Diagnosis of MS before, after pregnancy increases risk for depression, anxiety

Women diagnosed with MS prior to pregnancy experienced a greater risk for perinatal depression, while women who began experiencing MS symptoms within 5 years after pregnancy had greater risk for both depression and anxiety during pregnancy.

Researchers published results from the prospective, population-based cohort study of more than 114,600 pregnant women in Neurology.

“There is limited knowledge of the occurrence of depression and anxiety in the perinatal setting among women with MS. One study found that 26% of mothers and fathers with MS had depression or anxiety in relation to pregnancy, compared to 19% of parents without MS,” the researchers wrote. “Since mothers with MS are at increased risk of depression and anxiety, it is important to identify risk factors associated with these symptoms in the perinatal setting to provide optimal prevention, treatment, and follow-up for women at risk.”

Karine Eid, MD, a PhD candidate in the department of clinical medicine at the University of Bergen and the department of neurology at Haukeland University Hospital, both in Norway, and colleagues obtained data on 114,629 pregnant women included in the Norwegian Mother, Father and Child Cohort study from 1999 to 2008. The researchers evaluated depression and anxiety with questionnaires conducted during and after pregnancy. They identified women with MS using national health registries and hospital records.

Researchers grouped women according to timing of MS diagnosis: women with MS diagnosed before pregnancy (n = 140), women with MS diagnosed after pregnancy, with symptom onset prior to pregnancy (n = 98) and women with MS diagnosed after pregnancy, with symptom onset following pregnancy (n = 308). The study also included 35 women diagnosed with MS in the postpartum period and a reference group of 111,627 women without MS.

Study results demonstrated that women with MS diagnosed prior to pregnancy experienced an adjusted OR of 2 (95% CI, 1.2-3.1) for depression in the third trimester, which accounted for age, parity, weight and socioeconomic factors. Specifically, 15% of women diagnosed with MS prior to pregnancy experienced depression in the third trimester compared with 9% of women in the reference group. Risk factors included adverse socioeconomic conditions, history of psychiatric illness and physical/sexual abuse. Researchers also confirmed this increased risk in the sensitivity analysis, which used a higher cutoff for depression; 8% of women with diagnosed MS had severe depression compared with 4% in the reference group (adjusted OR = 2.2; 95%, CI 1.2–4.2). The risk for anxiety was not increased in this group, Eid and colleagues found.

The risk for postpartum depression in women diagnosed with MS during the postpartum period was “especially high,” according to the study results. Additionally, women who experienced the onset of MS symptoms within 5 years of pregnancy demonstrated a greater risk for both depression and anxiety in pregnancy, while women with more than 5 years until the onset of symptoms did not. Specifically, in women who started having symptoms of MS after pregnancy, participants with their first MS symptom within 5 years of pregnancy (n = 136) had greater rates of depression and anxiety in the third trimester compared with the reference group (depression, 14% vs. 9%; anxiety, 9% vs. 6%). Conversely, women with more than 5 years until the start of symptoms (n = 172) did not have higher frequency of depression or anxiety at any assessment point during the perinatal period.

“Perinatal depression in women with MS requires intervention, as it reduces quality of life, often leads to paternal depression, and reduces adherence to MS treatment,” Eid and colleagues wrote. “It may also influence the mother-infant bond negatively and is associated with higher risk of psychiatric disorders in children.”

Eid and colleagues also noted that clinicians “should be especially aware” of the signs of depression among women diagnosed with MS during the postpartum period.

In a related editorial, Victoria M. Leavitt, PhD, an assistant professor of neuropsychology (in neurology) at Columbia University Irving Medical Center, and colleagues wrote that the presence, as well as the implications, of perinatal depression and anxiety among women with MS “remains limited, while also noting that perinatal depression is the most common complication associated with pregnancy. The greater rate of anxiety and depression and a female “preponderance” in MS prioritize the need to understand the relationship between MS and perinatal mood disorders, the researchers wrote.

Leavitt and colleagues highlighted “several strengths” of the results from Eid and colleagues and noted that the study “raises important questions.” Additionally, the research from Eid and colleagues “highlights that pregnant women with MS deserve better,” according to Leavitt and colleagues.

“It demonstrates the need for proactive attention around perinatal mental health in women with established and newly diagnosed MS, as well as those with neither clear symptoms nor a diagnosis of MS,” the researchers wrote. “Shedding light on this critical issue has the potential to lead to meaningful improvements in the diagnosis of, and subsequent access to treatment for, perinatal mood disorders.”