嚴重精神疾病女性患者的總生育率、不良產科與新生兒結果：一項系統性文獻回顧與統合分析

Abstract

背景：嚴重精神疾病的定義，一般包含思覺失調、躁鬱症及情感性精神疾病等，罹患研究嚴重精神疾病的育齡女性存在著生育力下降與不良產科及新生兒出生結果風險上升的情形，但結果並未完全一致。目的：本研究旨在以人口群的角度，比較嚴重精神疾病育齡女性之總生育率，並探討嚴重精神疾病與孕期併發症、新生兒出生結果之間的相關性。 材料與方法：本研究為一項系統性回顧與統合分析，納入2000年至2024年間國際學術期刊發表的觀察性研究。分析結果包含總生育率、妊娠糖尿病、妊娠高血壓、子癲前症、胎盤早期剝離、胎死腹中、早產、出生時小於妊娠年齡、低出生體重及先天性畸形等具有公共衛生與臨床重要性的指標。 結果：統合分析顯示，嚴重精神疾病育齡女性患者的總生育率顯著低於一般女性，且其妊娠與新生兒併發症的風險有顯著提高。整體風險比在早產、出生時小於妊娠年齡、低出生體重、死產、先天性畸形、妊娠糖尿病與妊娠高血壓等不良後果的風險皆顯著上升。然而，部分結果也顯示出潛在存有發表偏差的現象。 結論：處於育齡之嚴重精神疾病女性患者為不利生殖健康的高風險族群，需整合精神醫療與周產期照護、懷孕期檢查與早期產前篩檢，以及針對精神疾病污名化與該群婦女潛在就醫障礙之公衛介入策略。

Background: Women of severe mental illness (SMI), including schizophrenia, bipolar disorder, and schizoaffective disorder, at childbearing age were found to experience reduced fertility and increased risks of adverse obstetric and neonatal outcomes without full consistency. Objectives: This study aimed to assess the total fertility rate (TFR) in women with SMI and to examine the associations between SMI and pregnancy/neonatal complications. Methods: We conducted a systematic review and meta-analysis of observational studies published in academic journals from 2000 to 2024. Outcomes included TFR, gestational diabetes mellitus, gestational hypertension, preeclampsia, placental abruption, stillbirth, preterm birth, small-for-gestational-age, low birth weight, and congenital malformation. Results: Meta-analysis showed that women with SMI had significantly lower TFR and higher relative risks of gestational and neonatal complications. Pooled risk ratios were elevated for preterm birth, small-for-gestational-age, low birth weight, stillbirth, congenital malformation, gestational diabetes mellitus, and gestational hypertension. However, publication bias was detected for some specific outcomes. Conclusion: Women with SMI represent a high-risk group with reproductive vulnerability. Integrated psychiatric and perinatal care, clinical exams in each trimester, early prenatal screening, and public health strategies addressing the stigma of mental disorders and healthcare service access are urgently needed for this group of people.