Obstetric complications predict treatment response in first-episode schizophrenia

Background. Understanding the role of obstetric complications (OCs) in schi zophrenia could potentially shed light on the heterogeneity in the aetiolog y and course of schizophrenia. Many investigators have reported an associat ion between OCs and schizophrenia, but few have examined the association be tween OCs and treatment outcome. We investigated this question in a sample of patients studied during their first episode of schizophrenia, schizoaffe ctive or schizophreniform disorder. Method. OC histories were obtained for 59 patients participating in the Hil lside First Episode Study. Cox proportional hazards regression analysis was used to estimate the effect of OCs on treatment response during the first episode of schizophrenia. Results. Twelve of the 59 patients (20 %) had positive histories of OCs. Th is group exhibited lower rates of treatment response than those with negati ve OC histories (hazard ratio controlling for sex = 0.28; 95 % CI = 0.13, 0 .62). The positive OC group also had significantly greater lateral ventricl e volume, baseline disorganization and number of live births. The effect of OC history on treatment response held when these three variables were cont rolled for. Conclusion. A history of obstetric complications predicted poor response to treatment in the first episode of schizophrenia. This large effect was bas ed on a small sample of 59 patients. Thus, replication is called for.