Signs of asphyxia at birth and risk of schizophrenia

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Abstract

Background

Previous research has found an association between obstetric complications and schizophrenia, but in many studies the sample size was limited, and no assessment of specific exposures was possible.

Aims

To assess the role of different complications, and in particular to distinguish between disordered foetal development and hypoxia at birth.

Method

From the Stockholm County In-Patient Register and community registers, we identified 524 cases of schizophrenia and 1043 controls, matched for age, gender, hospital and parish of birth. Data on obstetric complications were obtained from birth records.

Results

There was a strong association between signs of asphyxia at birth and schizophrenia (OR 4.4; 95% C11.9–10.3) after adjustment for other obstetric complications, maternal history of psychotic illness and social class.

Conclusions

Signs of asphyxia at birth are associated with an increased risk of schizophrenia in adults.

Related collections

Most cited references 13

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Schizophrenia as a long-term outcome of pregnancy, delivery, and perinatal complications: a 28-year follow-up of the 1966 north Finland general population birth cohort.

P B Jones, P Rantakallio, A L Hartikainen … (1998)

The 1966 North Finland general population birth cohort was studied to determine whether abnormalities during pregnancy, delivery, and the neonatal period are associated with adult-onset schizophrenia. The authors included all 11,017 subjects alive in Finland at age 16. For each individual, standardized assessments made during pregnancy, delivery, and infancy were linked to national psychiatric case registers covering the period up to age 28. Subjects with DSM-III-R schizophrenia were identified by using a two-stage screen that included perusal of individual case records. Associations (adjusted odds ratios) between schizophrenia and specific pregnancy, delivery, and neonatal characteristics were calculated. Within this cohort, 76 cases of DSM-III-R schizophrenia arose by age 28 years; 51 (67.1%) of these persons were men. Demographic characteristics and previous obstetric histories of the mothers were similar in the case and unaffected comparison groups, although the former were more likely to have been more depressed than usual during pregnancy. Low birth weight (< 2500 g) and the combination of low birth weight and short gestation (< 37 weeks) were more common among the schizophrenic subjects. Being small for gestational age (< 10th percentile) was not more common. Of 125 survivors of severe perinatal brain damage, six (4.8%) later developed schizophrenia. The spectrum of adverse outcomes after fetal and perinatal insults unfolded beyond childhood and included adult-onset schizophrenia. The findings have implications for understanding the mechanisms involved in the development of schizophrenia and, possibly, for its prevention.

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Obstetric complications and schizophrenia: a meta-analysis.

David Lawrie, Timothy Geddes (1995)

This systematic review of the association between schizophrenia and obstetric complications (OCs) was performed to assess the degree of heterogeneity between studies and to quantify the increased risk of schizophrenia in exposed subjects. Twenty case-control, one prospective cohort and two historical cohort studies were identified using a MEDLINE search supplemented by a manual search and direct communication with other researchers. Individual odds ratios were calculated for each study and a pooled estimate produced. The effect of methodological variation between studies was further assessed by partitioning studies according to study characteristics. Overall, there was no significant heterogeneity of effect between studies, and the pooled odds ratio for the exposure to OCs on subsequent development of schizophrenia was 2.0 (95% CI 1.6-2.4). However, partitioning according to study design revealed significant heterogeneity (z = -2.60, P < 0.01) between the pooled estimate from the case-control studies and that from the historical cohort studies. There was a gap on the funnel plot in the region of small studies finding no effect. Although the result indicates that subjects exposed to OCs are twice as likely to develop schizophrenia, the analysis suggests that the observed association could be inflated by both selection and publication biases.

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A comparison between ultrasound and a reliable last menstrual period as predictors of the day of delivery in 15,000 examinations.

K Tunón, S H Eik-Nes, P Grøttum (1996)

In a non-selected population comprising 15,241 women, an evaluation was performed of the ultrasonic measurement of the biparietal diameter compared with a reliable last menstrual period as the basis for estimation of the day of delivery. In women with a reliable menstrual history and spontaneous onset of labor, the ultrasound estimate was the significantly better predictor of the day of delivery in 52% of cases, and the last menstrual period estimate was the better predictor in 46% of cases. The percentages of women who delivered within 7 days of the predicted day were 61 and 56% for the ultrasound and the last menstrual period estimations, respectively. There was a significantly narrower distribution of births according to the ultrasound estimate (p < 0.001). The proportion of estimated postterm births was 4% using the ultrasound method and 10% using the last menstrual period method (p < 0.001). Even when the difference between the methods in predicting the day of delivery was less than 7 days, the ultrasound method was better than the last menstrual period method. It is concluded that ultrasonic measurement of the biparietal diameter between 15 and 22 weeks of pregnancy is the best method for the estimation of the day of delivery and should be used as a routine procedure.

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Author and article information

Journal

Journal ID (publisher-id): applab

Title: British Journal of Psychiatry

Abbreviated Title: Br J Psychiatry

Publisher: Royal College of Psychiatrists

ISSN (Print): 0007-1250

ISSN (Electronic): 1472-1465

Publication date Created: November 2001

Publication date (Print): January 2 2018

Volume: 179

Issue: 05

Pages: 403-408

Article

DOI: 10.1192/bjp.179.5.403

SO-VID: 19a4e87c-0dbd-4787-bd3c-fc4a1ff34d31

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