Hostname: page-component-8448b6f56d-wq2xx Total loading time: 0 Render date: 2024-04-17T15:18:21.171Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  05 August 2015

V. Bergink ,
T. M. Laursen ,
B. M. W. Johannsen ,
S. A. Kushner ,
S. Meltzer-Brody  and
T. Munk-Olsen
V. Bergink*
Affiliation:
National Center for Register-Based Research, Aarhus School of Business and Social Sciences, Aarhus University, Fuglesangs Allé 4, Aarhus, Denmark Department of Psychiatry, Erasmus Medical Center, ‘s Gravendijkwal 230, 3000 CA, Rotterdam, The Netherlands
T. M. Laursen
Affiliation:
National Center for Register-Based Research, Aarhus School of Business and Social Sciences, Aarhus University, Fuglesangs Allé 4, Aarhus, Denmark CIRRAU, Centre for Integrated Register-based Research, Aarhus School of Business and Social Sciences, Aarhus University, Fuglesangs Allé 4, Aarhus, Denmark
B. M. W. Johannsen
Affiliation:
National Center for Register-Based Research, Aarhus School of Business and Social Sciences, Aarhus University, Fuglesangs Allé 4, Aarhus, Denmark
S. A. Kushner
Affiliation:
Department of Psychiatry, Erasmus Medical Center, ‘s Gravendijkwal 230, 3000 CA, Rotterdam, The Netherlands
S. Meltzer-Brody
Affiliation:
Department of Psychiatry, The University of North Carolina at Chapel Hill, Campus Box #7160, Chapel Hill, NC 27599, USA
T. Munk-Olsen
Affiliation:
National Center for Register-Based Research, Aarhus School of Business and Social Sciences, Aarhus University, Fuglesangs Allé 4, Aarhus, Denmark
*
* Address for correspondence: V. Bergink, Department of Psychiatry, Erasmus Medical Center, ‘s Gravendijkwal 230, 3000 CA, Rotterdam, The Netherlands. (Email: v.bergink@erasmusmc.nl)
Get access Rights & Permissions [Opens in a new window]

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

Epidemiologyimmunologypostpartum depressionpostpartum psychosispre-eclampsia
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 16 , December 2015 , pp. 3481 - 3489
Copyright
Copyright © Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Amburgey, OA, Chapman, AC, May, V, Bernstein, IM, Cipolla, MJ (2010). Plasma from preeclamptic women increases blood–brain barrier permeability: role of vascular endothelial growth factor signaling. Hypertension 56, 1003–1008.CrossRefGoogle ScholarPubMed
Andersen, TF, Madsen, M, Jorgensen, J, Mellemkjoer, L, Olsen, JH (1999). The Danish National Hospital Register. A valuable source of data for modern health sciences. Danish Medical Bulletin 46, 263–268.Google Scholar
Bergink, V, Armangue, T, Titulaer, MJ, Markx, S, Dalmau, J, Kushner, SA (2015 a). Autoimmune encephalitis in postpartum psychosis. American Journal of Psychiatry. Published online 17 July 2015. doi:10.1176/appi.ajp.2015.14101332.Google Scholar
Bergink, V, Boyce, P, Munk-Olsen, T (2015 b). Postpartum psychosis: a valuable misnomer. Australian and New Zealand Journal of Psychiatry 49, 102–103.Google Scholar
Bergink, V, Burgerhout, KM, Weigelt, K, Pop, VJ, de Wit, H, Drexhage, RC, Kushner, SA, Drexhage, HA (2013). Immune system dysregulation in first-onset postpartum psychosis. Biological Psychiatry 73, 1000–1007.CrossRefGoogle ScholarPubMed
Bergink, V, Gibney, SM, Drexhage, HA (2014). Autoimmunity, inflammation and psychosis: a search for peripheral markers. Biological Psychiatry 75, 324–331.CrossRefGoogle ScholarPubMed
Bergink, V, Lambregtse-van den Berg, MP, Koorengevel, KM, Kupka, R, Kushner, SA (2011). First-onset psychosis occurring in the postpartum period: a prospective cohort study. Journal of Clinical Psychiatry 72, 1531–1537.Google Scholar
Bloch, M, Daly, RC, Rubinow, DR (2003). Endocrine factors in the etiology of postpartum depression. Comprehensive Psychiatry 44, 234–246.CrossRefGoogle ScholarPubMed
Brockington, I (1996). Motherhood and Mental Health. Oxford University Press: Oxford.Google Scholar
Buyon, JP (1998). The effects of pregnancy on autoimmune diseases. Journal of Leukocyte Biology 63, 281–287.CrossRefGoogle ScholarPubMed
Byrne, EM, Carrillo-Roa, T, Penninx, BW, Sallis, HM, Viktorin, A, Chapman, B, Henders, AK, Psychiatric Genomic Consortium Major Depressive Disorder Working Group, Pergadia, ML, Heath, AC, Madden, PA, Sullivan, PF, Boschloo, L, van Grootheest, G, McMahon, G, Lawlor, DA, Landen, M, Lichtenstein, P, Magnusson, PK, Evans, DM, Montgomery, GW, Boomsma, DI, Martin, NG, Meltzer-Brody, S, Wray, NR (2014). Applying polygenic risk scores to postpartum depression. Archives of Women's Mental Health 17, 519–528.Google Scholar
Capuron, L, Miller, AH (2011). Immune system to brain signaling: neuropsychopharmacological implications. Pharmacology and Therapeutics 130, 226–238.Google Scholar
Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases 40, 373–383.Google Scholar
Confavreux, C, Hutchinson, M, Hours, MM, Cortinovis-Tourniaire, P, Moreau, T (1998). Rate of pregnancy-related relapse in multiple sclerosis. Pregnancy in Multiple Sclerosis Group. New England Journal of Medicine 339, 285–291.Google Scholar
Delahaije, DH, Dirksen, CD, Peeters, LL, Smits, LJ (2013). Anxiety and depression following preeclampsia or hemolysis, elevated liver enzymes, and low platelets syndrome. A systematic review. Acta Obstetricia et Gynecologica Scandinavica 92, 746–761.Google Scholar
Di Florio, A, Jones, L, Forty, L, Gordon-Smith, K, Blackmore, ER, Heron, J, Craddock, N, Jones, I (2014). Mood disorders and parity – a clue to the aetiology of the postpartum trigger. Journal of Affective Disorders 152–154, 334–339.CrossRefGoogle Scholar
Gleicher, N (2007). Postpartum depression, an autoimmune disease? Autoimmune Reviews 6, 572–576.CrossRefGoogle ScholarPubMed
Grace, SL, Evindar, A, Stewart, DE (2003). The effect of postpartum depression on child cognitive development and behavior: a review and critical analysis of the literature. Archives of Women's Mental Health 6, 263–274.Google Scholar
Groer, MW, Morgan, K (2007). Immune, health and endocrine characteristics of depressed postpartum mothers. Psychoneuroendocrinology 32, 133–139.Google Scholar
Harris, B, Lovett, L, Smith, J, Read, G, Walker, R, Newcombe, R (1996). Cardiff puerperal mood and hormone study. III. Postnatal depression at 5 to 6 weeks postpartum, and its hormonal correlates across the peripartum period. British Journal of Psychiatry 168, 739–744.Google Scholar
Haupl, T, Ostensen, M, Grutzkau, A, Burmester, GR, Villiger, PM (2008). Interaction between rheumatoid arthritis and pregnancy: correlation of molecular data with clinical disease activity measures. Rheumatology 47 (Suppl. 3), iii19–iii22.CrossRefGoogle ScholarPubMed
Hoedjes, M, Berks, D, Vogel, I, Franx, A, Bangma, M, Darlington, AS, Visser, W, Duvekot, JJ, Habbema, JD, Steegers, EA, Raat, H (2011). Postpartum depression after mild and severe preeclampsia. Journal of Women's Health 20, 1535–1542.CrossRefGoogle ScholarPubMed
Howard, LM, Molyneaux, E, Dennis, CL, Rochat, T, Stein, A, Milgrom, J (2014). Non-psychotic mental disorders in the perinatal period. Lancet 384, 1775–1788.Google Scholar
Jones, I, Chandra, PS, Dazzan, P, Howard, LM (2014). Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. Lancet 384, 1789–1799.Google Scholar
Jones, I, Hamshere, M, Nangle, JM, Bennett, P, Green, E, Heron, J, Segurado, R, Lambert, D, Holmans, P, Corvin, A, Owen, M, Jones, L, Gill, M, Craddock, N (2007). Bipolar affective puerperal psychosis: genome-wide significant evidence for linkage to chromosome 16. American Journal of Psychiatry 164, 1099–1104.CrossRefGoogle ScholarPubMed
Kendell, RE, Chalmers, JC, Platz, C (1987). Epidemiology of puerperal psychoses. British Journal of Psychiatry 150, 662–673.CrossRefGoogle ScholarPubMed
Klier, CM, Muzik, M, Dervic, K, Mossaheb, N, Benesch, T, Ulm, B, Zeller, M (2007). The role of estrogen and progesterone in depression after birth. Journal of Psychiatric Research 41, 273–279.Google Scholar
Laursen, TM, Munk-Olsen, T (2010). Reproductive patterns in psychotic patients. Schizophrenia Research 121, 234–240.CrossRefGoogle ScholarPubMed
Lynge, E, Sandegaard, JL, Rebolj, M (2011). The Danish National Patient Register. Scandinavian Journal of Public Health 39, 30–33.Google Scholar
Mors, O, Perto, GP, Mortensen, PB (2011). The Danish Psychiatric Central Research Register. Scandinavian Journal of Public Health 39, 54–57.CrossRefGoogle ScholarPubMed
Munk-Olsen, T, Jones, I, Laursen, TM (2014). Birth order and postpartum psychiatric disorders. Bipolar Disorders 16, 300–307.Google Scholar
Munk-Olsen, T, Laursen, TM, Mendelson, T, Pedersen, CB, Mors, O, Mortensen, PB (2009). Risks and predictors of readmission for a mental disorder during the postpartum period. Archives of General Psychiatry 66, 189–195.Google Scholar
Munk-Olsen, T, Laursen, TM, Pedersen, CB, Mors, O, Mortensen, PB (2006). New parents and mental disorders: a population-based register study. Journal of the American Medical Association 296, 2582–2589.CrossRefGoogle ScholarPubMed
Osborne, LM, Monk, C (2013). Perinatal depression – the fourth inflammatory morbidity of pregnancy?: Theory and literature review. Psychoneuroendocrinology 38, 1929–1952.Google Scholar
Parry, BL, Sorenson, DL, Meliska, CJ, Basavaraj, N, Zirpoli, GG, Gamst, A, Hauger, R (2003). Hormonal basis of mood and postpartum disorders. Current Women's Health Reports Journal 3, 230–235.Google Scholar
Pedersen, CB (2011). The Danish Civil Registration System. Scandinavian Journal of Public Health 39, 22–25.CrossRefGoogle ScholarPubMed
Redman, CW, Sargent, IL (2001). The pathogenesis of pre-eclampsia. Gynécologie Obstétrique et Fertilité 29, 518–522.Google Scholar
Roberts, JM, Bell, MJ (2013). If we know so much about preeclampsia, why haven't we cured the disease? Journal of Reproductive Immunology 99, 1–9.CrossRefGoogle ScholarPubMed
Robillard, PY, Dekker, G, Chaouat, G, Hulsey, TC, Saftlas, A (2011). Epidemiological studies on primipaternity and immunology in preeclampsia – a statement after twelve years of workshops. Journal of Reproductive Immunology 89, 104–117.Google Scholar
Sargent, IL, Borzychowski, AM, Redman, CW (2006). NK cells and human pregnancy – an inflammatory view. Trends in Immunology 27, 399–404.CrossRefGoogle ScholarPubMed
Steegers, EA, von Dadelszen, P, Duvekot, JJ, Pijnenborg, R (2010). Pre-eclampsia. Lancet 376, 631–644.CrossRefGoogle ScholarPubMed
Stein, A, Pearson, RM, Goodman, SH, Rapa, E, Rahman, A, McCallum, M, Howard, LM, Pariante, CM (2014). Effects of perinatal mental disorders on the fetus and child. Lancet 384, 1800–1819.CrossRefGoogle ScholarPubMed
Tandberg, A, Klungsoyr, K, Romundstad, L, Skjaerven, R (2015). Pre-eclampsia and assisted reproductive technologies: consequences of advanced maternal age, interbirth intervals, new partner and smoking habits. BJOG: An International Journal of Obstetrics and Gynaecology 122, 915–922.Google Scholar
Weetman, AP (2010). Immunity, thyroid function and pregnancy: molecular mechanisms. Nature Reviews Endocrinology 6, 311–318.CrossRefGoogle ScholarPubMed
World Health Organization (1994). WHO ICD-10: Psykiske lidelser og adfærdsmæssige forstyrrelser. Klassifikation og diagnostiske kriterier (WHO ICD-10: Mental and Behavioural Disorders. Classification and Diagnostic Criteria). Munksgaard: Copenhagen.Google Scholar