Obstetric Complications and Psychosis Risk Factors

Obstetric complications encompass adverse events during pregnancy, labour and delivery that can disrupt foetal development and brain maturation. Such events include perinatal asphyxia, severe hypoxia, pre-eclampsia and premature birth, each of which may trigger inflammatory responses and oxidative stress in the developing nervous system. A growing body of evidence links these complications to an elevated risk for psychotic disorders, notably schizophrenia and bipolar affective disorder with psychotic features. Central to this association is the neurodevelopmental model, which posits that early insults alter trajectories of neuronal migration, synaptic pruning and myelination, thereby sensitising neural circuits to later environmental or genetic challenges. Gene–environment interactions further refine this picture, as variants implicated in psychosis susceptibility often converge on pathways involved in hypoxia response and epigenetic regulation. Clinically, markers such as intracranial volume, regional brain morphometry and cognitive performance have been associated with a history of obstetric trauma, underscoring the lasting impact on brain structure and function. By elucidating the molecular and cellular mechanisms bridging perinatal adversity with psychosis risk, researchers aim to inform preventive strategies and optimise perinatal care worldwide.

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Obstetric Complications and Psychosis Risk Factors publication trend

The graph below shows the total number of articles in obstetric complications and psychosis risk factors across all publications each year (not limited to Nature Index journals).

Technical terms

Obstetric complications: Adverse events during pregnancy, labour or delivery that pose risk to foetal development and neonatal health.

Perinatal asphyxia: Oxygen deprivation of the foetal or neonatal brain occurring around the time of birth, leading to hypoxic injury.

Epigenetic modifications: Heritable changes in gene expression without alteration of the DNA sequence, including DNA methylation and histone modification.

Neurodevelopment: The process by which the nervous system forms, grows and matures from embryonic stages through early adulthood.

Gene–environment interaction: The dynamic interplay whereby genetic predispositions and environmental exposures jointly influence the risk of disease.

Intracranial volume (ICV): The total volume enclosed within the skull, used as a marker of overall brain growth.

Hypoxia-inducible factors (HIFs): Transcription factors activated under low-oxygen conditions that regulate adaptation to hypoxic stress.

References

1. Divergent epigenetic responses to perinatal asphyxia in severe mental disorders. Translational Psychiatry (2024).
2. Asphyxia at birth affects brain structure in patients on the schizophrenia-bipolar disorder spectrum and healthy participants. Psychological Medicine (2020).
3. Analysis of GWAS-Derived Schizophrenia Genes for Links to Ischemia-Hypoxia Response of the Brain. Frontiers in Psychiatry (2020).
4. Environmental Risk Factors for Schizophrenia and Bipolar Disorder and Their Relationship to Genetic Risk: Current Knowledge and Future Directions. Frontiers in Genetics (2021).
5. How do established developmental risk-factors for schizophrenia change the way the brain develops?. Translational Psychiatry (2021).
6. Obstetric complications and intelligence in patients on the schizophrenia-bipolar spectrum and healthy participants. Psychological Medicine (2019).