Peripartum Complications as Risk Factors for Postpartum Psychosis: A Systemic Review

Nguyen, Kim Anh; Mukona, Lawrance T; Nalbandyan, Linette; Yar, Nadia; Fleur, Guinda St.; Mukona, Lorraine; Hernandez, Edward W; Lamberty, Norman

doi:10.7759/cureus.29224

Cited by 5 publications

(5 citation statements)

References 22 publications

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“…These were included to be as broad as possible in our search. Our findings are similar to a previous systematic review of peripartum complications in relation to postpartum psychosis ( 23 ), which showed a lack of replication for any single risk factor. Notably this previous systematic review had limited information on included studies, did not formally assess study quality, and included study designs with high risk of bias, such as case reports.…”

Section: Discussionsupporting

confidence: 83%

“…The following databases were searched from inception until June 2021: MEDLINE, EMBASE, PsychInfo. References from a recent review ( 23 ) examining associations between obstetric complications and postpartum psychosis were searched. Titles, abstracts, and keywords were searched using the combinations of terms shown below, with the full search strategy outlined in the Supplementary Materials:…”

Section: Methodsmentioning

confidence: 99%

“…Given the contribution of adverse life events to development of (non-postpartum) psychosis and postpartum depression, a systematic appraisal of their role in the onset of postpartum psychosis in warranted. We are aware of one systematic review that examined peripartum complications in relation to first onset postpartum psychosis ( 23 ): the authors identified various risk factors from single studies but included case reports and case series (which could introduce bias) and did not utilize a risk of bias tool to assess this in a structured way.…”

Section: Introductionmentioning

confidence: 99%

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Systematic review of the association between adverse life events and the onset and relapse of postpartum psychosis

et al. 2023

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Postpartum psychosis is defined as a psychotic episode occurring within 4 to 6 weeks of childbirth. While there is robust evidence that adverse life events are associated with the onset and relapse of psychosis outside the postpartum period, the extent to which these contribute to postpartum psychosis is less clear. This systematic review examined whether adverse life events are associated with an increased likelihood of developing postpartum psychosis or subsequent relapse in women diagnosed with postpartum psychosis. The following databases were searched from inception to June 2021: MEDLINE, EMBASE, PsycInfo. Study level data were extracted including setting, number of participants, type of adverse event, and differences between groups. A modified version of the Newcastle-Ottawa Quality Assessments Scale was used to assess risk of bias. In total, 1933 records were identified, of which 17 met the inclusion criteria, comprising nine case–control studies and eight cohort studies. Most studies (16/17) examined the association between adverse life events and the onset of postpartum psychosis, with only in which the outcome was relapse of psychosis. Overall, there were 63 different measures of adversity examined (most of which were examined in a single study only) and 87 associations between these measures and postpartum psychosis tested across the studies. In terms of statistically significant associations with onset/relapse of postpartum psychosis, 15 (17%) were positive (i.e., the adverse event increased the risk of onset/relapse), 4 (5%) were negative, and 68 (78%) were not statistically significant. Our review highlights the diversity of risk factors examined in this field, with few attempts at replication, hence limiting the ability to conclude that any single risk factor is robustly associated with the onset of postpartum psychosis. Further large-scale studies, that attempt to replicate earlier studies, are urgently needed to determine whether adverse life events play a role in the onset and exacerbation of postpartum psychosis.Systematic review registration[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=260592], identifier [CRD42021260592].

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Section: Discussionsupporting

confidence: 83%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Systematic review of the association between adverse life events and the onset and relapse of postpartum psychosis

et al. 2023

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“…We think that boosting the immunity of mothers, which can lead to less severe forms and reduce the workload and the feeling of work exhaustion. Furthermore, in the postpartum period, several cases of puerperal psychosis were observed during the COVID-19 pandemic, which seems to be related to maternal anxiety about themselves and their newborns and being obsessed by possible perinatal complications [36,37]. So, the mothers' awareness of the degree of protection when vaccinated with a booster dose may help.…”

Section: F O R P U B L I C a T I O N 10mentioning

confidence: 99%

The impact of COVID-19 booster vaccination in the current pregnancy during the Omicron waves on maternal and perinatal outcomes: a multicentre observational study

Kammoun¹,

Jarraya²,

Ellouze³

et al. 2023

Ital J Gynaecol Obstet

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Material and Methods. This was an observational multicenter study. Pregnant women who gave birth while infected by SARS CoV2 during the Omicron waves were included. Patients were divided into 2 groups: the "booster vaccination" group included pregnant women who had completed vaccination and had received an additional dose of vaccine during pregnancy; the "non-booster vaccination" group included pregnant women who had completed primary vaccination without booster shots. Data about obstetrical and neonatal outcomes in both groups were compared.Results. In total, 59 patients were included: 41 received booster shots during the current pregnancy, and 18 did not. Asymptomatic forms were seen in 58.5% of the "booster vaccination" group versus 16.6% of the "non-boosted vaccination" group with p = 0.003. The need for cesarean delivery was reduced from 72.2% to 41.4% with p = 0.028. The length of hospitalization was reduced from 4.67 ± 4 days in the "non-boosted vaccination" group to 1.98 ± 0.93 days in the booster vaccination group with p = 0.001. The booster vaccination allowed reduced rates of prematurity with p = 0.011 and neonatal intensive care admissions with p = 0.007. Conclusions.The COVID-19 booster vaccination seems to be beneficial during the Omicron waves. It improved obstetrical and neonatal outcomes. So, pregnant women could be advised to get a booster dose of the COVID-19 vaccine when they get pregnant.

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“…Risk factors for PP include preeclampsia, eclampsia, peripartum infections, cesarean section, and a personal or family history of bipolar disorder [ 12 , 13 ]. Although rare in the general population, PP is significantly more common among women with a personal history of bipolar disorder.…”

Section: Introductionmentioning

confidence: 99%

Posterior Reversible Encephalopathy Syndrome Presenting as Delirium With Psychosis and Agitation in the Postpartum Period

West,

Christopher,

Arkhipov

et al. 2024

Cureus

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Posterior reversible encephalopathy syndrome (PRES), which was first described in 1996, is a neurologic condition characterized by a combination of clinical and neuroimaging findings. PRES may arise in the context of preeclampsia, eclampsia, renal failure, and sepsis, among other conditions. Neuropsychiatric symptoms of PRES include altered mental status, agitation, and in some cases psychosis. PRES occurring in the postpartum period is understudied, especially with regard to its psychiatric manifestations. We aim to add to the literature a case of PRES associated with psychosis and agitation in a postpartum woman, highlighting clinical implications and offering suggestions for practice. A female in her late 20s, with no significant psychiatric or medical history, presented to the hospital at 29 weeks and one day of gestation following a witnessed seizure. She was found to be hypertensive and hyponatremic, was diagnosed with eclampsia, and underwent an emergent cesarean section due to fetal malpresentation. The next day, the patient developed paranoia with acute agitation, and the psychiatry team diagnosed her with delirium with psychosis/agitation secondary to her underlying medical condition. She required intramuscular medications for agitation, was placed in restraints, and was transferred to the ICU for sedation. Subsequently, CT and MRI scans of her head both indicated that she had developed PRES. The patient’s delirium and psychotic behavior resolved after appropriate treatment of her eclampsia. To our knowledge, this case report is the second documented case in the literature, of a patient who presented with PRES characterized by agitation and psychotic features in the postpartum period. Due to the significant overlap in symptoms between delirium and postpartum psychosis, this case highlights the crucial importance of interdisciplinary collaboration for accurate diagnosis and prompt treatment of PRES in the postpartum period. The case also speaks to the importance of differentiating postpartum psychosis associated with a primary psychiatric disorder from delirium arising in postpartum patients with or without a previous psychiatric history.

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Peripartum Complications as Risk Factors for Postpartum Psychosis: A Systemic Review

Cited by 5 publications

References 22 publications

Systematic review of the association between adverse life events and the onset and relapse of postpartum psychosis

Systematic review of the association between adverse life events and the onset and relapse of postpartum psychosis

The impact of COVID-19 booster vaccination in the current pregnancy during the Omicron waves on maternal and perinatal outcomes: a multicentre observational study

Posterior Reversible Encephalopathy Syndrome Presenting as Delirium With Psychosis and Agitation in the Postpartum Period

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