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Comorbidity of autoimmune thyroid disorders and psychiatric disorders during the postpartum period: a Danish nationwide register-based cohort study

  • V. Bergink (a1), V. J. M. Pop (a2), P. R. Nielsen (a3), E. Agerbo (a3) (a4) (a5), T. Munk-Olsen (a3) and X. Liu (a3)...

Abstract

Background

The postpartum period is well-known risk period for the first onset of autoimmune thyroid disorders (AITDs) as well as first onset of psychiatric disorders. These two disorders are some of the most prevalent medical conditions postpartum, often misdiagnosed and disabling if left untreated. Our study was designed to explore the possible bidirectional association between AITDs and psychiatric disorders during the postpartum period.

Methods

A population-based cohort study through linkage of Danish national registers, which comprised 312 779 women who gave birth to their first child during 1997–2010. We conducted Poisson regression analysis to estimate the incidence rate ratio (IRR) of psychiatric disorders among women with first-onset AITDs, the IRR of AITDs among women with first-onset psychiatric disorders as well as the overlap between these disorders using a comorbidity index.

Results

Women with first-onset AITDs postpartum were more likely to have first-onset psychiatric disorders than women who did not have postpartum AITDs (IRR = 1.88, 95% confidence interval (CI): 1.25–2.81). Women with first-onset postpartum psychiatric disorders had a higher risk of AITDs than women with no psychiatric disorders (IRR = 2.16, 95% CI: 1.45–3.20). The comorbidity index 2 years after delivery was 2.26 (95% CI: 1.61–2.90), indicating a comorbidity between first-onset AITDs and psychiatric disorders.

Conclusions

First-onset AITDs and psychiatric disorders co-occur in the postpartum period, which has relevance to further studies on the etiologies of these disorders and why childbirth in particular triggers the onset.

Copyright

Corresponding author

Author for correspondence: V. Bergink, E-mail: v.bergink@erasmusmc.nl

References

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Alexander, EK, Pearce, EN, Brent, GA, Brown, RS, Chen, H, Dosiou, C, Grobman, WA, Laurberg, P, Lazarus, JH, Mandel, SJ, Peeters, RP, Sullivan, S (2017) 2017 guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid 27, 315389.
Andersen, SL, Carle, A, Olsen, J, Laurberg, P (2016) Hypothyroidism incidence in and around pregnancy: a Danish nationwide study. European Journal of Endocrinology 175, 387393.
Andersen, SL, Olsen, J, Carle, A, Laurberg, P (2015) Hyperthyroidism incidence fluctuates widely in and around pregnancy and is at variance with some other autoimmune diseases: a Danish population-based study. Journal of Endocrinology and Metabolism 100, 11641171.
Andersen, TF, Madsen, M, Jorgensen, J, Mellemkjoer, L, Olsen, JH (1999) The Danish National Hospital Register. A valuable source of data for modern health sciences. Danish Medical Bulletin 46, 263268.
Banti, S, Mauri, M, Oppo, A, Borri, C, Rambelli, C, Ramacciotti, D, Montagnani, MS, Camilleri, V, Cortopassi, S, Rucci, P, Cassano, GB (2011) From the third month of pregnancy to 1 year postpartum. Prevalence, incidence, recurrence, and new onset of depression. Results from the perinatal depression-research & screening unit study. Comprehensive Psychiatry 52, 343351.
Bergink, V, Burgerhout, KM, Weigelt, K, Pop, VJ, de Wit, H, Drexhage, RC, Kushner, SA, Drexhage, HA (2013) Immune system dysregulation in first-onset postpartum psychosis. Biological Psychiatry 73, 10001007.
Bergink, V, Gibney, SM, Drexhage, HA (2014) Autoimmunity, inflammation, and psychosis: a search for peripheral markers. Biological Psychiatry 75, 324331.
Bergink, V, Kushner, SA, Pop, V, Kuijpens, H, Lambregtse-van den Berg, MP, Drexhage, RC, Wiersinga, W, Nolen, WA, Drexhage, HA (2011) Prevalence of autoimmune thyroid dysfunction in postpartum psychosis. The British Journal of Psychiatry 198, 264268.
Bocchetta, A, Traccis, F, Mosca, E, Serra, A, Tamburini, G, Loviselli, A (2016) Bipolar disorder and antithyroid antibodies: review and case series. International Journal of Bipolar Disorders 4, 5.
Coviello, V, Boggess, M (2004) Cumulative incidence estimation in the presense of competing risks. The Stata Journal 4, 103112.
Gavin, NI, Gaynes, BN, Lohr, KN, Meltzer-Brody, S, Gartlehner, G, Swinson, T (2005) Perinatal depression: a systematic review of prevalence and incidence. Obstetrics & Gynecology 106, 10711083.
Gleicher, N (2007) Postpartum depression, an autoimmune disease? Autoimmunity Reviews 6, 572576.
Glick, AB, Wodzinski, A, Fu, P, Levine, AD, Wald, DN (2013) Impairment of regulatory T-cell function in autoimmune thyroid disease. Thyroid 23, 871878.
Jorgensen, KT, Pedersen, BV, Nielsen, NM, Jacobsen, S, Frisch, M (2012) Childbirths and risk of female predominant and other autoimmune diseases in a population-based Danish cohort. Journal of Autoimmunity 38, J81J87.
Kildemoes, HW, Sorensen, HT, Hallas, J (2011) The Danish National Prescription Registry. Scandinavian Journal of Public Health 39, 3841.
Knudsen, LB, Olsen, J (1998) The Danish Medical Birth Registry. Danish Medical Bulletin 45, 320323.
Laursen, TM, Agerbo, E, Pedersen, CB (2009) Bipolar disorder, schizoaffective disorder, and schizophrenia overlap: a new comorbidity index. Journal of Clinical Psychiatry 70, 14321438.
Lazarus, JH, Parkes, AB, Premawardhana, LD (2002) Postpartum thyroiditis. Autoimmunity 35, 169173.
Luppi, P (2003) How immune mechanisms are affected by pregnancy. Vaccine 21, 33523357.
Mohandas, R, Gupta, KL (2003) Managing thyroid dysfunction in the elderly. Answers to seven common questions. Postgraduate Medical Journal 113, 5456, 65-8, 100.
Mors, O, Perto, GP, Mortensen, PB (2011) The Danish Psychiatric Central Research Register. Scandinavian Journal of Public Health 39, 5457.
Muller, AF, Drexhage, HA, Berghout, A (2001) Postpartum thyroiditis and autoimmune thyroiditis in women of childbearing age: recent insights and consequences for antenatal and postnatal care. Endocrine Reviews 22, 605630.
Munk-Olsen, T, Maegbaek, ML, Johannsen, BM, Liu, X, Howard, LM, di Florio, A, Bergink, V, Meltzer-Brody, S (2016) Perinatal psychiatric episodes: a population-based study on treatment incidence and prevalence. Translational Psychiatry 6, e919.
Osborne, LM, Monk, C (2013) Perinatal depression--the fourth inflammatory morbidity of pregnancy?: theory and literature review. Psychoneuroendocrinology 38, 19291952.
Pop, VJ, de Rooy, HA, Vader, HL, van der Heide, D, van Son, M, Komproe, IH, Essed, GG, de Geus, CA (1991) Postpartum thyroid dysfunction and depression in an unselected population. The New England Journal of Medicine 324, 18151816.
Schiller, CE, Meltzer-Brody, S, Rubinow, DR (2015) The role of reproductive hormones in postpartum depression. CNS Spectrums 20, 4859.
Shi, X, Li, C, Li, Y, Guan, H, Fan, C, Teng, Y, Ouyang, Y, Shan, Z, Teng, W (2009) Circulating lymphocyte subsets and regulatory T cells in patients with postpartum thyroiditis during the first postpartum year. Clinical and Experimental Medicine 9, 263267.
Stagnaro-Green, A (2004) Postpartum thyroiditis. Best Practice & Research Clinical Endocrinology & Metabolism 18, 303316.
Stewart, DE, Vigod, S (2016) Postpartum depression. The New England Journal of Medicine 375, 21772186.
Weetman, AP (2010) Immunity, thyroid function and pregnancy: molecular mechanisms. Nature Reviews Endocrinology 6, 311318.
Wegienka, G, Havstad, S, Bobbitt, KR, Woodcroft, KJ, Zoratti, EM, Ownby, DR, Cole Johnson, C (2011) Within-woman change in regulatory T cells from pregnancy to the postpartum period. Journal of Reproductive Immunology 88, 5865.
Wiersinga, WM (2016) Clinical relevance of environmental factors in the pathogenesis of autoimmune thyroid disease. Endocrinology and Metabolism (Seoul) 31, 213222.
Yoo, WS, Chung, HK (2016) Recent advances in autoimmune thyroid diseases. Endocrinology and Metabolism (Seoul) 31, 379385.

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