Are prenatal, obstetric, and infant complications associated with postpartum psychosis among women with pre‐conception psychiatric hospitalisations?

Abstract

Objective To examine the associations of maternal and infant complications with postpartum hospitalisation for psychosis in women with a pre-conception history of psychiatric hospitalisation. Design Population-based study. Setting Swedish medical birth register. Population Primiparous women who gave birth between 1 January 1987 and 31 December 2001, and who had a pre-conception history of psychiatric hospitalisation but who were not hospitalised during pregnancy (n = 1842). Methods International Classification of Diseases (ICD) codes were used to identify prenatal, obstetric, postpartum maternal complications, and newborn health conditions. We used multivariable logistic regression to describe the associations between maternal and infant health conditions and the odds for postpartum hospitalisation for psychosis. Main outcome measure Psychiatric hospitalisation within 90 days of delivery. Results Compared with women who did not have a postpartum psychiatric hospitalisation, hospitalised women were at 2.3 times higher odds (95% CI 1.0–4.9) of having non-psychiatric puerperium complications (e.g. infection, lactation problems or venous complications). No other maternal complications were associated with postpartum psychiatric hospitalisation. Although their infants were at no higher odds for health complications, the offspring of women who had a postpartum psychiatric hospitalisation were at 4.1 times higher odds (95% CI 1.3–12.6) of death within the first 365 days of life than those of women who were not hospitalised. Conclusions We found no prenatal indicators of postpartum risk for psychiatric hospitalisation among high-risk women, but they had higher odds of postpartum pregnancy-related medical problems and, rarely, offspring death.

Adverse childhood life events and postpartum psychosis in bipolar disorder

“…Evidence has implicated obstetric complications (Hellerstedt et al, 2013), primiparity (Di Florio et al, 2014) genetic variation (Jones et al, 2007), immunological factors (Bergink et al, 2013) and sustained sleep loss during delivery and the early postpartum (Sharma et al, 2004). The findings of this study are consistent with previous literature that points to biological factors as being of central importance in the aetiology of PP.…”

<p>Maternal bereavement shortly before or during pregnancy and risk of postpartum psychotic illness: a population-based study from Denmark and Sweden</p>

“…Thus, women at high risk of a psychotic episode may have received prophylactic antipsychotic medication that attenuated the potential effect of stress on the risk of postpartum psychosis 8,10. Finally, it is possible that other hormonal and immune factors than those involved in the stress response7,8 or that the rapid changes in hormone levels and not their absolute levels are important for the development of postpartum psychosis 34…”

“…The primary outcome was a diagnosis of psychotic illness at any time in the first 90 days after delivery1,4,7,13,29 in the Danish Psychiatric Central Register, the Danish National Hospital Register or the Swedish Patient Register. A diagnosis of postpartum psychosis is usually given by psychiatrists based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders.…”

Postpartum psychosis: Risk factors identification

“…The similar trends were observed in a recent population based retrospective study, which revealed that although prenatal complications were not associated with PP, women with puerperium complications were twice as likely as those without them to develop PP. [ 26 ] In a Swedish study, it was found that neonatal complications like respiratory disorder in the neonate, severe birth asphyxia, preterm birth, and perinatal death were associated with an increased risk of PP. [ 25 ]…”