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One-third of women at high risk experience postpartum relapse

A meta-analysis indicated one-third of women with a history of bipolar disorder, postpartum psychosis or both experience postpartum relapse.

“Estimation of relapse risks for women with isolated postpartum psychosis or bipolar disorder have been described in prospective, retrospective, and birth cohort studies. However, the high variability of reported relapse rates across different studies has hampered efforts to obtain a precise quantification,” Richard Wesseloo, MD, of Erasmus Medical Centre, Rotterdam, the Netherlands, and colleagues wrote.

To estimate the risk of postpartum relapse among women with a history of bipolar disorder, postpartum psychosis or both, researchers conducted a systematic literature search of all public medical electronic databases. They analyzed 37 articles describing 5,700 deliveries among 4,023 patients with bipolar disorder and/or a history of postpartum psychosis or mania according to DSM or ICD criteria.

Overall postpartum relapse risk was 35% (95% CI, 29-41).

Women with bipolar disorder were significantly less likely to experience severe episodes postpartum compared with women with a history of postpartum psychosis (17% vs. 29%).

Researchers were unable to determine relapse rates for patients with bipolar disorder and a history of postpartum episodes due to insufficient information.

Among women with bipolar disorder, postpartum relapse rates were significantly higher among those who were medication free during pregnancy (66%; 95% CI, 57-75), compared with those who used prophylactic medication (23%; 95% CI, 14-37).

“The distinction between women with bipolar disorder and those with a history of postpartum psychosis is of substantial clinical relevance, as patients with bipolar disorder were significantly less likely to experience severe episodes postpartum (17%) compared with patients with a history of postpartum psychosis (29%). Moreover, for women with bipolar disorder, continuation of prophylactic medication during pregnancy appears to be critically important for maintaining mood stability after delivery,” Wesseloo and colleagues wrote. “Women have multiple contacts with health services during pregnancy, which provide a compelling opportunity for prevention of postpartum psychiatric episodes. Postpartum relapse prevention plans should be drafted for all women at high risk.” – by Amanda Oldt

Disclosure: Wesseloo reports no relevant financial disclosures. Please see the full study for a list of all authors’ relevant financial disclosures.