Postpartum Depression and Subsequent Autoimmune Diseases in Taiwan.

Heng-Chang Chuang,Jui-Ming Liu,Ren-Jun Hsu,Chien-Yu Lin,Cheng-Kai Li,Fung-Wei Chang

doi:10.3390/ijerph15081783

Abstract

Postpartum depression (PPD) is one of the most common examples of postnatal morbidity, but the subsequent risks of autoimmune diseases in patients with PPD have yet to be fully investigated. This nationwide population-based study utilized data of the National Health Insurance Research Database of Taiwan for the period from 1996 to 2013. In total, 45,451 women with primiparity were identified. Among them, 542 patients with PPD were enrolled as a study group while 2165 matched patients without PPD were enrolled as a control group. The demographic characteristics and comorbidities of the patients were analyzed, and Cox regression analysis was applied to calculate the hazard ratios for the risk of autoimmune diseases. Of the 2707 women enrolled in this study, 469 (17.3%) patients with newly diagnosed autoimmune diseases were identified, including 123 (22.7%) in the PPD group and 346 (16%) in the non-PPD group. After adjusting for confounding factors, it was determined that the patients with PPD had a significantly higher risk of subsequent autoimmune diseases (adjusted hazard ratio (aHR): 1.61, 95% confidence interval (CI): 1.30–1.99; p < 0.001). Specifically, increased risks of pernicious anemia (aHR: 3.85, 95% CI: 2.06–7.22), rheumatoid arthritis (aHR: 2.62, 95% CI: 1.28–5.39), and Graves’ disease (aHR: 1.57, 95% CI: 1.05–2.33) were observed in the PPD group. This study demonstrated that patients with PPD have higher risks of subsequent autoimmune diseases, especially pernicious anemia, rheumatoid arthritis, and Graves’ disease. This useful information provides physicians with clues regarding the associations between autoimmune diseases and PPD.

Highlights

Postpartum depression (PPD) is a major morbidity during the perinatal period
The women with PPD had a higher overall risk of subsequent autoimmune diseases with an adjusted HRs (aHRs) of 1.61
(aHR: 2.62, 95% confidence interval (CI): 1.28–5.39, p < 0.05), Graves’ disease, and pernicious anemia than the non-PPD group

Summary

Introduction

Postpartum depression (PPD) is a major morbidity during the perinatal period. 9% of women who have given birth suffer from PPD, a condition which has consequences for both a mother and her neonates [1]. The prompt diagnosis and treatment of PPD, can protect the health and quality of life of all family members. Multiple risk factors for PPD have been identified, including demographic, clinical, psychosocial, husband/marriage-related, and child-related factors [2,3]. The frequency of primiparity is higher in patients with PPD. The exact pathophysiology of PPD is not fully understood. Dramatic changes in hormones and extreme mood swings are believed to contribute to PPD. Immune-mediated cytokine alterations have been found to play important roles in the underlying mechanism of PPD [4,5,6].

Methods

Results

Discussion

Conclusion