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Obstetrical, pregnancy and socio-economic predictors for new-onset severe postpartum psychiatric disorders in primiparous women

Published online by Cambridge University Press:  23 January 2017

S. Meltzer-Brody ,
M. L. Maegbaek ,
S. E. Medland ,
W. C. Miller ,
P. Sullivan  and
T. Munk-Olsen
S. Meltzer-Brody*
Affiliation:
Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
M. L. Maegbaek
Affiliation:
National Center for Register-based Research, Aarhus University, Aarhus, Denmark
S. E. Medland
Affiliation:
Quantitative Genetics, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
W. C. Miller
Affiliation:
Department of Epidemiology, The Ohio State University, Columbus, OH, USA
P. Sullivan
Affiliation:
Departments of Genetics and Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
T. Munk-Olsen
Affiliation:
National Center for Register-based Research, Aarhus University, Aarhus, Denmark
*
*Address for correspondence: S. Meltzer-Brody, M.D., M.P.H., Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. (Email: samantha_meltzer-brody@med.unc.edu)
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Abstract

Background

Childbirth is a potent trigger for the onset of psychiatric illness in women including postpartum depression (PPD) and postpartum psychosis (PP). Medical complications occurring during pregnancy and/or childbirth have been linked to postpartum psychiatric illness and sociodemographic factors. We evaluated if pregnancy and obstetrical predictors have similar effects on different types of postpartum psychiatric disorders.

Method

A population-based cohort study using Danish registers was conducted in 392 458 primiparous women with a singleton delivery between 1995 and 2012 and no previous psychiatric history. The main outcome was first-onset postpartum psychiatric episodes. Incidence rate ratios (IRRs) were calculated for any psychiatric contact in four quarters for the first year postpartum.

Results

PPD and postpartum acute stress reactions were associated with pregnancy and obstetrical complications. For PPD, hyperemesis gravidarum [IRR 2.69, 95% confidence interval (CI) 1.93–3.73], gestational hypertension (IRR 1.84, 95% CI 1.33–2.55), pre-eclampsia (IRR 1.45, 95% CI 1.14–1.84) and Cesarean section (C-section) (IRR 1.32, 95% CI 1.13–1.53) were associated with increased risk. For postpartum acute stress, hyperemesis gravidarum (IRR 1.93, 95% CI 1.38–2.71), preterm birth (IRR 1.51, 95% CI 1.30–1.75), gestational diabetes (IRR 1.42, 95% CI 1.03–1.97) and C-section (IRR 1.36, 95% CI 1.20–1.55) were associated with increased risk. In contrast, risk of PP was not associated with pregnancy or obstetrical complications.

Conclusions

Pregnancy and obstetrical complications can increase the risk for PPD and acute stress reactions but not PP. Identification of postpartum women requiring secondary care is needed to develop targeted approaches for screening and treatment. Future work should focus on understanding the contributions of psychological stressors and underlying biology on the development of postpartum psychiatric illness.

Keywords

Acute stress disorderobstetrical predictorspostpartum depressionpostpartum psychosispregnancy.
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 8 , June 2017 , pp. 1427 - 1441
Copyright
Copyright © Cambridge University Press 2017 

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Footnotes

This work was previously presented as an oral podium talk at The 12th World Congress of Biological Psychiatry, Athens, Greece, 16 June 2015 and at The Perinatal Mental Health Conference in Chicago, November 2015.

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