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

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.

Keywords: Epidemiology; immunology; postpartum depression; postpartum psychosis; pre-eclampsia.

Fig. 1

Incidence rates per 1000 person-years for psychiatric contacts in primiparous mothers with and without pre-eclampsia 0–12 months postpartum. Values are incidence rates, with 95% confidence intervals represented by vertical bars.

Fig. 2

Incidence rate ratios for psychiatric contacts in primiparous mothers with (--■--) and without (–●–) pre-eclampsia 0–12 months postpartum. Adjusted for age, calendar period, birth complications (number of diagnoses related to childbirth), reproductive history, gestational diabetes, somatic co-morbidities and family history of psychiatric disorders. Values are incidence rate ratios, with 95% confidence intervals represented by vertical bars.