Hostname: page-component-7d8f8d645b-p72pn Total loading time: 0 Render date: 2023-05-29T05:47:52.569Z Has data issue: false Feature Flags: { "useRatesEcommerce": true } hasContentIssue false
  • English

Obstetric Complications and Schizophrenia: A Meta-Analysis

Published online by Cambridge University Press:  02 January 2018

John R. Geddes  and
Stephen M. Lawrie
John R. Geddes*
Affiliation:
University Department of Psychiatry, Warneford Hospital, Oxford
Stephen M. Lawrie
Affiliation:
Kennedy Tower, Royal Edinburgh Hospital, Edinburgh
*
Dr Geddes, University Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX
Get access Rights & Permissions[Opens in a new window]

Abstract

Background

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.

Method

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.

Results

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.

Conclusions

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.

Type
Papers
Information
The British Journal of Psychiatry , Volume 167 , Issue 6 , December 1995 , pp. 786 - 793
Copyright
Copyright © 1995 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.Google ScholarPubMed
Bourgeois, M. & Verdoux, H. A. (1993) A comparative study of obstetric history in schizophrenics, bipolar patients and normal subjects. Schizophrenia Research, 9, 67–69.Google Scholar
Buka, S. L., Tsuang, M. T. & Lipsitt, L. P. (1993) Pregnancy/delivery complications and psychiatric diagnosis: a prospective study. Archives of General Psychiatry, 50, 151–156.CrossRefGoogle ScholarPubMed
Coughlin, S. S., Benichou, J. & Weed, D. L. (1994) Attributable risk estimation in case-control studies. Epidemiologic Reviews, 16, 51–64.CrossRefGoogle ScholarPubMed
De Lisi, L. E., Goldin, L. R., Maxwell, E., et al (1987) Clinical features of illness in siblings with schizophrenia or schizoaffective disorder. Archives of General Psychiatry, 44, 891–896.CrossRefGoogle Scholar
Done, D. J., Johnstone, E. C., Frith, C. D., et al (1991) Complications of pregnancy and delivery in relation to psychosis in adult life: data from the British perinatal mortality survey sample. British Medical Journal, 202, 1576–1580.CrossRefGoogle Scholar
Eagles, J. M., Gibson, I., Bremner, M. H., et al (1990) Obstetric complications in DSM–III schizophrenics and their siblings. Lancet, 335, 1139–1141.CrossRefGoogle ScholarPubMed
Goodman, R. (1988) Are complications of pregnancy and birth causes of schizophrenia? Developmental Medicine and Child Neurology, 30, 391–406.CrossRefGoogle ScholarPubMed
Greenland, S. (1987) Quantitative methods in the review of epidemiologic literature. Epidemiologic Reviews, 9, 1–30.CrossRefGoogle ScholarPubMed
Günther-Genta, F., Bovet, P. & Hohlfeld, P. (1994) Obstetric complications and schizophrenia: a case control study. British Journal of Psychiatry, 164, 165–170.CrossRefGoogle ScholarPubMed
Gureje, O., Bamidele, R. & Raji, O. (1994) Early brain trauma and schizophrenia in Nigerian patients. American Journal of Psychiatry, 151, 368–371.Google ScholarPubMed
Heun, R. & Maier, W. (1993) The role of obstetric complications in schizophrenia. Journal of Nervous and Mental Disease, 181, 220–226.CrossRefGoogle Scholar
Jacobsen, B. & Kinney, D. K. (1980) Perinatal complications in adopted and non-adopted schizophrenics and their controls: preliminary results. Acta Psychiatrica Scandinavica, 285 (supplement), 337–346.CrossRefGoogle Scholar
Kety, S. S., Rosenthal, D., Wender, P. H., et al (1975) Mental illness in the biological and adoptive families of adopted individuals who have become schizophrenic: A preliminary report based on psychiatric interviews. In Genetic Research in Psychiatry (eds Fieve, R. R., Rosenthal, D. & Brill, H.). Baltimore: Johns Hopkins University Press.Google Scholar
Kinney, D. K., Yurgelun-todd, D. A., Waternaux, C. M., et al (1994) Obstetrical complications and trail-making deficits discriminate schizophrenics from unaffected siblings and controls. Schizophrenia Research, 12, 63–73.CrossRefGoogle ScholarPubMed
Lewis, S. W. (1989) Congenital risk factors for schizophrenia. Psychological Medicine, 19, 5–13.CrossRefGoogle Scholar
Lewis, S. W. & Murray, R. M. (1987) Obstetric complications, neurodevdopmental deviance, and risk of schizophrenia. Journal of Psychiatric Research, 21, 413–421.CrossRefGoogle ScholarPubMed
Lewis, S. W., Owen, M. J. & Murray, R. M. (1989) Obstetric complications and schizophrenia: methodology and mechanisms. In Schizophrenia: Scientific Progress (eds Schulz, S. C. & Tamminga, C. A.), pp 56–68. New York: Oxford University Press.Google Scholar
McCreadie, R. G., Hall, D. J., Berry, I. J., et al (1992) The Nithsdale schizophrenia surveys. X: obstetric complications, family history and abnormal movements. British Journal of Psychiatry, 160, 799–805.CrossRefGoogle ScholarPubMed
McNeil, T. F. (1988) Obstetric factors and perinatal injuries. In Handbook of Schizophrenia: Nosology, Epidemiology and Genetics (eds Tsuang, M. T. & Simpson, J. C.). New York: Elsevier Science.Google Scholar
McNeil, T. F. & Kaij, L. (1978) Obstetric factors in the development of schizophrenia: complications in the births of preschizophrenics and in reproduction by schizophrenic parents. In The Nature of Schizophrenia (eds Wynne, L. C., Cromwell, R. L. & Matthyses, S.). New York: John Wiley.Google ScholarPubMed
Mednick, S. A. & Cannon, T. D. (1991) Fetal development, birth and the syndromes of adult schizophrenia. In Fetal Development and Adult Schizophrenia (eds Mednick, S. A., Cannon, T. D., Barr, C. E., et al). Cambridge: Cambridge University Press.Google ScholarPubMed
Morrison, J. J. & Sackett, G. A. (1993) Obstetric complications and schizophrenia. British Medical Journal, 306, 268.CrossRefGoogle Scholar
Murray, R. M. (1994) Neurodevelopmental schizophrenia: the rediscovery of dementia praecox. British Journal of Psychiatry, 165 (supplement 25), 6–12.Google Scholar
O'Callaghan, E., Gibson, T., Colohan, H. A. (1992) Risk of schizophrenia in adults born after obstetric complications and their association with early onset of illness: a controlled study. British Medical Journal, 305, 1256–1259.CrossRefGoogle ScholarPubMed
Parnas, J., Schulsinger, F. & Teasdale, T. W. (1982) Perinatal complications and clinical outcome within the schizophrenia spectrum. British Journal of Psychiatry, 140, 416–420.CrossRefGoogle ScholarPubMed
Pearlson, G. D., Garbacz, D. J., Moberg, P. J., et al (1985) Symptomatic, familial, perinatal and social correlates of computerized axial tomography changes in schizophrenics and bipolars. Journal of Nervous and Mental Disease, 173, 42–50.CrossRefGoogle ScholarPubMed
Pollack, M. & Greenberg, I. M. (1966) Paranatal complications in hospitalized schizophrenic and non-schizophrenic patients. Journal of the Hillside Hospital, 15, 191–204.Google Scholar
Pollack, M., Woerner, M. G., Goodman, W., et al (1966) Childhood development patterns of hospitalized adult schizophrenic and non-schizophrenic patients and their siblings. American Journal of Orthopsychiatry, 36, 510–517.CrossRefGoogle Scholar
Reddy, R., Mukherjee, S. & Schnur, D. (1989) Pregnancy and birth complications and premorbid functioning in schizophrenic and bipolar patients. Biological Psychiatry, 25, 93A.CrossRefGoogle Scholar
Rifkin, L., Lewis, S., Jones, P., et al (1994) Low birth weight and schizophrenia. British Journal of Psychiatry, 165, 357–362.CrossRefGoogle Scholar
Schwarzkopf, S. B., Nasrallah, H. A., Olson, S. C., et al (1989) Perinatal complications and genetic loading in schizophrenia: preliminary findings. Psychiatry Research, 27, 233–239.CrossRefGoogle ScholarPubMed
Spitzer, R. L., Endicott, J. & Robins, E. (1978) Research diagnostic criteria: rationale and reliability. Archives of General Psychiatry, 35, 773–782.CrossRefGoogle ScholarPubMed
Stöber, G., Franzek, E. & Beckmann, H. (1993) Schwangerschafts- und Geburtskomplikationen – ihr Stellenwert in der Entstehung schizophrener Psychosen. Fortschritte der Neurologie-Psychiatrie, 61, 329–337.CrossRefGoogle Scholar
Thompson, S. G. & Pocock, S. J. (1991) Can meta-analysis be trusted? Lancet, 338, 1127–1130.CrossRefGoogle ScholarPubMed
Turner, S. W., Toone, B. K. & Brett-Jones, J. R. (1986) Computerized tomographic scan changes in early schizophrenia –preliminary findings. Psychological Medicine, 16, 219–225.CrossRefGoogle ScholarPubMed
Verdoux, H. & Bourgeois, M. (1993) A comparative study of obstetric history in schizophrenics, bipolar patients and normal subjects. Schizophrenia Research, 9, 67–69.CrossRefGoogle ScholarPubMed
Woerner, M. G., Pollack, M. & Klein, D. F. (1973) Pregnancy and birth complications in psychiatric patients: a comparison of schizophrenic and personality disorder patients with their siblings. Acta Psychiatrica Scandinavica, 49, 712–721.CrossRefGoogle ScholarPubMed
Submit a response

eLetters

No eLetters have been published for this article.