Impact of a prenatal episode and diagnosis in women with serious mental illnesses on neonatal complications (prematurity, low birth weight, and hospitalization in neonatal intensive care units)

  • Reda Boukakiou
  • Nine M. C. Glangeaud-Freudenthal
  • Bruno Falissard
  • Anne-Laure Sutter-Dallay
  • Florence GressierEmail author
Original Article


Pregnancy in women with mental disorders is increasingly common. The aim of this study was to determine, in women with severe mental illnesses, whether a prenatal episode was related to neonatal complications and if a specific disorder was associated with a higher risk. A population of infants and their mothers (n = 1439) jointly admitted to psychiatric Mother-Baby Units in France and Belgium (2001–2010) was assessed respectively for prematurity, low birth weight (LBW), hospitalization in neonatal intensive care units (NICUs), and maternal mental health during pregnancy. Logistic regression was used to explore the association between neonatal complications and a prenatal episode of mental illness and if the presence of a specific disorder was related to a higher risk, taking into account maternal socio-demographic characteristics, pregnancy data, and antenatal exposure to psychotropic drugs. Among the children, 145 (10.2%) were premature, 226 (15.8%) had a LBW, and 348 (24.3%) have been hospitalized in neonatology. The presence of an episode of mental illness during pregnancy was linked to LBW (OR = 2.21 [1.44–3.38]; p = 0.003) and NICU hospitalizations (OR = 1.53 [1.06–2.19], p = 0.002). Among diagnoses, the presence of a severe substance use disorder in these women was related to LBW (OR = 2.96 [1.49–5.85]; p = 0.002) and NICU (OR = 2.88 [1.56–5.29]; p = 0.04). Our results underline the importance of systematic and early detection of psychiatric symptoms and substance use disorders during pregnancy in preventing neonatal complications in women with serious mental illness.


Low birth weight NICU hospitalization Pregnancy Prematurity Psychiatric disorder Substance use disorder 



The authors thank the members of MBUs: Bordeaux, Montesson, Strasbourg, Le Vesinet, Créteil, Villejuif, Paris, Brussels, Limoges, Ottiginies, Marseille, Gent, Lille, Besançon, Albi, and Brumath who contributed to data collection, and the women who participated in the study.

Funding information

The study received financial support from the Francophone Marcé Society.

Compliance with ethical standards

All selected women provided informed consent for their inclusion in the database. The study was performed in accordance with the ethics standards of the French National Data Protection Authority (CNIL) which the CNIL approved the study.

Conflicts of interest

Regarding potential conflicts of interest, all of them were indirect:

Reda Boukakiou, Nine Glangeaud-Feudenthal, and Anne-Laure Sutter-Dallay report no financial relationships with commercial interests.

Bruno Falissard has been a consultant, expert, or has given talks for E. Lilly, BMS, Servier, Sanofi, GlaxoSmithKline, HRA, Roche, Boeringer Ingelheim, Bayer, Almirall, Allergan, Stallergene, Genzyme, Pierre Fabre, Astra Zeneca, Novartis, Janssen, Astellas, Biotronik, Daiichi-Sankyo, Gilead, MSD, and Lundbeck. Florence Gressier has given talks for Lundbeck and Servier and received a grant from Servier for a postdoctoral degree (2011–2012).

Supplementary material

737_2018_915_MOESM1_ESM.doc (242 kb)
ESM 1 (DOC 242 kb)


  1. Austin MP, Leader L (2000) Maternal stress and obstetric and infant outcomes: epidemiological findings and neuroendocrine mechanisms. Aust N Z J Obstet Gynaecol 40:331–337CrossRefGoogle Scholar
  2. Behnke M, Eyler FD, Garvan CW, Wobie K (2001) The search for congenital malformations in newborns with fetal cocaine exposure. Pediatrics 107:e74–e74CrossRefGoogle Scholar
  3. Black M, Bhattacharya S, Fairley T, Campbell DM, Shetty A (2013) Outcomes of pregnancy in women using illegal drugs and in women who smoke cigarettes. Acta Obstet Gynecol Scand 92:47–52CrossRefGoogle Scholar
  4. Boardman JD, Powers DA, Padilla YC, Hummer RA (2002) Low birth weight, social factors, and developmental outcomes among children in the United States. Demography 39:353–368CrossRefGoogle Scholar
  5. Bodén R, Lundgren M, Brandt L, Reutfors J, Andersen M, Kieler H (2012) Risks of adverse pregnancy and birth outcomes in women treated or not treated with mood stabilisers for bipolar disorder: population based cohort study. BMJ 345:e7085CrossRefGoogle Scholar
  6. Bonello MR, Xu F, Li Z, Burns L, Austin MP, Sullivan EA (2014) Mental and behavioral disorders due to substance abuse and perinatal outcomes: a study based on linked population data in New South Wales, Australia. Int J Environ Res Public Health 11(5):4991–5005CrossRefGoogle Scholar
  7. Combier E, Gouyon JB, Roussot A, Cottenet J, Quantin C (2014) Increased morbidity and mortality of children born at 35-38 weeks of gestation in metropolitan France. Bull Epidemiol Hebd 34-35:558–566Google Scholar
  8. Conner SN, Bedell V, Lipsey K, Macones GA, Cahill AG, Tuuli MG (2016) Maternal marijuana use and adverse neonatal outcomes. Obstet Gynecol 128:713–723CrossRefGoogle Scholar
  9. Ferraguti G, Ciolli P, Carito V, Battagliese G, Mancinelli R, Ciafrè S, Tirassa P, Ciccarelli R, Cipriani A, Messina MP, Fiore M, Ceccanti M (2017) Ethylglucuronide in the urine as a marker of alcohol consumption during pregnancy: comparison with four alcohol screening questionnaires. Toxicol Lett 275:49–56CrossRefGoogle Scholar
  10. Glangeaud-Freudenthal NC, Sutter AL, Thieulin AC, Dagens-Lafont V, Zimmermann MA et al (2011) Inpatient mother-and-child postpartum psychiatric care: factors associated with improvement in maternal mental health. Eur Psychiatry 26:215–223CrossRefGoogle Scholar
  11. Gressier F, Guillard V, Cazas O, Falissard B, Glangeaud-Freudenthal NM, Sutter-Dallay AL (2017) Risk factors for suicide attempt in pregnancy and the post-partum period in women with serious mental illnesses. J Psychiatr Res 84:284–291CrossRefGoogle Scholar
  12. Harrison W, Goodman D (2015) Epidemiologic trends in neonatal intensive care, 2007-2012. JAMA Pediatr 169:855–862CrossRefGoogle Scholar
  13. Howard LM, Megnin-Viggars O, Symington I, Pilling S; Guideline Development Group (2014) Antenatal and postnatal mental health: summary of updated NICE guidance. BMJ 349:g7394CrossRefGoogle Scholar
  14. Howlett H, Sarah Abernethy S, Brown NW, Rankin J, GrayWK (2017) How strong is the evidence for using blood biomarkers alone to screen for alcohol consumption during pregnancy? A systematic review. Eur J Obstet Gynecol Reprod Biol 213:45–52CrossRefGoogle Scholar
  15. Hwang SS, Diop H, Liu CL, Yu Q, Babakhanlou-Chase H, Cui X, Kotelchuck M (2017) Maternal Substance Use Disorders and Infant Outcomes in the First Year of Life among Massachusetts Singletons, 2003-2010. J Pediatr 191:69–75CrossRefGoogle Scholar
  16. Kelly RH, Russo J, Holt VL, Danielsen BH, Zatzick DF, Walker E, Katon W (2002) Psychiatric and substance use disorders as risk factors for low birth weight and preterm delivery. Obstet Gynecol 100:297–304PubMedGoogle Scholar
  17. Kramer MS (1987) Determinants of low birth weight: methodological assessment and meta-analysis. Bull World Health Organ 65:663–737PubMedPubMedCentralGoogle Scholar
  18. Lee SW, Han YJ, Cho DH, Kwak HS, Ko K, Park MH, Han JY (2018) Smoking exposure in early pregnancy and adverse pregnancy outcomes: usefulness of urinary tobacco-specific nitrosamine metabolite 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol levels. Gynecol Obstet Investig 83:365–374CrossRefGoogle Scholar
  19. Mitchell J, Goodman J (2018) Comparative effects of antidepressant medications and untreated outmcomes: a systematic review. Arch Womens Ment Health 21:505–516. CrossRefGoogle Scholar
  20. Moore E, Blatt K, Chen A, Van Hook J, DeFranco EA (2016) Relationship of trimester-specific smoking patterns and risk of preterm birth. Am J Obstet Gynecol 215:109-e1CrossRefGoogle Scholar
  21. Moutquin JM (2003) Classification and heterogeneity of preterm birth. BJOG Int J Obstet Gynaecol 110:30CrossRefGoogle Scholar
  22. Patrick SW, Dudley J, Martin PR, Harrell FE, Warren MD, Hartmann KE, Ely EW, Grijalva CG, Cooper WO (2015) Prescription opioid epidemic and infant outcomes. Pediatrics 135:842–850CrossRefGoogle Scholar
  23. Pereira PPDS, Da Mata FA, Figueiredo ACG, de Andrade KRC, Pereira MG (2017) Maternal active smoking during pregnancy and low birth weight in the Americas: a systematic review and meta-analysis. Nicotine Tob Res 19:497–505CrossRefGoogle Scholar
  24. Rondó PH, Ferreira RF, Nogueira F, Ribeiro MC, Lobert H, Artes R (2003) Maternal psychological stress and distress as predictors of low birth weight, prematurity and intrauterine growth retardation. Eur J Clin Nutr 57:266–272CrossRefGoogle Scholar
  25. Salmon MP, Appleby A (2000) Predictors of clinical outcome, other outcomes and risk of harm to babies using data from the national audit of mother and baby admissions to psychiatric hospitals. Arch Womens Ment Health 3:107Google Scholar
  26. Salmon MP, Abel K, Webb R, Warburton AL, Appleby L (2004) A national audit of joint mother and baby admissions to UK psychiatric hospitals: an overview of findings. Arch Womens Ment Health 7:65–70CrossRefGoogle Scholar
  27. Schneid-Kofman N, Sheiner E, Levy A (2008) Psychiatric illness and adverse pregnancy outcome. Int J Gynecol Obstet 101:53–56CrossRefGoogle Scholar
  28. Sentilhes L, Sénat MV, Ancel PY, Azria E, Benoist G, Blanc J, Brabant G, Bretelle F, Brun S, Doret M, Ducroux-Schouwey C, Evrard A, Kayem G, Maisonneuve E, Marcellin L, Marret S, Mottet N, Paysant S, Riethmuller D, Rozenberg P, Schmitz T, Torchin H, Langer B (2017) Prevention of spontaneous preterm birth: Guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol 210:217–224CrossRefGoogle Scholar
  29. Singh GK, Kenney MK, Ghandour RM et al (2013) Mental health outcomes in us children and adolescents born prematurely or with low birthweight. Depress Res Treat 2013:570743CrossRefGoogle Scholar
  30. Sutter-Dallay AL, Bales M, Pambrun E, Nine MC, Wisner KL, Verdoux H (2015) Impact of prenatal exposure to psychotropic drugs on neonatal outcome in infants of mothers with serious psychiatric illnesses. J Clin Psychol 76:967–973Google Scholar
  31. The World Health Report (2005) 2005 : Make every mother and child count. World Health Organization, GenevaGoogle Scholar
  32. Thibaut F, Chagraoui A, Buckley L, Gressier F, Labad J, Lamy S, Potenza MN, Marta Rondon M, Rossler A, Mickael Soyka M, Yonkers K (2018) WSBP and IAWMH guidelines for the treatment of alcohol use disorders in pregnant women. World J Biol Psychiatry.
  33. Vittinghoff E, McCulloch CE (2007) Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol 165:710–718CrossRefGoogle Scholar
  34. Walhovd KB, Fjell AM, Brown TT, Kuperman JM, Chung Y, Hagler DJ Jr, Roddey JC, Erhart M, McCabe C, Akshoomoff N, Amaral DG, Bloss CS, Libiger O, Schork NJ, Darst BF, Casey BJ, Chang L, Ernst TM, Frazier J, Gruen JR, Kaufmann WE, Murray SS, van Zijl P, Mostofsky S, Dale AM, for the Pediatric Imaging, Neurocognition, and Genetics Study, Jernigan TL, McCabe C, Chang L, Akshoomoff N, Newman E, Dale AM, Ernst T, Dale AM, van Zijl P, Kuperman J, Murray S, Bloss C, Schork NJ, Appelbaum M, Gamst A, Thompson W, Bartsch H, Jernigan TL, Dale AM, Akshoomoff N, Chang L, Ernst T, Keating B, Amaral D, Sowell E, Kaufmann W, van Zijl P, Mostofsky S, Casey BJ, Ruberry EJ, Powers A, Rosen B, Kenet T, Frazier J, Kennedy D, Gruen J (2012) Long-term influence of normal variation in neonatal characteristics on human brain development. Proc Natl Acad Sci U S A 109:20089–20094CrossRefGoogle Scholar
  35. Wiencrot A, Nannini A, Manning SE, Kennelly J (2012) Neonatal outcomes and mental illness, substance abuse, and intentional injury during pregnancy. Matern Child Health J 16:979–988CrossRefGoogle Scholar
  36. Wright TE, Schuetter R, Tellei J, Sauvage L (2015) Methamphetamines and pregnancy outcomes. J Addict Med 9:111–117CrossRefGoogle Scholar
  37. Yang X, Belin TR, Boscardin WJ (2005) Imputation and variable selection in linear regression models with missing covariates. Biometrics 61:498–506CrossRefGoogle Scholar
  38. Zhao L, McCauley K, Sheeran L (2017) The interaction of pregnancy, substance use and mental illness on birthing outcomes in Australia. Midwifery 54:81–88CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  • Reda Boukakiou
    • 1
  • Nine M. C. Glangeaud-Freudenthal
    • 2
  • Bruno Falissard
    • 3
  • Anne-Laure Sutter-Dallay
    • 4
  • Florence Gressier
    • 1
    • 5
    Email author
  1. 1.Department of Psychiatry, Assistance Publique-Hôpitaux de ParisBicêtre University HospitalLe Kremlin BicêtreFrance
  2. 2.INSERM Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics (U1153)Paris Descartes UniversityParisFrance
  3. 3.Department of Biostatistics, Maison de SolennUniversité Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM U1178Paris Cedex 14France
  4. 4.Research Center Inserm 1219, Bordeaux Population Health Bordeaux University, University Department of Adult PsychiatryCharles-Perrens HospitalBordeauxFrance
  5. 5.Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM U1178Bicêtre University HospitalLe Kremlin BicêtreFrance

Personalised recommendations