Fertility and pregnancy in women with psychotic disorders

The majority of women with psychotic disorders have children but their pregnancies are at an increased risk of obstetric and psychiatric complications. This paper reviews research into the fertility of women with psychosis and complications occurring during their pregnancies and in the postpartum period. Mesh terms were used to search electronic databases (Medline, Embase, Psychlit and the Cochrane database of systematic reviews). Recent studies have confirmed earlier findings of a low fertility in women with schizophrenia, though fertility is less affected by mood disorders. Psychotic relapse during pregnancy is rare but women with a history of mood disorders (affective psychoses) are at high risk of postpartum relapse. There is a high risk of obstetric complications, mixed evidence of stillbirths and neonatal deaths and there is some weaker evidence of an association with sudden infant death syndrome. A significant proportion of mothers with psychotic disorders have parenting difficulties and lose custody of their infant. Close liaison between all health professionals during pregnancy and postpartum is essential for optimal management of these high risk pregnancies.