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. 2025 Feb 25;104(4):e210170.
doi: 10.1212/WNL.0000000000210170. Epub 2025 Jan 22.

Peripartum Mental Illness in Mothers With Multiple Sclerosis and Other Chronic Diseases in Ontario, Canada

Ruth Ann Marrie  1   2 , James Bolton  3 , Yushu Vicki Ling  4 , Charles Bernstein  5 , Kristen M Krysko  6 , Ping Li  4 , Kyla A Mckay  7 , Priscila Pequeno  4 , Neda Razaz  8 , Dalia Rotstein  6 , Karma Deakin-Harb  9 , Colleen J Maxwell  10
Affiliations

Peripartum Mental Illness in Mothers With Multiple Sclerosis and Other Chronic Diseases in Ontario, Canada

Ruth Ann Marrie et al. Neurology. .

Abstract

Background and objectives: Peripartum mood and anxiety disorders constitute the most frequent form of maternal morbidity in the general population, but little is known about peripartum mental illness in mothers with multiple sclerosis (MS). We compared the incidence and prevalence of peripartum mental illness among mothers with MS, epilepsy, inflammatory bowel disease (IBD), and diabetes and women without these conditions.

Methods: Using linked population-based administrative health data from ON, Canada, we conducted a cohort study of mothers with MS, epilepsy, IBD, and diabetes and without these diseases (comparators) who had a live birth with index dates, defined as 1 year before conception, between 2002 and 2017. Using validated definitions, we estimated the incidence and prevalence of mental illness (any, depression, anxiety, bipolar disorder, psychosis, substance use, suicide attempt) during the prenatal (PN) period (from conception to birth) and 3 years postpartum. We compared incidence and prevalence estimates between cohorts using simple incidence ratios (IRs) and prevalence ratios with 95% CIs and using Poisson regression models adjusting for confounders.

Results: We included 894,852 mothers (1,745 with MS; 5,954 with epilepsy; 4,924 with IBD; 13,002 with diabetes; 869,227 comparators). At conception, the mean (SD) maternal age was 28.6 (5.7) years. Any incident mental illness affected 8.4% of mothers with MS prenatally and 14.2% during the first postpartum year; depression and anxiety were the most common incident disorders. The first postpartum year was a higher risk period than the PN period (any mental illness IR 1.27; 95% CI 1.08-1.50). After adjustment, mothers with MS had an increased incidence of any mental illness during the PN (IR 1.26; 95% CI 1.11-1.44) and postpartum (IR 1.33; 95% CI 1.20-1.47, first postpartum year) periods than comparator mothers. Similarly, mothers with MS had an increased incidence of all specific mental illnesses except suicide attempt during the PN period vs comparator mothers. Any prevalent mental illness affected 42% of mothers with MS prenatally and 50.3% in the first postpartum year.

Discussion: Mothers with MS had an elevated incidence and prevalence of peripartum mental illness compared with comparator mothers, although residual confounding cannot be excluded. These findings emphasize the need for preventive interventions and early treatment of mental illness.

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Conflict of interest statement

R.A. Marrie receives research funding from CIHR, MS Canada, Crohn's and Colitis Canada, the National Multiple Sclerosis Society, CMSC, the Arthritis Society, and the US Department of Defense, and is a coinvestigator on studies receiving funding from Biogen Idec, Roche Canada, and the Pfizer Foundation. J. Bolton receives research funding from MS Canada and the Ruth Hurd Professorship. V. Ling reports no disclosures relevant to the manuscript. C. Bernstein is supported by the Bingham Chair in Gastroenterology. C. Bernstein has served on advisory boards for AbbVie Canada, Amgen Canada, Bristol Myers Squibb Canada, Eli Lilly Canada, Ferring Canada, Innomar Pharmacy, JAMP Pharmaceuticals, Janssen Canada, Pendopharm Canada, Sandoz Canada, Takeda Canada, and Pfizer Canada; received educational grants from AbbVie Canada, Boston Scientific, Eli Lilly Canada, Fresenius Kabi Canada, Ferring Canada, Organon Canada, Pfizer Canada, Takeda Canada, and Janssen Canada; served on speaker's panel for AbbVie Canada, Janssen Canada, Pfizer Canada, and Takeda Canada; and received research funding from AbbVie Canada, Takeda Canada, and Pfizer Canada. K.M. Krysko has received grants from MS Canada and the University of Toronto Division of Neurology; received a contract for a study site from Roche; received speaking or consulting fees from Biogen, EMD Serono, Novartis, and Roche; served as advisory board member for Biogen, EMD Serono, Novartis, and Roche, and served as a scientific advisory committee member for Bristol Myers Squibb. P. Li reports no disclosures relevant to the manuscript. K.A. Mckay receives research funding from the Karolinska Institutet and StratNeuro and has received speaker honoraria from Biogen Inc. and Sanofi. P. Pequeno reports no disclosures relevant to the manuscript. N. Razaz receives funding from the Swedish Research Council. D. Rotstein receives research funding from MS Canada, the National MS Society, the Consortium of Multiple Sclerosis Centers, the University of Toronto Division of Neurology, and Roche Canada; and has received consulting or speaker fees from Alexion, Amgen, Biogen, EMD Serono, Novartis, Roche, Sanofi Aventis, and Touch International Medical Education. K. Deakin-Harb reports no disclosures relevant to the manuscript. C. J. Maxwell receives funding from CIHR, MS Canada, National Multiple Sclerosis Society, the Public Health Agency of Canada, and the Alzheimer Society of Canada. Go to Neurology.org/N for full disclosures.

Figures

Figure 1
Figure 1. Study Design and Periods
Figure 2
Figure 2. Crude Incidence Proportion of Mental Illness by Pregnancy Period in Mothers With Multiple Sclerosis
*Where 2 definitions were tested, only the sensitive definition is presented here. Empty cells are shown where 6 or fewer events were observed to preserve privacy and confidentiality.
Figure 3
Figure 3. Association Between Mothers With MS, Epilepsy, IBD, and Diabetes, Compared With Controls and Incident Mental Illness in the Prenatal Period (Adjusted Rate Ratios, 95% CI)*,^
*Adjusted for age at conception, delivery year, income quintile, and Obstetric Comorbidity Index. Where sensitive and specific definitions were tested, only specific definitions were shown for visual simplicity. No suicide attempts were recorded for multiple sclerosis. ^E-value analysis for the smallest statistically significant association of RR 1.13 (lower confidence limit): 1.51 (1.49). Rate ratios of 1.25 have an E-value of 1.81, rate ratios of 1.50 have an E-value of 2.37, and rate ratios of 2.0 have an E-value of 3.41. IBD = inflammatory bowel disease; MS = multiple sclerosis.
Figure 4
Figure 4. Association Between MS and Incident Mental Illness During Prenatal (PN) and First 3 Postpartum Years (PYs), Compared With Controls (Adjusted Rate Ratios, 95% CI)*,^
*Adjusted for age at conception, delivery year, income quintile, and Obstetric Comorbidity Index. The strength of association is generally higher for specific than sensitive definitions. Suicide attempt was suppressed because of some cells <6. ^E-value analysis for the smallest statistically significant association of RR 1.26 (lower confidence limit): 1.83 (1.46). Rate ratios of 1.50 have an E-value of 2.37, and rate ratios of 2.0 have an E-value of 3.41. IBD = inflammatory bowel disease; MS = multiple sclerosis; Sens = sensitive; Spec = specific.
Figure 5
Figure 5. Crude Period Prevalence of Mental Illness by Pregnancy Period in Mothers With Multiple Sclerosis
Where 2 definitions were tested, the sensitive definition is presented for simplicity. Y= year.
See this image and copyright information in PMC

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