Epidemiology Obstetric Complications

Question: Discuss about theEpidemiology for Obstetric Complications. Answer: Introduction Obstetric complications imply to the problems and disorders related to pregnancy, labour pain, delivering the child and the early period of the child after birth. It could leave a long time effect on child which affects the brain development in the child. (Ishikawa Raine, 2003). It is considered as one of the major environmental risk factor which causes Schizophrenia. Many studies are conducted in this direction to find the association of complication in the pregnancy phase with the schizophrenia. It is analysed in several studies that the obstetric complication can give rise to the development of schizophrenia. (Cannon, Jones Murray, 2002). It is also observed that if a mother develops schizophrenia after the child birth, the chances of obstetric complications are less whereas in cases where the mother develops schizophrenia before child birth, the chances of obstetric complication are high. (Jablensky et al, 2005). The study conducted by Byrne et al (2007) to investigate the risk of developing schizophrenia with the exposure to conditions leading to schizophrenia. The study was a nested case control on a national level based on the Danish longitudinal registers. A nested control study is designed to observe the disease occurrence in a specified group and compared with a definite number of control who do not show the signs of the disease. This method is cost effective and with lesser relative loss in the statistical efficacy. (Ernster, 1994). They aim to examine the association on a national level using information from the registers collected. The role of confounders like the financial and social status of parents, age of parents, place of the child birth (urban or rural), citizenship of mother and genetic factor i.e. a prehistory of schizophrenia in the family. The outcome of the study expected in this case was to establish a relation between the obstetric complication and risk to schizophreni a. The method involved citizens of Denmark falling in the age group of 15 years and above. The time duration of the study was for 10 years from 1973 t0 1983. The main factor to observe in the selection was that the participants were in contact with the psychiatric facility of Denmark first time during the years 1981 to 1998 for developing ICD-8 till December 1993 or ICD-10 from January 1994 onwards. Both the type of schizophrenia was considered with a maternal identity recorded in the register. These factors were considered for the sampling. A total number of 1039 persons having schizophrenia were registered for the study with around 99% having no paternal identity and 1% with paternal identity not disclosed. 65% of the participants were male. The mean of the age of participants was 19.8. A control of 25 people randomly selected was used for each case considering the facts that they are born in same year with same sex and with no psychiatric disease history. The number of control wa s around 24,826. The database of the family and their status was obtained from the integrated database for longitudinal labour market research. The study was the analysis of the development of the disease in the selected population on exposure. The findings suggest that there is an association of the problems or complications related with pregnancy leads to the risk of developing schizophrenia. Although the role of other factors could not be observed in regards to developing the schizophrenia. They also determined the role of obstetric complication in causing maternal influenza, pre mature birth and bleeding during pregnancy etc. The study conducted by Byrne et al (2007) on the obstetric condition and risk of first admission with schizophrenia in Denmark was an attempt to examine the association of obstetric complication with schizophrenia. The study conducted also took an account of the other factors which are possible reasons to developing schizophrenia. Health of the child depends on the health of mother. If the mother is going through illness it can affect the development of the child causing the disease to develop in the child due to the genetic risk. (Suvisaari et al, 2013). Observation is the most important factor to consider in the epidemiology. Epidemiology involves the skills to recognise the causal relation of the clinical outcomes with the surgical methods and the drugs. (Hyde, 2005). Epidemiology serves the purpose of providing a basis for the formulating disease control and preventive measures. It aims at investigating the frequency and distribution of the disease taking an account of the indivi duals affected, the place, time factors and identifying the possible causes of the disease considering the causal agents, environmental condition and the host. Many explanations are for the observed experimental results are important to notice before determining the possible cause of the disease. The observed associations could be affected by Chance, Bias or Confounding. (PHAST, 2011). To prove whether the observed association between the risk factor and the disease it is required to observe the magnitude of association, consistency of the observations considering different studies on the topic. (Hennekens Buring, 1987). Chance or variable bias must be taken into account. It is important to determine the null hypothesis and calculate the P value to avoid the chances of error. (Buchan, 2000).Confounder is not the involved with association between exposure and disease. It is used to predict the disease. The distribution is unequal and confounding is done for the known studies. (Dr.Gr imes Schulz, 2002). The exposure in this case is shows relation with the outcome in the sense that when conditions causing obstetric complications were introduced, risk of schizophrenia was high. The possibility of getting a outcome before exposure was minimum as the participants were selected having no previous record of psychiatric interventions. The chances of selection bias are less as the selected participants belongs to a particular age group with an average of 19.8 years of age. The selection was based on the registered data. Possibility of measurement bias is there as the study considered the ICD-8 and ICD-10 together. Cases with only ICD-8 were excluded. Yet this cannot pose much difference on the result as there were only 26 such cases. Owing to the large cohort involved in the study, this is not of much significance. The role of confounders is well established. Some of the important factors which were included are the financial and status of the parents, place of birth, education of mother an d family psychiatric history. Although these factors pose no risk of developing schizophrenia. The study was divided into 2 periods one from 1973 to 1983 and other was from 1978 to 1983. The number of cases in the period of 1973-1983 was 700 with a control of 14,713, having no genetic psychiatric interventions history in the family. The only association with the socio-economic and demographic factors had been in case of more than 3 pregnancies compared with the control group having no previous pregnancy case. The p value was less than 1 which shows that the possibility of chance is low. Three types of non causal associations are recognised by the epidemiologist- random occurrence of the chance associations, artifactual associations and indirect associations. To examine the causal association a guideline given by Bradford hill (1965) is followed. It includes the following- Temporality is used to determine the evidences to prove that the outcome does not precede the evidence. Strength of the association is used to determine if it is causal or not. Stronger association signifies a more causal association. Replicability of the observed findings is established considering the findings from other studies. Biological plausibility is important factor to relate the consistency of the study with present biological knowledge. Cessation of exposure is important to observe the change in outcome if the exposure is removed. Dose-response relationship is to be considered to determine the magnitude of the exposure in regards to the disease occurrence. Alternative explanations should be considered before interpreting the result. Specificity is also to be considered to determine whether the effects are generalised or specific. (Lucas McMichael, 2005). Selection or measurement bias can affect the interpretation of the result. It can lead to wrong estimation of association. Exposure means the increased or decreased frequency at which a disease of interest occurs. It could also be related to the environmental factor, life style and health outcomes. Outcome is the result related to various form of exposure. The outcome may be many and different. The exposure is measured taking account of the nature of the exposure, dose, and time. (Penn State, 2016). The data for the exposure can be obtained through questionnaires which can be self administered or personal interviews. Diaries, records, biological measurements, environmental measurements can be used to collect the data. The measurement of the outcome is done by validating the data. The related errors and bias are also considered by the researcher to obtain the correct results. There is strong association between the outcome and the risk. The analysis shows that chances of getting schizophrenia are high if the obstetric conditions are there in pregnancy. Both univariate and multivariate analysis is done and the outcomes are presented in tables showing a high risk due to the exposure. The dose response relationship is there in the study as the numbers of complications are high, the risk is high. The incident risk rate with value more than 2 was considered significant. The consistency in the result is observed in both the periods and in both univariate and multivariate analysis. It is well observed and established by the researcher. The researchers have observed the previous studies and also compared their results with other scientific research and studies done in this regard. Suvisaari et al (2012) observed the relation of obstetric complication in developing schizophrenia in the offspring due to maternal history of schizophrenia. A similar study performed in Australia showed that the effect of schizophrenia have complications in pregnancy. (Jablensky et al., 2005). The study was performed in large cohort and showed positive association. A study in Sweden was to determine the risk factor of developing schizophrenia in children. Both prenatal and post natal risk factors were examined. (Hultman et al., 1999). Risk of development of schizophrenia in case of adults who were born after the obstetric conditions and development of early illness in their case was analysed by O'Callaghan et al (1992), showed that males associated with schizophrenia disease go through obstetric complications in the early phase of their l ife but there was no proper conclusion about the efficiency of the result. Biological plausibility is the analysis factor which determines that the study is biologically correct. The relevance of the study with the present knowledge in science should be established. It is used in the study by comparing the study with other scientific work on the same issue. The study presented in this article is biologically plausible as there are several studies by other scientists in this context which is well analysed by the researcher in the discussion. (Borgert et al., 2006). Schizophrenia in women can lead to several complications in pregnancy. The symptoms of the obstetric complication due to psychiatric condition like depression panic and schizophrenia is common in pregnancy. (Dr. Jaffe, 2004). Pregnancy involves higher risk of schizophrenia and vulnerability in women. (Naomi, 2007). The effects can be severe and can be observed in the child leading to abnormal development of the child's brain. The study incorporated such conditions and the various obstetric factors which can promote the risk of schizophrenia. Generalisability involves applying the study on a large population. It mainly implies to application of the study on the cases and situation which were not involved in the study. (Collis Hussey, 2003). It is important in the survey studies to justify the findings in other samples or groups. (Blanche, Durrheim Painter, 2006). Since the analysis was focused on a particular age group, the generalisability of the result is uncertain. The effect of the general population can vary from the result obtained in this study. The application of the study on general population can be effective considering the larger cohort which was involved in the study. The successful implication cannot be predicted. The group considered by the researcher in the study involved individuals belonging to age group of 15 or above. The individual were selected born during the year 1973 and 1983 having no history of Psychiatric disorder. The selected individuals were taking the facilities of Danish psychiatric centre for the first time having diagnosed with ICD-8 during the year 1981- 1998. The individuals with ICD-10 during the same time period were also included. The maternal identity was an important selection requirement. The mean age of the individuals in the study was 19.8. Although it is important to note that the study was performed on national level with a large cohort. This study was one of the largest studies with a unique method on a mass level. The promotion of such studies in this regard will prove beneficial in developing better and effective measures to control severe diseases and related outcomes. The obstetric complications can cause the development of aggression and schizophrenia in the life span of the person. Better and quality prenatal and perinatal care by the health organisations will help in reducing such complications and prevent the development of disease in the mother and the child. The future research aspect in this regard would be know about the effect of these complication on the brain development of the child and the does the schizophrenia in mother shows similar effect in the baby in future. Identification of the various associated factors which can lead to development of schizophrenia. References Blanche, M. T., Durrheim, K Painter, D. (2006). Putting design into practise. Research in practice: applied methods for the social sciences. 2nd edition. Cape Town, Africa: University of Cape Town Press (pty) ltd. Borgert et al. 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