Obstetric complications are a broad class of deviations from a normal course of events experienced during pregnancy, labour, delivery and the early neonatal period. Studies have attempted to investigate whether any deviation or combination of deviations are related to the subsequent development of schizophrenia. Please also see the topic on maternal illness during pregnancy.

What is the evidence for obstetric complications?

Moderate quality evidence found medium-sized increased risk of psychotic disorders in general (mostly schizophrenia spectrum or non-affective psychosis) following exposure to congenital malformation or polyhydramnios. There were small effects of maternal hypertension, pre-eclampsia or toxaemia, hypoxia, ruptured membranes, blood loss in pregnancy (but not during labour), rhesus-associated factors and incompatibility, asphyxic state, low birth weight (<3000g), gestational age <37 weeks, and birth length <49cm. No associations were found for placental complications, caesarean section, prolonged labour, induced labour, instrument delivery, abnormal presentation, cephalopelvic disproportion, baby being kept in hospital or special care, need for incubator, non-spontaneous delivery, uterine atony, 5min apgar score <7, umbilical cord complications, abnormal fetal heart rate/ rhythm, or ponderal index.

Compared to people with bipolar disorder, moderate quality evidence finds a medium-sized increased risk of ultra high-risk mental states and a small effect of increased risk of schizophrenia following exposure to any obstetric complication.

April 2022

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Obstetric complications are a broad class of deviations from a normal course of events experienced during pregnancy, labour, delivery and the early neonatal period. Studies have attempted to investigate whether any deviation or combination of deviations are related to the subsequent development of bipolar disorder. Teasing out possible effects of obstetric complications is not simple because many other, and often unknown, contributing factors are most probably involved.

What is the evidence for obstetric complications as risk factors for bipolar disorder?

Moderate quality evidence suggests an increased risk of bipolar disorder with both early (<36-37 weeks) and late (>39-40 weeks) gestational age. Low birth weight (<2500g) accompanied by gestational age under 37 weeks may also increase the risk in female, but not male offspring.

There were no associations between bipolar disorder and caesarean section, apgar score, birth presentation, birth type, uterine bleeding, or induced labour.

October 2021

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