General and age-specific fertility rates in non-affective psychosis: population-based analysis of Scottish women

Angus MacBeth* (Corresponding Author), Paula McSkimming, Sohinee Bhattacharya, John Park, Andrew Gumley, David St Clair, Sarah J.E. Barry

*Corresponding author for this work

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Purpose: Women diagnosed with non-affective psychosis have a lower general fertility rate (GFR) and age-specific fertility rate (ASFR) than women in the general population.
Contemporary data on GFR in this group remains limited, despite substantive changes in prescribing and management. We calculated contemporary estimates of the GFR and ASFR for women diagnosed with non-affective psychosis compared with the general population of women without this diagnosis.
Methods: A population-based design combined routinely collected historical maternity and psychiatric data from two representative areas of Scotland. Women were included from the NHS Grampian or Greater Glasgow and Clyde areas and were aged 15-44 between 2005 and 2013 inclusive. The 'exposed' group had a diagnosis of non-affective psychosis (ICD-10 F20 – F29) and were compared to the general population of 'unexposed' women in the same geographical areas.
Results: Annual GFR between 2005 and 2013 for women with non-affective psychopsis varied from 9.6 – 21.3 live births/1000 women per year in the exposed cohort and 52.7 to 57.8 live births/1000 women per year in the unexposed cohort, a Rate Ratio (RR) of 0.28 (p < 0.001; 95% CI (0.24, 0.32). ASFR for all 5-year age groups was lower in the exposed cohort than amongst unexposed women.
Conclusion: We highlight continued low fertility rates in women with a diagnosis of nonaffective psychosis, despite widespread availability of prolactin-sparing atypical antipsychotics. Accurate estimation of fertility rates remains crucial in developing needs matched perinatal care for these women. Methodological improvements using routine datasets to investigate perinatal mental health are also urgently needed.
Original languageEnglish
Pages (from-to)105-112
Number of pages8
JournalSocial Psychiatry and Psychiatric Epidemiology
Issue number2
Early online date1 Jun 2022
Publication statusPublished - 1 Feb 2023

Bibliographical note

The study was funded by Chief Scientist Office, Scottish Government Health and Social Care Directorate (Grant CZH/4/951), NHS Research Scotland (NHS Research Scotland Career Research Fellowship).

Data Availability Statement

The online version contains supplementary material available at


  • Schizophrenia
  • Fertility
  • Women
  • Antipsychotics
  • psychotic Disorders


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