Rochon-Terry Geneviève, Gruneir Andrea, Seeman Mary V, Ray Joel G, Rochon Paula, Dennis Cindy-Lee, Grigoriadis Sophie, Fung Kinwah, Kurdyak Paul A, Vigod Simone N
Queen's University, Kingston, Ontario, Canada.
J Clin Psychiatry. 2016 Apr;77(4):541-7. doi: 10.4088/JCP.14m09697.
Almost 50% of women with schizophrenia become pregnant. Little is known about their psychiatric service use patterns during or shortly after pregnancy.
Using health administrative data, we identified 1,433 women in Ontario, Canada, with schizophrenia (ICD-9, ICD-10, or DSM-IV-TR) who had a live birth delivery from January 2003 through March 2011 and described their use of acute psychiatric care services including hospitalizations, emergency department visits not requiring hospitalization, and self-harm-related emergency department visits during pregnancy and in the first 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 are presented as incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Similar comparisons were made for psychiatric emergency department visits not requiring hospitalization, as well as for self-harm-related emergency department visits.
About 12% of the women had at least 1 psychiatric hospitalization during pregnancy, and 19% in the first year postpartum. About 10% had at least 1 psychiatric emergency department visit without hospitalization during pregnancy, and 16% had at least 1 emergency department visit postpartum. Self-harm-related emergency department visits were rarer, affecting only about 1% of the 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), which is 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 to 29 postpartum (0.87; 95% CI, 0.56-1.24). Emergency department visits for psychiatric and self-harm reasons were consistently lower during pregnancy and postpartum compared to the year before conception.
Psychiatric hospitalizations and emergency department 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.
近50%的精神分裂症女性会怀孕。关于她们在孕期或产后不久的精神科服务使用模式，人们了解甚少。
利用卫生行政数据，我们在加拿大安大略省识别出1433名患有精神分裂症（国际疾病分类第九版、第十版或精神疾病诊断与统计手册第四版修订版）且在2003年1月至2011年3月期间有活产分娩的女性，并描述了她们在孕期及产后第一年对急性精神科护理服务的使用情况，包括住院治疗、无需住院的急诊科就诊以及与自残相关的急诊科就诊。将孕期及产后1年内精神科住院的发生率分别与受孕前1年期间精神科住院的发生率进行比较。结果以发生率比（IRR）和95%置信区间（CI）呈现。对无需住院的精神科急诊科就诊以及与自残相关的急诊科就诊进行了类似比较。
约12%的女性在孕期至少有1次精神科住院治疗，产后第一年为19%。约10%的女性在孕期至少有1次无需住院的精神科急诊科就诊，产后有16%的女性至少有1次急诊科就诊。与自残相关的急诊科就诊较为少见，在每个时间段仅影响约1%的女性。相对于受孕前1年期间（每100人年50次），孕期精神科住院的发生率较低（每100人年25次），这相当于发生率比为0.50（95%CI，0.43 - 0.60）。虽然产后1年期间精神科住院的发生率比更低（0.66；95%CI，0.57 - 0.76），但在产后的前9天短暂升高（3.59；95%CI，2.74 - 4.69），然后在产后第10至29天下降（0.87；95%CI，0.56 - 1.24）。与受孕前一年相比，孕期和产后因精神科及自残原因的急诊科就诊持续较低。
对于患有精神分裂症的女性，孕期和产后精神科住院及急诊科就诊并不罕见。然而，除分娩后的短暂时期外，与受孕前1年相比，患有精神分裂症的女性在孕期及产后1年内需要急性精神科住院和急诊护理的风险相对较低。这是为患有精神分裂症的女性、其家人以及就怀孕、为人母和精神分裂症管理提供咨询的医护人员提供的关键预后信息。确定围产期有需要急性精神科服务风险的女性值得进一步研究。
