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Pre-eclampsia and first-onset postpartum psychiatric episodes: a Danish population-based cohort study

Published online by Cambridge University Press:  05 August 2015

V. Bergink*
Affiliation:
National Center for Register-Based Research, Aarhus School of Business and Social Sciences, Aarhus University, Fuglesangs Allé 4, Aarhus, Denmark Department of Psychiatry, Erasmus Medical Center, ‘s Gravendijkwal 230, 3000 CA, Rotterdam, The Netherlands
T. M. Laursen
Affiliation:
National Center for Register-Based Research, Aarhus School of Business and Social Sciences, Aarhus University, Fuglesangs Allé 4, Aarhus, Denmark CIRRAU, Centre for Integrated Register-based Research, Aarhus School of Business and Social Sciences, Aarhus University, Fuglesangs Allé 4, Aarhus, Denmark
B. M. W. Johannsen
Affiliation:
National Center for Register-Based Research, Aarhus School of Business and Social Sciences, Aarhus University, Fuglesangs Allé 4, Aarhus, Denmark
S. A. Kushner
Affiliation:
Department of Psychiatry, Erasmus Medical Center, ‘s Gravendijkwal 230, 3000 CA, Rotterdam, The Netherlands
S. Meltzer-Brody
Affiliation:
Department of Psychiatry, The University of North Carolina at Chapel Hill, Campus Box #7160, Chapel Hill, NC 27599, USA
T. Munk-Olsen
Affiliation:
National Center for Register-Based Research, Aarhus School of Business and Social Sciences, Aarhus University, Fuglesangs Allé 4, Aarhus, Denmark
*
* Address for correspondence: V. Bergink, Department of Psychiatry, Erasmus Medical Center, ‘s Gravendijkwal 230, 3000 CA, Rotterdam, The Netherlands. (Email: v.bergink@erasmusmc.nl)

Abstract

Background.

Recent evidence suggests that postpartum psychiatric episodes may share similar etiological mechanisms with immune-related disorders. Pre-eclampsia is one of the most prevalent immune-related disorders of pregnancy. Multiple clinical features are shared between pre-eclampsia and postpartum psychiatric disorders, most prominently a strong link to first pregnancies. Therefore, we aimed to study if pre-eclampsia is a risk factor for first-onset postpartum psychiatric episodes.

Method.

We conducted a cohort study using the Danish population registry, with a total of 400 717 primiparous women with a singleton delivery between 1995 and 2011. First-lifetime childbirth was the main exposure variable and the outcome of interest was first-onset postpartum psychiatric episodes. The main outcome measures were monthly incidence rate ratios (IRRs), with the period 11–12 months after birth as the reference category. Adjustments were made for age, calendar period, reproductive history, and perinatal maternal health including somatic and obstetric co-morbidity.

Results.

Primiparous women were at particularly high risk of first-onset psychiatric episodes during the first month postpartum [IRR 2.93, 95% confidence interval (CI) 2.53–3.40] and pre-eclampsia added to that risk (IRR 4.21, 95% CI 2.89–6.13). Having both pre-eclampsia and a somatic co-morbidity resulted in the highest risk of psychiatric episodes during the 3-month period after childbirth (IRR 4.81, 95% CI 2.72–8.50).

Conclusions.

We confirmed an association between pre-eclampsia and postpartum psychiatric episodes. The possible explanations for this association, which are not mutually exclusive, include the psychological impact of a serious medical condition such as pre-eclampsia and the neurobiological impact of pre-eclampsia-related vascular pathology and inflammation.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2015 

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