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Family psychiatric history increases risk for postpartum psychiatric disorders
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NEW YORK — Women with a family history of mental illness, especially bipolar disorder, are at higher risk for postpartum psychiatric disorders, according to data released here and simultaneously published in The American Journal of Psychiatry.
“The medical community has recently recognized the importance of screening women for postpartum mood and anxiety disorders, but screening generally relies on identifying women after they develop symptoms,” Anna E. Bauer, PhD, from the departments of psychiatry and genetics, University of North Carolina at Chapel Hill, told Healio Psychiatry. “At the moment, we have little ability to predict who will experience a postpartum psychiatric illness before they become symptomatic, particularly if the mother has not previously experienced mental illness. We have known that family history is an important risk factor for psychiatric illness overall, but know less about the postpartum period.”
In their population-based cohort study, the investigators examined how family history of diagnosed psychiatric disorders was related to postpartum psychiatric disorders in mothers with and without psychiatric history, and whether this risk differed by degree of relationship, type of disorder and sex of family members. Mother, father and full siblings were considered first-degree relatives; grandparents, half siblings, uncles and aunts were defined as second-degree relatives; and cousins as third-degree relatives. Participants were first-time mothers born in Denmark in 1970 or later who gave birth after age 15 years and before 2013.
Overall, 2,603 new mothers experienced a psychiatric disorder within 6 months postpartum and 4,085 within 1-year postpartum.
Analysis showed the risk for a psychiatric disorder within the first 6 months postpartum was higher among mothers with a first-degree relative who had experienced a psychiatric disorder than those whose relatives did not (HR = 1.45, 95% CI, 1.28-1.65). The risk for experiencing a postpartum psychiatric episode was highest when mothers had a first-degree relative with bipolar disorder (HR = 2.86; 95% CI, 1.88–4.35). The associations were stronger among those with no previous psychiatric history.
Familial risk was also increased for women with a first-degree relative with schizophrenia (HR = 1.58; 95% CI, 1.27-1.95), unipolar disorder (HR = 1.52; 95% CI, 1.24-1.87) or other mood disorder (HR = 1.78; 95% CI, 1.03-3.06), but not other psychiatric disorders. Unlike with first-degree relatives, familial risk for postpartum psychiatric disorders was only slightly elevated for familial psychiatric disorders among more distant relatives, according to the authors. In addition, familial risk for postpartum disorders was similar regardless of whether it was the proband mother’s mother or father who had a psychiatric disorder, indicating that sex did not influence the risk.
“Family history is not currently a consideration in clinical practice guidelines for screening of perinatal psychiatric disorders but could be included as a relatively simple measure to assess who may develop a postpartum psychiatric disorder,” Bauer told Healio Psychiatry. “When assessing risk of postpartum psychiatric disorders by inquiring about family history, clinicians should take special note of bipolar disorder in a family member and be sure to ask about both male and female relatives.” – by Savannah Demko
Disclosures: Bauer reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.