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Am J Psychiatry 1997; 154:1220-1227
Copyright © 1997 by American Psychiatric Association
Obstetric complications and age at onset in schizophrenia: an international collaborative meta-analysis of individual patient data
H Verdoux, JR Geddes, N Takei, SM Lawrie, P Bovet, JM Eagles, R Heun, RG McCreadie, TF McNeil, E O'Callaghan, G Stober, MU Willinger, P Wright and RM Murray
Department of Psychiatry, Universite Victor Segalen Bordeaux 2, France.
OBJECTIVE: An excess of obstetric complications in the histories of
schizophrenic patients is a well-replicated finding, but less consistent
results have been found concerning the relationships between obstetric
complications and family history of schizophrenia, age at onset of
schizophrenia, and gender. Small sample size limited the power of previous
studies that attempted to assess such relationships. The aim of this study
was to use data on individual patients from all available studies to
examine the links between a history of obstetric complications and family
history of schizophrenia, age at onset, and gender. METHOD: Raw data from
854 schizophrenic patients concerning history of obstetric complications
rated according to the Lewis and Murray scale were obtained from 11
different research groups. Weighted average estimates were calculated with
the use of regression techniques. RESULTS: A significant association was
found between age at onset of schizophrenia and obstetric complications:
the earlier the age at onset, the more likely the history of obstetric
complications. Subjects with onset of schizophrenia before age 22 were 2.7
times more likely than those with onset at a later age to have had a
history of abnormal presentation at birth and 10 times more likely to have
had a history of complicated Cesarean birth. No association was found
between obstetric complications and family history of schizophrenia or
gender. CONCLUSIONS: The association between obstetric complications and
early age at onset of schizophrenia indicates that the pathophysiology of
early-onset schizophrenia involves neurodevelopmental impairment.
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