Schizophrenia and complications of pregnancy and labor: an individual patient data meta-analysis.

Several epidemiological studies have reported an association between complications of pregnancy and delivery and schizophrenia, but none have had sufficient power to examine specific complications that, individually, are of low prevalence. We, therefore, performed an individual patient meta-analysis using the raw data from case control studies that used the Lewis-Murray scale. Data were obtained from 12 studies on 700 schizophrenia subjects and 835 controls. There were significant associations between schizophrenia and premature rupture of membranes, gestational age shorter than 37 weeks, and use of resuscitation or incubator. There were associations of borderline significance between schizophrenia and birthweight lower than 2,500 g and forceps delivery. There was no significant interaction between these complications and sex. We conclude that some abnormalities of pregnancy and delivery may be associated with development of schizophrenia. The pathophysiology may involve hypoxia and so future studies should focus on the accurate measurement of this exposure.

[1]  L F Burmeister,et al.  A comparison of meta-analytic results using literature vs individual patient data. Paternal cell immunization for recurrent miscarriage. , 1995, JAMA.

[2]  R. Murray,et al.  Schizophrenia after prenatal exposure to 1957 A2 influenza epidemic , 1991, The Lancet.

[3]  S Greenland,et al.  Modeling and variable selection in epidemiologic analysis. , 1989, American journal of public health.

[4]  M Marmot,et al.  Child developmental risk factors for adult schizophrenia in the British 1946 birth cohort , 1994, The Lancet.

[5]  C. Tamminga,et al.  Schizophrenia: Scientific Progress , 1989 .

[6]  R. Murray,et al.  Obstetric complications and age at onset in schizophrenia: an international collaborative meta-analysis of individual patient data. , 1997, The American journal of psychiatry.

[7]  E. O'callaghan,et al.  Obstetric complications in schizophrenia and the validity of maternal recall , 1990, Psychological Medicine.

[8]  P. Jones,et al.  Low Birth Weight and Schizophrenia , 1994, British Journal of Psychiatry.

[9]  D. Weinberger,et al.  From neuropathology to neurodevelopment , 1995, The Lancet.

[10]  K. Dickersin,et al.  Meta-analysis: state-of-the-science. , 1992, Epidemiologic reviews.

[11]  G. Stöber,et al.  Maternal infectious diseases during pregnancy and obstetric complications in the etiology of distinct subtypes of schizophrenia: further evidence from maternal hospital records , 1995, European Psychiatry.

[12]  R. Heun,et al.  The Role of Obstetric Complications in Schizophrenia , 1993, The Journal of nervous and mental disease.

[13]  H. Beckmann,et al.  Schwangerschafts- und Geburtskomplikationen - ihr Stellenwert in der Entstehung schizophrener Psychosen , 1993 .

[14]  L. Stewart,et al.  Systematic Reviews: Obtaining data from randomised controlled trials: how much do we need for reliable and informative meta-analyses? , 1994 .

[15]  N. Breslow,et al.  Statistical methods in cancer research. Vol. 1. The analysis of case-control studies. , 1981 .

[16]  N. E. Breslow.  Statistical Methods in Cancer Research , 1986 .

[17]  R. Murray,et al.  The Familial/Sporadic Distinction as a Strategy in Schizophrenia Research , 1987, British Journal of Psychiatry.

[18]  Klaus P. Ebmeier,et al.  Obstetric complications in DSM -III schizophrenics and their siblings , 1990, The Lancet.

[19]  R. McCreadie,et al.  The Nithsdale Schizophrenia Surveys X: Obstetric Complications, Family History and Abnormal Movements , 1992, British Journal of Psychiatry.

[20]  E. Robins,et al.  Research diagnostic criteria: rationale and reliability. , 1978, Archives of general psychiatry.

[21]  R. Murray,et al.  A neurodevelopmental approach to the classification of schizophrenia. , 1992, Schizophrenia bulletin.

[22]  E. Susser,et al.  Schizophrenia after prenatal exposure to the Dutch hunger winter of 1944–1945 , 1993, Schizophrenia Research.

[23]  A. Farmer,et al.  The Strength of the Genetic Effect , 1994, British Journal of Psychiatry.

[24]  T. Mcneil.  Perinatal risk factors and schizophrenia: selective review and methodological concerns. , 1995, Epidemiologic reviews.

[25]  R. Kendell,et al.  Obstetric Complications and Schizophrenia: A Case Control Study Based on Standardised Obstetric Records , 1996, British Journal of Psychiatry.

[26]  J Benichou,et al.  Attributable risk estimation in case-control studies. , 1994, Epidemiologic Reviews.

[27]  L. Stewart,et al.  From science to practice. Meta-analyses using individual patient data are needed. , 1995 .

[28]  Obstetric complications and schizophrenia: A meta-analysis , 1996, Schizophrenia Research.

[29]  T. Stompe,et al.  Obstetric complications, premorbid and current cognitive functioning in schizophrenics and their same-sex healthy siblings , 1996, Schizophrenia Research.

[30]  S. Cooper.  Schizophrenia after Prenatal Exposure to 1957 A2 Influenza Epidemic , 1992, British Journal of Psychiatry.

[31]  N. Breslow,et al.  The analysis of case-control studies , 1980 .

[32]  O. Gureje,et al.  Early brain trauma and schizophrenia in Nigerian patients. , 1994, The American journal of psychiatry.

[33]  R. Murray,et al.  Neurodevelopmental Schizophrenia: The Rediscovery of Dementia Praecox , 1994, British Journal of Psychiatry.

[34]  E. Cantor-Graae,et al.  Head Circumference in ‘Preschizophrenic’ and Control Neonates , 1993, British Journal of Psychiatry.

[35]  H. Verdoux,et al.  A comparative study of obstetric history in schizophrenics, bipolar patients and normal subjects , 1993, Schizophrenia Research.

[36]  P. Bovet,et al.  Obstetric Complications and Schizophrenia a Case-Control Study , 1994, British Journal of Psychiatry.