Perinatal Depression and Anxiety in Women With Multiple Sclerosis: A Population-Based Cohort Study

Abstract

Objective: To assess the occurrence of perinatal depression and anxiety in women before and after diagnosis of multiple sclerosis (MS).

Methods: A total of 114,629 pregnant women were included in the Norwegian Mother, Father and Child Cohort study (1999-2008). We assessed depression and anxiety by questionnaires during and after pregnancy. Women with MS were identified from national health registries and hospital records and grouped into (1) MS diagnosed before pregnancy (n = 140) or MS diagnosed after pregnancy with (2) symptom onset before pregnancy (n = 98) or (3) symptom onset after pregnancy (n = 308). Thirty-five women were diagnosed with MS in the postpartum period. The reference group (n = 111,627) consisted of women without MS.

Results: Women with MS diagnosed before pregnancy had an adjusted odds ratio of 2.0 (95% confidence interval, 1.2-3.1) for depression in the third trimester. Risk factors were adverse socioeconomic factors and history of psychiatric disease and physical/sexual abuse. The risk of anxiety was not increased. Women diagnosed with MS in the postpartum period had especially high risk of postpartum depression. Women with MS symptom onset within 5 years after pregnancy had increased risk of both depression and anxiety during pregnancy, whereas women with more than 5 years until symptom onset did not.

Conclusion: Women diagnosed with MS have increased risk of perinatal depression. Women with MS symptom onset within 5 years after pregnancy have increased risk of both depression and anxiety during pregnancy.

Figure 1. Multiple Sclerosis (MS) Diagnosis and Symptom Onset in Relation to Pregnancy and Childbirth

We identified 546 women with MS from the Norwegian Mother, Father and Child Cohort (MoBa). Women were divided into 3 groups defined by their MS status on inclusion. The periods of established MS diagnosis are illustrated by colored arrows. Periods of symptom onset are shown with dotted lines for the groups with MS diagnosed after pregnancy. We also studied a subgroup of women who were diagnosed with MS in the postpartum period (0–18 months). ^aMS diagnosed up to pregnancy weeks 18–20.

Figure 2. Flowchart of Excluded and Included Cases

Pregnancies included in the Norwegian Mother, Father and Child Cohort (MoBa) study version 12. MS = multiple sclerosis; Q = questionnaire.

Figure 3. Perinatal Depression in Women Diagnosed With Multiple Sclerosis (MS) or Other Chronic Disease in the Postpartum Period

Point prevalence of depression from pregnancy week 30 until 18 months postpartum in women who were diagnosed with MS (n = 35) or another chronic disease (n = 2,640) in the 18-month postpartum period. Women without MS or another postpartum chronic diagnosis (n = 108,987) represents the reference group. Depression is defined as Hopkins Symptom Checklist 4D mean >1.75. N values are given for the first assessment and are later lower due to missing data. Women who were pregnant 18 months postpartum were excluded (figure 2).