Hospitalizations and emergency department visits for psychiatric illness during and after pregnancy among women with schizophrenia
Rochon-Terry G, Gruneir A, Seeman MV, Ray JG, Rochon P, Dennis CL, Grigoriadis S, Fung K, Kurdyak PA, Vigod SN. J Clin Psychiatry. 2016; 77(4):541-7. Epub 2016 Mar 15.
Background — Almost 50 percent of women with schizophrenia become pregnant. Little is known about their psychiatric service use patterns during or shortly after pregnancy.
Methods — Using health administrative data, we identified 1433 women in Ontario with schizophrenia who had a live birth delivery between 2003 and 2011, and described their use of acute care psychiatric services including hospitalizations, emergency department (ED) visits not requiring hospitalization and self-harm related ED visits in pregnancy and in the 1 year postpartum. Incidence rates of psychiatric hospitalization during pregnancy, and also within 1 year postpartum, were each compared to the incidence rate of psychiatric hospitalization in the 1-year period before conception. Results were presented as incidence rate ratios (IRRs) and 95% confidence intervals (CI). Similar comparisons were made for psychiatric ED visits not requiring hospitalization, as well as for self-harm-related ED visits.
Results — About 12% of women had at least one psychiatric hospitalization in pregnancy, and 19% in the first year postpartum. About 10% had at least one psychiatric ED visit without hospitalization in pregnancy, and 15% had at least one ED visit postpartum. Self-harm related ED visits were more rare, affecting only about 1% of women in each time period. Relative to that in the 1-year period before conception (50 per 100 person-years), the incidence rate of psychiatric hospitalizations was lower during pregnancy (25 per 100 person-years), equivalent to an IRR of 0.50 (95% CI 0.43-0.60). While the IRR of psychiatric hospitalizations was lower over the entire 1-year period postpartum (0.66, 95% CI 0.57-0.76), it was transiently higher in the first 9 days postpartum (3.59, 95% CI 2.74-4.69), and then waned by days 10-29 postpartum (0.87, 95% CI 0.56-1.24). ED visits for psychiatric and self-harm reasons were consistently lower in pregnancy and postpartum compared to the year before conception.
Conclusions — Psychiatric hospitalizations and ED visits are not uncommon for women with schizophrenia during pregnancy and the postpartum period. However, except for a brief period after delivery, women with schizophrenia are at relatively lower risk of requiring acute psychiatric inpatient and emergency care during and 1 year after pregnancy compared to the 1- year period prior to conception. This is key prognostic information for women with schizophrenia, their families and providers who counsel them regarding pregnancy, motherhood, and management of schizophrenia. Identifying women at risk of requiring acute psychiatric services in the perinatal period warrants further investigation.