0% (n = 44), hypnotics and sedatives 19.0% (n = 40), antidepressants 18.0% (n = 38), antipsychotics 5.5% (n = 11), and cannabis 3.0% (n = 5). By revealing drugs and metabolites beyond the ordinary scope, the present procedure helps the pediatrician in cases where maternal denial is strong but the infant seems to suffer from typical drug-withdrawal symptoms. Intrapartum drug administration cannot be differentiated from gestational drug use by meconium analysis, which affects the interpretation of oxycodone, tramadol, fentanyl, pethidine, and ephedrine findings.

Amniotic lamellar body counts determined with the Sysmex XE-2100 analyzer to predict fetal lung maturity during diabetic and other complicated pregnancies.

OBJECTIVE: The detection of amniotic lamellar bodies (LB) has been shown to be a rapid and simple way to assess fetal lung maturity (FLM). The maturity thresholds for LB vary due to different factors, one being the type of particle-count analyser used. MATERIAL AND METHODS: The Sysmex XE-2100 hematological analyser was evaluated in determination of amniotic LB counts and compared with lecithin/sphingomyelin (L/S) and phosphatidylglycerol (PG) determination. We analysed 132 amniotic samples from a total of 109 mothers (71 diabetic) with 112 infants. Results. The correlation between the LB counts obtained with the Sysmex XE-2100 and our reference thin layer chromatography (TLC) phospholipid method was good. Samples with low L/S ratio (< or = 2.0) and no PG (i.e. premature fetal lung status), had low LB counts (n = 18, mean 8500/L, range 1000-26000), whereas 51 samples with mature fetal lung status had high LB counts (mean 63600/uL, range 20,000-139,000). In all our four cases of respiratory distress syndrome the LB counts were low (range 1000-28000/uL). The reference values for FLM determination were established: < or = 6000/microL for immature, values between 7000 and 35,000/uL for borderline results and >35,000/uL for mature. CONCLUSIONS. The amniotic LB count analysis with Sysmex XE-2100 has many advantages being a repeatable, inexpensive and quantitative method with a very short turn-around time. Consequently, our routine is to perform LB counts initially from all amniotic samples and only borderline LB results are analysed with TLC.

Pregnancy, delivery and postpartum in women with schizophrenia or schizoaffective disorder in Finland: a national register-based comparative study.

As part of anational Finnish study on reproductive health of women with severe mental disorders, we compared pregnancy- and delivery-, and postpartum-related outcomes between women with schizophrenia (n = 3444) and those with schizoaffective disorder (n = 985), focusing on their singleton pregnancies after illness onset (n = 708 and n = 242, respectively). For comparison, data also included 22,101 controls with 3668 pregnancies. The Finnish Medical Birth Register, the Register of Congenital Malformations and the Child Welfare Register were used. Despite known differences between the two disorders, we found no robust differences between these patient groups.

Opioid maintenance treatment of pregnant women in the Scandinavian countries.

Background: WHO guidelines emphasise the need for descriptions of clinical practice and observational studies on risk and benefits of pharmacotherapies in pregnancy. The aims of the present study were to: (1) Describe opioid maintenance treatment (OMT) in the Scandinavian countries in general, and specifically for pregnant women, (2) Describe a project which utilises a new approach using registry-linkage data to examine associations between prenatal exposure to OMT and child outcomes: a Scandinavian cohort study of pregnant women in OMT during pregnancy (ScopeOMT). Data: Guidelines describing the treatment of persons with opioid use disorders in general, and specifically for pregnant women. Scandinavian registry-linkage data from ScopeOMT. Results: Registry data show that approximately 800 pregnant women received OMT during pregnancy in the period of the ScopeOMT study. Similarities across the Scandinavian countries include access to free healthcare and treatment; multidisciplinary teams trained to support pregnant women in OMT; buprenorphine as the recommended drug when initiating therapy; and a holistic focus on the patients' lives. An important difference is that Norwegian women who use illegal substances that may harm the foetus may be admitted - voluntarily, or against their will - for parts of, or the remainder of the pregnancy to inpatient treatment at specialised clinics. Conclusion: Many similarities in the treatment provided to opioid-dependent persons in the Scandinavian countries place this area in an excellent position to combine the efforts and carry out observational studies concerning the safety of OMT during pregnancy.

Maternal schizophrenia and out-of-home placements of offspring: A national follow-up study among Finnish women born 1965-1980 and their children.

Schizophrenia may affect a mother's ability to parent. We investigated out-of-home placements among children with a biological mother having schizophrenia, and their relation to maternal characteristics and adverse perinatal health outcomes of the offspring. For each Finnish woman born between 1 JAN 1965 - 31 DEC 1980 and diagnosed with schizophrenia before 31 DEC 2013 (n = 5214), five matched controls were randomly selected from the Finnish Central Population Register. Children born to these women were identified and followed till 31 DEC 2013. The Child Welfare Register, the Medical Birth Register and the Register of Congenital Malformations were used to gather information. Altogether 35.1% of children with an affected mother and 3.2% of control children were placed out of home during the follow-up. The incidence rate ratio (IRR) of out-of-home placement among children with an affected mother was 12.6 (95% confidence interval (CI) 10.80-13.46) when children with a non-affected mother served as a reference. Single motherhood (IRR 2.2, 95% Cl 1.88-2.60) and maternal smoking (IRR 1.9, 95% Cl 1.68-2.16), but not an adverse perinatal outcome of the offspring, increased the risk of out-of-home placement. To conclude, maternal schizophrenia is a strong risk factor for placement of children in out-of-home care.

Prenatal buprenorphine exposure: effects on biochemical markers of hypoxia and early neonatal outcome.

OBJECTIVE: To evaluate the possible association between prenatal buprenorphine exposure and compromised early neonatal outcome in view of markers of perinatal hypoxia. DESIGN, SETTING AND SAMPLE: The study group consisted of 27 full-term neonates exposed to buprenorphine prenatally and prospectively followed up at a special tertiary outpatient clinic for pregnant drug abusers. Serving as controls were 27 full-term neonates exposed prenatally to illicit substances other than opioids and 38 full-term neonates from uncomplicated pregnancies of healthy parturients. METHODS AND MAIN OUTCOME MEASURES: Apgar scores, cord pH and base excess were recorded. Cord serum samples were collected at birth for analysis of biochemical markers of fetal hypoxic stress: erythropoietin (EPO; chronic hypoxia), cardiac troponin T (cardiac involvement) and S100 (neural damage). RESULTS: All infants were born in good condition according to Apgar scores and pH of cord blood. No statistically significant differences were found between the three groups in cord serum concentrations of EPO (33.0 median, range: 9.0-476.0 U/L in the buprenorphine-exposed group vs 27.0, range: 8.0-114.0 U/L in substance-abusing controls vs 28.1, range: 11.6-260.0 U/L in healthy controls) or S100 (0.47, range: 0.25-0.91 microg/L vs 0.40, range: 0.12-1.22 microg/L vs 0.47, range: 0.20-2.15 microg/L). No significant differences existed in cardiac TnT levels (0.017, range: 0.010-0.072 U/L vs 0.010, range: 0.010-0.075 U/L vs 0.024, range: 0.010-0.075 U/L). CONCLUSIONS: While no significant differences in asphyxia markers were observed between the three groups, a tendency towards higher levels of EPO emerged in the buprenorphine-exposed group.

Longitudinal study on the predictors of parental stress in mothers and fathers of toddlers.

AIM: Longitudinal study on the predictors of parental stress in mothers and fathers of toddlers. BACKGROUND: To study whether anxiety, depression, or marital problems increase the parenting stress in parents of toddlers. METHODS: At early pregnancy, 2 - 3 months, and 2 - 3 years after delivery, 214 low-risk couples filled in questionnaires on their marital relationship, social support, child's temperament, and self-evaluated competence in routine care-taking. In hierarchical regression analyses, they were used as predictors of parental stress. RESULTS: Those mothers who in early pregnancy had adequate social support, adaptive social strategies, and high self-esteem, and who had given birth vaginally, enjoyed breastfeeding, and whose spouse supported breastfeeding reported less stress 2 - 3 years later. Pregnancy-related anxiety, depression, general anxiety, neuroticism, and vulnerability in early pregnancy, as well as child's temperament and low self-estimated competence in routine care-taking measured at both 2 - 3 months and 2 - 3 years after childbirth predicted parental stress. Depression and living alone in early pregnancy, and the child-related variables (temperament and care-taking, measured both at 2 - 3 months and 2 - 3 years after childbirth) predicted high parenting stress in fathers of toddlers. CONCLUSIONS: Parental stress in toddlers' parents was predicted both by the temperament of the child, and by the parents' depression, self-esteem, and anxiety, as well as by lack of support and low self-evaluated competence in routine care-taking.

Obstetric and perinatal health outcomes related to schizophrenia: A national register-based follow-up study among Finnish women born between 1965 and 1980 and their offspring.

BACKGROUND: This national register-based study assesses obstetric and perinatal health outcomes in women with schizophrenia and their offspring. METHODS: Using the Care Register for Health Care, we identified Finnish women who were born in 1965- 1980 and diagnosed with schizophrenia. For each case, five age- and place-of-birth- matched controls were obtained from the Central Population Register of Finland. They were followed from the day when the disorder was diagnosed in specialized health-care (the index day) until 31.12.2013. Information related to births was obtained from the Medical Birth Register and the Register of Congenital Malformations. We focused on singleton pregnancies that led to a delivery after the index day. We restricted the analysis of deliveries in controls to those that occurred after the index day of the case. Maternal age, marital status, smoking status, sex of the newborn, and parity were used as covariates in adjusted models. RESULTS: We identified 1162 singleton births among women with schizophrenia and 4683 among controls. Schizophrenic women had a 1.4-fold increased risk of induction of labor, delivery by cesarean section, and delivery by elective cesarean section. Regarding offspring, the risk of premature birth and the risk of low Apgar score at 1 min (<7) were 1.6-fold, of resuscitation 2.5-fold, and of neonatal monitoring 2.1-fold higher. CONCLUSIONS: Schizophrenia associates with some specific delivery methods, but delivery complications are rare and their prevalence does not differ from that observed among community women. Maternal schizophrenia associates with some negative perinatal health outcomes of the offspring.

Schizophrenia and induced abortions: A national register-based follow-up study among Finnish women born between 1965-1980 with schizophrenia or schizoaffective disorder.

BACKGROUND: The objectives of this study were to investigate, in women with schizophrenia or schizoaffective disorder, the number and incidence of induced abortions (= pregnancy terminations performed by a physician), their demographic characteristics, use of contraceptives, plus indications of and complications related to pregnancy termination. METHODS: Using the Care Register for Health Care, we identified Finnish women born between the years 1965-1980 who were diagnosed with either schizophrenia or schizoaffective disorder during the follow-up period ending 31.12.2013. For each case, five age- and place-of-birth- matched controls were obtained from the Population Register of Finland. Information about births and induced abortions were obtained from the Medical Birth Register and the Induced Abortion Register. RESULTS: The number and incidence of induced abortions per 1000 follow-up years did not differ between cases and their controls. However, due to fewer pregnancies, cases exhibited an over 2-fold increased risk of pregnancy termination (RR 2.28; 95% CI 2.20-2.36). Cases were younger, were more often without a partner at the time of induced abortion, and their pregnancies resulted more often from a lack of contraception. Among cases, the indication for pregnancy termination was more often mother-to-be's medical condition. Induced abortions after 12weeks gestation were more common among cases. However, cases had no more complications related to termination. CONCLUSIONS: The incidence of induced abortions among Finnish women with schizophrenia or schizoaffective disorder is similar to the general population, but their risk per pregnancy over two-fold. They need effective, affordable family planning services and long-term premeditated contraception.