Mental Health Linked To Newborn Deaths

Mothers with any form of serious mental illness are more likely to have children who are stillborn or who die within the first month. But the links between the causes of stillbirth and newborn death depend on the type of mental illness of the mother. Many perinatal deaths have been found in babies of women with psychiatric inpatient histories across a range of psychiatric illnesses, including schizophrenia and related disorders, bipolar and other affective disorders, and substance-abuse disorders.

Link between maternal mental health and newborn deaths

Researchers at the centre for women’s mental health at The University of Manchester (2008) revealed that women with a history of serious mental illness are much more likely to have babies that are stillborn or die within the first month of life. The results of the study put forth that the risk of stillbirth for women with schizophrenia was twice as high as healthy mothers, while women with affective disorders were also more than twice as likely to give birth to stillborn babies.

Women with other psychotic illnesses, including mood-affective disorders, manic depression and drug and alcohol addiction, were also shown to have a much greater risk of stillborn and newborn deaths. The risk of stillbirth due to complications during delivery among women with drug and alcohol problems was more than double that of healthy women.

Sudden infant death syndrome and parental mental illness

Sudden infant death syndrome (SIDS) is the most common cause of post neonatal death in developed countries. A SIDS case is recorded when a sudden unexpected death in infancy occurs but a thorough postmortem examination and scene-of-death inquiry are unable to determine a specific cause of death. Many risk factors for SIDS have been identified, one of which is maternal schizophrenia.

A Danish population-based study supported by Danish Medical Research Council (2001) reported a 5-fold higher risk in infants whose mothers have schizophrenia. Other studies have found an increased risk of SIDS with postnatal depression. In a study published in the Journal of Clinical Psychology, researchers put forth that depression during pregnancy, and after birth, is associated with SIDS, particularly if the mother is depressed in the year before delivery. Factors mediating the association between maternal depression and SIDS need further investigation.

High risk of neonatal death with alcohol dependence

Another Danish population-based study published in American Journal of Psychiatry (2006) found that among parents with a variety of psychiatric disorders, the highest risk of death was found in infants whose mothers had been admitted for an alcohol- or drug-related disorder. In this study, researchers investigated sudden infant death syndrome, in infants whose parents had been admitted as psychiatric inpatients.

The results showed that psychiatric admission history in either parent doubled the risk of sudden infant death syndrome, but there was no difference in risk whether infants were exposed to maternal or paternal admission. Risk was particularly high if both parents had been admitted for any psychiatric disorder. Among specific parental disorders, the greatest risk was associated with admission for alcohol- or drug-related disorders.

It was concluded that infants whose parents have been admitted for psychiatric treatment are at greater risk for sudden infant death syndrome. However, risks may be lower than previously thought with maternal schizophrenia and related disorders.

Innovative targeted programs for women with psychiatric illnesses

Such women are often remote from mainstream society, experience a great deal of social isolation and withdrawal, and are unable or unwilling to access established community resources.

Conventional community programs may not work in this group of women, so other innovative ways should be found for such cases. Doctors are currently exploring the acceptability and feasibility of delivering targeted parenting programs to women with serious mental illness to help improve outcomes.

One successful outreach program for hard-to-access and vulnerable families is the Nurse-Family Partnership (NFP) program, a Louisiana-based initiative that targets low-income, first-time teenage mothers to improve outcomes for the women and their children. These programs require adequate funding to provide support and resources to mentally ill patients. Research is still ongoing and appropriate care is a must for better outcomes of these vulnerable women and their families.

Psychoactive medication during pregnancy

Teratogenesis and other adverse events can occur in the fetus or newborn, and other varying degrees of concern exist when any drug is prescribed during pregnancy. Drug treatment is indicated if psychotherapy is inadequate or inappropriate for the patient's severity of illness. Exposure to certain drugs in utero may increase the risk for some specific congenital anomalies or even fetal death, but the rate of occurrence of these anomalies even with the increased risk remains low.

Use of medications during pregnancy is appropriate in many clinical conditions and should include thoughtful weighing of risk of prenatal exposure versus risk of relapse following drug discontinuation. Once a decision to offer pharmacotherapy is made, important factors in drug selection for the mother include efficacy of the drugs available, the anticipated response of the individual patient, and the overall toxicity profile of the drug for the mother and fetus.