Association Between Paternal Schizophrenia and Low Birthweight: A Nationwide Population-Based Study
Herng-Ching Lin; Chao-Hsiun Tang; Hsin-Chien Lee

Abstract
Using a nationwide population-based dataset, the aim of the present study was to investigate the association between paternal schizophrenia and the risk of low birthweight (LBW). This study linked the 2001 Taiwan National Health Insurance Research Data set with Taiwan's birth and death certificate registries. In total, 220 465 singleton live births were included. The key dependent variable was whether or not an infant's father was diagnosed with schizophrenia, while the independent variable of interest was whether an infant had LBW.

Multivariate logistic regression analysis was performed to explore the relationship between paternal schizophrenia and the risk of LBW, after adjusting for the infant and parents' characteristics. The results show that infants whose fathers had schizophrenia were more likely to have LBW than those whose fathers did not (12.6% vs 8.0%). Infants whose fathers had schizophrenia were found to be 1.58 times more likely to have LBW than their counterparts whose fathers did not have schizophrenia, following adjustment for gestational week at birth, parity, paternal age and highest educational level, family monthly incomes, and marital status. We conclude that the offspring whose fathers had a diagnosis of schizophrenia had increased risk of LBW compared with those whose fathers had no schizophrenia. This finding paves the way for further studies and suggests that there may be potential benefit to early intervention to prevent LBW in pregnant women with husbands with schizophrenia.

Introduction
Increasing attention has been paid to the effect of paternal characteristics on adverse pregnancy outcomes, particularly infant
birthweight, during the past decade. A growing number of studies have reported that paternal characteristics such as age,
height, weight, race, educational level, and occupation were associated with variation in birthweight, after adjusting for maternal and pregnancy-specific factors. Some researchers have suggested that because the placenta is largely dependent the expression of genes of paternal origin, it is biologically plausible that fetal growth is influenced by paternal factors. With regard to mental illness, literature reviews reveal that women with schizophrenia have an increased risk of giving birth to low birthweight (LBW) babies, compared with healthy pregnant women. Still, to the best of our knowledge, few attempts have been made to examine the relationship between paternal mental illness and adverse pregnancy outcomes.

Schizophrenia is considered strongly influenced by genetic inheritance,whether traceable to maternal or paternal schizophrenia. Thus,it seems reasonable to assume that not only children of mothers with schizophrenia but also those with fathers with schizophrenia might be at increased risk of neurodevelopmental impairment. Recently, Webb et al published a study on the association between paternal schizophrenia and fatal birth defects. They used the data on all singleton live births in Denmark during 1973-1998 but found no elevation in risk of fatal birth defects relating to paternal schizophrenia. However, their study measured only severely adverse birth outcomes, and a substantial proportion of the paternal data was missing.

Such limitations preclude unequivocal acceptance of their findings. Using a Taiwan nationwide population-based dataset, the aim of the present study is to investigate the association between paternal schizophrenia and the risk of LBW, after adjusting for the characteristics of infant, mother, and father. LBW is associated not only with neurodevelopmental impairment but also with increased risk of mortality and morbidity in infants, as well as adverse long-term consequences for the child. LBW may be preventable, however. Therefore, exploring the association between paternal schizophrenia and the risk of LBW might not only help researchers understand the possible genetic or environmental mechanisms linking parental mental illness and fetal birth weight but could also generate opportunities for clinicians to provide specific, optimal prenatal care.

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