Atopic diseases prior to pregnancy increase risk for peripartum mental disorders

Women with a history of asthma, atopic dermatitis and allergic rhinitis before conception demonstrated increased risk for peripartum mental disorders, according to a study published in Clinical and Translational Allergy.

Tai Ren, MD, a postdoctoral student at Shanghai Jiao Tong University School of Medicine, and colleagues also found that women with atopic diseases before pregnancy may benefit from systematic mental health monitoring.

The researchers studied 937,422 primiparous women who had given birth to a live singleton between 1978 and 2016 in Denmark. Before conception, 24,016 (2.6%) of them had received a diagnosis of at least one of the three atopic diseases studied, including asthma (1.7%), atopic dermatitis (0.6%) or allergic rhinitis (0.8%). Also, 4,461 of those diagnosed (18.6%) had atopic multimorbidity.

The researchers were particularly interested in affective disorders such as peripartum depression and peripartum anxiety — which represent the two most prevalent types of peripartum mental disorders — and they also analyzed substance abuse.

Overall, 1.2% of the women without asthma, atopic dermatitis or allergic rhinitis were affected by peripartum mental disorders, compared with 2.7% of the women who had been exposed to these atopic diseases. After adjustment for potential confounders, the researchers found a 37% increased risk for mental disorders among exposed women (HR = 1.37; 95% CI, 1.27-1.49).

Women with atopic multimorbidity had slightly higher risk for peripartum mental disorders (HR = 1.48; 95% CI, 1.23-1.77).

There also was a more pronounced association among women who gave birth in spring (HR = 1.49; 95% CI, 1.27-1.75) and an attenuated association among women who gave birth in summer (HR = 1.29; 95% CI, 1.1-1.51).

Specifically, asthma, atopic dermatitis and allergic rhinitis were associated with increased risk for affective disorders (HR = 1.42; 95% CI, 1.22-1.66); neurotic, stress-related and somatoform disorders (HR = 1.31; 95% CI, 1.16-1.49); and substance abuse (HR = 1.31; 95% CI, 1.07-1.59).

Researchers found similar levels of association for affective disorders when they looked at asthma, atopic dermatitis and allergic rhinitis separately. Specifically, asthma increased risk for neurotic, stress-related and somatoform disorders (HR = 1.4; 95% CI, 1.21-1.62), and atopic dermatitis was associated with substance abuse (HR = 1.62; 95% CI, 1.12-2.34).

The researchers noted that poor control of atopic diseases during the peripartum period aggravates symptoms and may influence mental disorders through various causal pathways. For example, aggravated atopic symptoms may contribute to mental stress via severe pruritus or dyspnea-induced sleep disorder. Allergic reactions also may dysregulate the autoimmune system and trigger mental disorders, and peripheral inflammation may affect the brain.

Plus, the researchers wrote that there are genetic overlaps between asthma and attention deficit hyperactivity disorder, anxiety and major depressive disorder, indicating that shared genetic susceptibility also may be among these underlying causes.

Early detection is necessary in effective management of peripartum mental disorders, the researchers wrote, so women with poor control of atopic diseases during pregnancy may benefit from systematic mental health monitoring and consultation with a specialist.