Complications obstétricales dans la schizophrénie : étude comparative en population tunisienne

The neurodevelopmental hypothesis in schizophrenia argues that this disorder may be a result of abnormal brain development due to genetic risk and or to environmental injury such as those due to obstetric complications. Very few studies from emerging countries have been published concerning obstetric complications in schizophrenia. However, meteorological, demographic and health factors in most of these countries are different from those in Western countries, and studies in this field may bring more findings. Our objectives were to compare the frequency of obstetric complications in a group of schizophrenic patients compared to two other groups: a group of first-degree relatives and a healthy control group, and to search for the relationships between these complications and the epidemiological and clinical features of schizophrenic patients. The study is a retrospective case-controlled one: a schizophrenic patient group (N = 55, 43 males and 12 females, median age = 30 years) was compared to a group of non-affected first degree relatives (N = 40, 31 males and 9 females, median age = 29 years) and to healthy controls without familial psychiatric history (N = 38, 25 males and 13 females, median age = 29 years), all matched according to age and sex. Obstetric complications were collected at home from the biological mothers at the time of a visit using the McNeil-Sjostrom questionnaire. Schizophrenic patients were clinically assessed using the Positive and Negative Symptoms (PANSS), the General Assessment of Functioning (GAF) and the Clinical Global Impressions (CGI). Obstetric complications frequency was significantly higher in schizophrenic patients: 67,3 versus 20,0% in their non affected relatives and 28,9% in the healthy controls (P < 0,001). The mean total score of obstetric complications was significantly higher in the schizophrenic group: 1,52 ± 1,47 versus 0,8 ± 1,77 in the non affected relatives and 0,5 ± 0,97 in the healthy controls (P < 0,001). In the schizophrenic patients, obstetric complications were more frequent during delivery period (50,9%) and neonatal period (45,5 %). More particularly in pre-term births (21,8%), low birth weight and fetal distress (18,2%) and premature rupture of the membranes (16,4%). A statistical relationship was established between obstetric complications frequency, autumn-wintry birth season, low school level and negative symptoms in the PANSS. However, no significant correlation was found between obstetric complications frequency, family psychiatric history and age of onset of schizophrenia. Through an investigation involving mental recall, our results proved a higher frequency of obstetric complications in schizophrenic patients. Our results support the role of obstetric complications in the etio-pathology of schizophrenia, in interaction with other environmental or genetic factors. This association favors the neuro-developmental hypothesis in schizophrenia. Further studies assessing influence of weather, specific infectious agents, and demographic factors could also be relevant.