Complex chronic conditions among children born to women with schizophrenia

Purpose — Maternal schizophrenia is linked to complications in offspring near the time of birth. Whether there is also a higher future risk of the child having a complex chronic condition (CCC) – a pediatric condition affecting any bodily system expected to last at least 12 months that is severe enough to require specialty care and/or a period of hospitalization – is not known.

Methods — In this population-based health administrative data cohort study (Ontario, Canada, 1995–2018), the risk for CCC was compared in 5066 children of women with schizophrenia (the exposed) vs. 2,939,320 unexposed children. Adjusted hazard ratios (aHR) were generated for occurrence of any CCC, by CCC category, and stratified by child sex, and child prematurity.

Results — CCC was more frequent in the exposed (7.7 per 1000 person-years [268 children]) than unexposed (4.2 per 100 person-years [124,452 children]) – an aHR of 1.25 (95% CI 1.10–1.41). aHRs were notably higher in 5 of 9 CCC categories: neuromuscular (1.73, 1.28–2.33), cardiovascular (1.94, 1.64–2.29), respiratory (1.83, 1.32–2.54), hematology/immunodeficiency (2.24, 1.24–4.05) and other congenital or genetic defect (1.59, 1.16–2.17). The aHR for CCC was more pronounced among boys (1.32, 1.13–1.55) than girls (1.16, 0.96–1.40), and of similar magnitude in term (1.22, 1.05–1.42) and preterm infants (1.18, 0.95–1.46).

Conclusions — The risk for a CCC appears to be higher in children born to women with schizophrenia. This finding introduces opportunities for targeted preconception counselling, optimization of maternal risk factors, and intervention to support a vulnerable parent population who will experience unique challenges caring for a child with CCCs.