Rapid repeat pregnancy in women with schizophrenia

Aim — Women with schizophrenia are vulnerable to adverse reproductive health outcomes. Short inter-pregnancy interval, or rapid repeat pregnancy, is associated with maternal and infant complications, and may be preventable. Whether women with schizophrenia are at disproportionate risk for rapid repeat pregnancy is unknown.

Methods — This population-based cohort study in Ontario, Canada (2002−2013) compared women with and without schizophrenia on their risk of rapid repeat pregnancy, defined as pregnancy within 12 months of an index live birth. Among women with public drug coverage, those with and without schizophrenia were compared on their use of non-barrier contraception (hormonal and surgical) post-delivery.

Results — Women with schizophrenia (n = 1565) were at higher risk for rapid repeat pregnancy than women without schizophrenia (n = 924,657) (6.3% vs. 3.9%, adjusted relative risk, aRR 1.31, 95% confidence interval, CI, 1.07–1.59). They had more rapid repeat pregnancies resulting in live births (aRR 1.85, 95% CI 1.26–2.72), but not pregnancy losses (aRR 1.50, 95% CI 0.99–2.29) or induced abortions (aRR 1.07, 95% CI 0.81–1.42). Post-delivery non-barrier contraception use was similar between groups (43.7% vs. 43.6%, aRR 1.06, 95% CI 0.93–1.20), although women with schizophrenia were more likely to use injectable contraception (14.1% vs. 10.1%, aRR 1.67, 95% CI 1.35–2.07).

Discussion — Women with schizophrenia are at higher risk than their peers for rapid repeat pregnancy, but use non-barrier contraception at similar rates. The postnatal period is an opportune time to initiate targeted interventions designed to optimize planning for any future pregnancies, and contribute to improving maternal and child health in this vulnerable group.