Schizophrenia and Pregnancy

 

Schizophrenia Disorder and Pregnancy

“I’m actually one of the few schizophrene who has a boyfriend and a child and lives with them. This is only possible, I think, because I have a realistic conception of my illness and accept help when it is needed.” ~ Mary

schizophrenia-and-pregnancy-early-pregnantThere are many facts about schizophrenia that are not well known.

The majority of people fear and misunderstand the scope of this illness.
Although approximately 2 million people in the U.S. are affected by schizophrenias, it is still a mystery illness.

Schizophrenia is treatable and with the right combination of therapy and medication, people can live fulfilling lives, which includes coping with schizophrenia disorder during pregnancy.

One concern is the development of schizophrenia in the offspring of parents with the disorder.
There is a 1% risk for the general population. However, when one parent has a schizophrenia disorder the risk increases to 13%. When two parents are diagnosed with schizophrenia the risk is increased to 46%.

 

Treatment during Pregnancy


Women coping with schizophrenia will sometimes need to be hospitalized during pregnancy if the symptoms of schizophrenia increase.
This is often true of those who have not adjusted to living on their own.

The first trimester is a very important time for decision making that will affect women who suffer from a severe schizophrenia disorder. Many physicians believe it is best to avoid anti-psychotics between 4 and 10 weeks after conception.

The treatment that will be followed throughout the pregnancy should be re-evaluated at the onset, especially if it is thought that the medications being used will have negative effects on the developing fetus.
Opinions differ on which drugs increase the risk of abnormalities.

Schizophrenia Drugs and Pregnancy

One of the most common misconceptions about schizophrenia is that there is not a schizophrenia treatment available for women who become pregnant. This is not true.pregnancy-and-schizophrenia

There are several that are considered safe and they can help to control psychotic episodes.

It is known that plasma volume is increased during pregnancy as well as the increase in blood flow to the kidneys. Due to numerous liver enzymes that are activated during pregnancy, drugs are transformed more quickly.

This, combined with increased blood flow to the kidneys, helps to eliminate them from the body at a faster rate. Additionally, neurotransmitter receptors are experiencing an increase in the concentration of sex steroids.

This means that many pregnant women may not need a high concentration of drugs to remain free of the symptoms of schizophrenia disorder.

Schizophrenia research shows evidence that older, typical anti-psychotics are less of a risk to the unborn baby than newer medications.
Clozapine is one. This is a medication for schizophrenia treatment. It works by aiding in the restoration of the balance of neurotransmitters in the brain. Clozapine has been shown to reduce hallucinations and help people to think more clearly.

Anti-psychotics

The following are medications that are frequently prescribed for symptoms of schizophrenia and the findings related to taking them during pregnancy.
In addition the medications that are prescribed for conditions that have a high rate of occurrence at the same time as schizophrenia such as depression, anxiety and mood swings are included.

Anti-psychotic medications such as Haldol are often used by pregnant women. This drug has not shown an increased risk to the fetus and is recommended for women who are in a high-risk category for psychotic episodes.

A low-potency anti-psychotic drug is Thorazine. It is not recommended for use during pregnancy because there is an increased risk of the fetus being malformed.

Patients who are taking atypical anti-psychotics such as olanzapine, quetiapine, risperidone and ziprasidone are normally switched to a high-potency anti-psychotic such as Haldol.
Schizophrenia research on these medications and pregnancy is still being conducted and there is not sufficient data to support the affects that may be experienced.

Depression

Medications for depression that are taken in addition to anti-psychotics for schizophrenia include Celexa, Paxil, Prozac and Zoloft.
These are Selective Serotonin Reuptake Inhibitors (SSRIs).

The only one that has been extensively tested for risks in pregnant women is Prozac. Findings do not indicate that it increases complications.
Preliminary tests on the others do not show any risks of malformation in fetuses, but if taken near the time of delivery they may increase the risk of prenatal symptoms such as increased crying, restlessness and tremor.

Tricyclics are used for patients with depression and include medications such as Pamelor and Tofranil.
They are considered among the safest that may be used during pregnancy as they have shown no unfavorable effects on babies.

Medications such as Nardil and Parnate are Monoamine Oxidase Inhibitors (MAOIs) and should not be used during pregnancy. Research has shown they can raise the risk of malformation in fetuses if used during the first trimester.

Anxiety

Medications for anxiety in schizophrenia patients include Benzodiazepines.
The information on these medications varies, but it is thought that they are linked to deficiencies in baby’s muscle tone, hypothermia and feeding troubles.

Mood Stabilizers

The mood stabilizers commonly taken by those with schizophrenia disorder include Lithium. If taken during the first trimester, the risk of development of Ebstein’s Anomaly – a heart defect – is increased 10 times.
Lithium is a tetragen. The use of tetragens during the first trimester has been associated with impeding the development of major organs in the fetus. Lithium, when taken near the time of birth is also thought to be responsible for diminished muscle tone and a bluish skin tint.

Another tetragen that is not recommended during the first trimester is Valproic Acid. It may raise the risk of malformation of the fetus by as much as 4%.

About Schizophrenia, Pregnancy and Stress

Information on schizophrenia and pregnancy does indicate that an untreated schizophrenia disorder can be dangerous to the mother and the baby.


Therefore, it is important to discuss this with the patient’s health care providers if planning to become pregnant or in the event of an unplanned pregnancy.

Discussing whether the medicine that is being taken is more of a danger to the unborn child than not taking the medicine should be priority. If the medicine is stopped, symptoms of schizophrenia may return.

These symptoms can result in the following:

• Not getting the prenatal care needed

• Taking medications that are harmful to the baby

• Not getting the proper nutrition needed

• Substance abuse that can harm the baby

The typical worries of pregnant women who are not suffering from a schizophrenia disorder include their ability to be a mother, the changes that a child will bring (including their relationship with their partner) and the labor and delivery of their baby.

These concerns are all sources of stress for those who are pregnant and women with a diagnosis of schizophrenia often do not handle them well.

As a matter of fact, when a woman with an untreated, serious schizophrenia disorder becomes pregnant, she may deny the fact or believe the unborn baby is a child of the devil or God.
This is especially true when she is near the end of the pregnancy. Women with schizophrenia also sometimes feel there is a threat of someone taking their child if the symptoms of schizophrenia cannot be managed.

Schizophrenia Disorder and Pregnancy – Past and Present

Before the 1950s, sexuality was not as prevalent among unmarried women as it has become today.
The cultural aspects associated with premarital sex and children born out of wedlock were mainly responsible for this because it was considered a disgrace or a mar on the reputation of women who had sex before marriage.
For those with a schizophrenia disorder, the prospects of marriage were slim and this resulted in reduced sexual activity.

pregnancy-and-schizophrenia-2There were on occasion illegitimate pregnancies that occurred while women were institutionalized, but these instances were rare. Schizophrenia statistics show there were more people institutionalized for schizophrenia prior to the 1950s as well.

By the 1990s, the number of people institutionalized for schizophrenia decreased as the success rate of medications for controlling psychotic episodes was higher. The changes contributed to more opportunities for sexual activity and pregnancy.

Schizophrenia research shows that more organized studies have been conducted to confirm ideas about the sexual activity of those with schizophrenia disorder. Before this time the information was mainly theoretical. Today’s schizophrenia statistics are based on studies and research that really only began in the 1980s.

Studies that included both women who were institutionalized and those who were not show the majority of women were sexually active and a large number had multiple partners. This increased the risk of pregnancy because even when the women had access to birth control it was not often considered a priority.

For women with chronic schizophrenia, there was also an increased risk of coerced sex, danger of contracting HIV and poor judgment. Substance abuse is another factor that has been determined to contribute to these problems.

The overall consensus among researchers has been that a decline in mental health for those with a schizophrenia disorder was more prevalent among younger women. It was also higher among women with unwanted pregnancies.

Fertility Rate of Women with Schizophrenia Disorder

The general agreement, based on the results of studies, is that women with a schizophrenia history have lower fertility rates than women who do not have schizophrenia.
One of the mitigating factors may be that women diagnosed with schizophrenia disorder are typically single due to difficulties forming lasting and close relationships.

In spite of this fact women with psychotic disorders have children and they have a higher probability of unplanned pregnancies.

Dangers associated with pregnancy for women with schizophrenia will vary. Prenatal care is not always received as needed. Some studies have shown a higher incidence of tobacco use as well as substance abuse during pregnancy. This increases the risk of low birth weight, preterm delivery, retardation, stillbirth and infant death. Although some women have fewer schizophrenia symptoms during pregnancy, some experience an increase in delusions.

Delusions are common in certain types of schizophrenia.
Sometimes the delusions include women believing they are pregnant when they are not or they may believe they are not pregnant and they actually are.
Delusions are different in males and females. Women are more preoccupied with romantic delusions while men tend to believe in conspiracies and that they are endowed with powers that others do not have.

Estrogen and Schizophrenia

mother-and-childEstrogen appears to have an effect on some women, causing them to feel better during the second half of the menstrual cycle after ovulation. This is when estrogen levels are higher. Studies have also shown that a relapse of schizophrenia symptoms is lower when estrogen levels are higher.
For example, during pregnancy when estrogen levels are high, the rate of relapse is lower. After childbirth, when estrogen levels are lower, the rate of relapse was higher.

Research concerning estrogen as a treatment option for women with schizophrenia is ongoing.

The studies included women who were given estrogen while remaining on the anti-psychotic medication that was prescribed. There was a marked improvement in the positive symptoms of schizophrenia, which included delusions and hallucinations. However, the study did not show a difference in the negative symptoms of schizophrenia.

The long term effects are being studied and if it is proven safe, this may be a viable treatment for women who do not have an improvement in positive symptoms while on common anti-psychotic medications.

The overall health of the child and mother is the ultimate concern for women who have a schizophrenia disorder and become pregnant. While research in this field is still fairly new, there have been promising results according to studies that have been conducted. With continued studies, the chances of finding beneficial treatments are increased.

As quoted above:

“I’m actually one of the few schizophrene who has a boyfriend and a child and lives with them. This is only possible, I think, because I have a realistic conception of my illness and accept help when it is needed.” ~ Mary

For the time being, women who become pregnant can manage the symptoms of schizophrenia with the help of their health care provider, family, friends and support groups.

Their willingness to accept this help is crucial to caring for their children.
As with the research that is ongoing in this field, the recognition of the need for support groups and caseworkers is becoming more common.

However, nationwide there is a huge gap between coordinating efforts of mental health systems and child welfare systems.

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