Obstetric complications

Mothers of preterm infants were also more likely than mothers of full-term infants to have obstetrical complications at the time of delivery. Eighty percent of mothers of preterm infants had three or more obstetrical complications. Possible complications included premature labor, oremature rupture of membranes, prolonged rupture of membranes, Caesarean section, chorioamnionitis, and marginal placenta abruption. In contrast, only one mother of a full-term infant developed obstetrical complications during the perinatal period. 

Patients receiving LT4 therapy who are not maintained in a euthyroid state are at risk for long-term adverse sequelae. In general, overtreatment and a suppressed TSH is more common than undertreatment27 with an elevated TSH. Patients with long-term overtreatment may be at higher risk for atrial fibrillation and other cardiovascular morbidities, depression, and post-menopausal osteoporosis. Patients who are undertreated are at higher risk for hypercholesterolemia and other cardiovascular problems, depression, and obstetric complications. 

O Callaghan E, Larkin C, Kinsella A, Waddington JL. Obstetric complications, the putative familial-sporadic distinction, and tardive dyskinesia in schizophrenia. Br J Psychiatry 1990 157 578-584. 

McNeil, T.F., Cantor-Graae, E., and Weinberger, D.R. (2000) Relationship of obstetric complications and differences in size of brain structures in monozygotic twin pairs discordant for schizophrenia. Am J Psychiatry 157 203-212. 

Patients with adult-onset schizophrenia have been reported to have an increased rate of obstetric complications in both case-control and epidemiological studies (when compared with siblings or community controls) (Jones et ah, 1998 Geddes et ah, 1999 Dal-man et ah, 1999), although not all studies have found this (Done et ah, 1991). A recent reanalysis of the original data from a number of studies found those schizophrenia patients with birth complications to have an earlier age of onset of illness (Verdoux et ah, 1997). 

Blinded scoring of the birth records of 36 patients with COS and 35 sibling controls found no significant differences between the groups (Nicolson et ah, 1999c). Moreover, the rate of complications in the early-onset patients of the NIMH study was similar to that seen in adult-onset patients. These preliminary results, as well as the work of others (Frangou, 1999), suggest that, while obstetric complications may play a role in the development of schizophrenia in some patients, they are not more salient in childhood-onset cases. 

Dalman, C., Allebeck, R, Cullberg, J., Grunewald, C., and Koster, M. (1999) Obstetric complications and the risk of schizophrenia a longitudinal study of a national birth cohort. Arch Gen Psychiatry 56 234-240. 

Nicoison, R., Malaspina, D., Giedd, J.N., Hamburger, S., Lenane, M., Bedwell, J., Berman, A., Susser, E., and Rapoport, J.L. (1999c) Obstetrical complications in childhood-onset schizophrenia. Am J Psychiatry 156 1650-1652... 

There is also evidence that the mothers of schizophrenics have a higher incidence of obstetric complications. Furthermore, schizophrenics have more soft neurological signs and developmental anomalies associated with fetal damage. All these complications occur more frequently in schizophrenics with enlarged ventricles. 

The anti-phospholipid syndrome refers to a range of autoimmune conditions which are characterised by venous or arterial thrombosis, recurrent strokes, pulmonary embolism, recurrent pregnancy loss or obstetric complications and the presence of circulating antibodies with specificity to a range of phospholipids including phosphatidylserine and cardiolipin. The syndrome is the leading cause of vascular thrombosis in children. It sometimes accompanies other autoimmune conditions such as systemic lupus erythematosus (SLE). 

Phelan S. Pregnancy during residency. II. Obstetric complications. Obstet Gynecol 1988 72 431 136. 

Cannon M, Jones PB, Murray RM. 2002. Obstetric complications and schizophrenia Historical and meta-analytic review. Am J Psychiatry 159 1080-1092. 

Nicodemus KK, Marenco S, Batten AJ, Vakkalanka R, Egan MF, et al. 2008. Serious obstetric complications interact with hypoxia-regulated/vascular-expression genes to influence schizophrenia risk. Mol Psychiatry 13 873-877. 

We propose that a redox/antioxidant dysregulation due to GSH deficit could represent a vulnerability factor at the early phase of brain development in at least a subgroup of schizophrenia patients. Combined with other genetic factors and environmental factors, such as stress, obstetrical complications or viral infections, it could favor the development of the disease. The role of the GSH deficit proposed allows integration in a causal way many phenomenological aspects of schizophrenia. It is compatible with both the DA and the glutamate/NMDA hypotheses and with the neuropathological observations. In contrast to... 

Marcelis M, Van Os J, Sham P, Jones P, Gilvarry C, et al. 1998. Obstetric complications and familial morbid risk of psychiatric disorders. Am J Med Genet 81 29-36. 

Dollfus S, Germain-Robin S, Chabot B, Brazo P, Delamillieure P, et al. 1998. Family history and obstetric complications in deficit and nondeficit schizophrenia Preliminary results. Eur Psychiatry 13 270-272. 

Further study has suggested that environmental factors must play a very important role. These factors and their impact are poorly understood at the present time, but they include the possibility of maternal intrauterine viral infections during the gestational period, obstetrical complications during delivery, and perinatal conditions during the early days or months of the patient s life. Essentially, it would appear that schizophrenic patients have a genetic vulnerability to develop the disorder, which is manifested later in life if and when certain environmental conditions occur. 

Contrary to early reports, which were affected by selection bias, later studies suggested that neither epilepsy nor prenatal exposure to antiepileptic drugs is associated with an increased risk of spontaneous abortion or other obstetric complications (169). 

Edema is a relatively frequent finding in normal pregnancy. It appears to be benign and can even be associated with improved obstetric performance (139). Edema, even in the presence of hypertension or proteinuria, is not a useful predictor of obstetric complications (140). These observations are important, in view of the finding that treatment with thiazide diuretics is associated with a reduced birth weight in normotensive pregnant subjects (141). 

Wilkins-Haug L, Gabow PA. 1991. Toluene abuse during pregnancy Obstetric complications and perinatal outcomes. Obstet Gynecol 77 504-509. 

Cocaine is a central nervous system stimulant that inhibits the peripheral re-uptake of catecholamines, leading to increased sympathomimetic activity [115]. Its abuse is associated with a variety of medical problems. These include acute myocardial infarction, cardiac arrhythmias, cerebrovascular accidents, hyperpyrexia and stimulated sympathetic activity, seizures and coma, obstetrical complications, intestinal ischemia, and a variety of psychiatric complications [114-117]. The most prominent renal complication of cocaine abuse is acute renal failure associated with rhabdomy-olysis. 

L Obstetric complications (placental tissue factor activates clotting)... 

Boog, G. (2004). Obstetrical complications and subsequent schizophrenia in adolescent and young adult offsprings is there a relationship Eur. J. Obstet. Gynecol. Reprod. Biol. 114 130—136. 

Several studies have shown that, when hypothyroid women become pregnant and maintain the pregnancy, they carry an increased risk for obstetric complications. Greater risk of abortion, anemia, gestation hypertension (including severe forms of eclampsia and preeclampsia), abrupto placentae and postpartum hemorrhage have been described (Table 113.2). 

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