Abstract
BackgroundPsychotic illness following childbirth is a relatively rare but severe condition with unexplained etiology. The aim of this study was to investigate the impact of maternal background characteristics and obstetric factors on the risk of postpartum psychosis, specifically among mothers with no previous psychiatric hospitalizations.Methods and FindingsWe investigated incidence rates and potential maternal and obstetric risk factors of psychoses after childbirth in a national cohort of women who were first-time mothers from 1983 through 2000 (n = 745,596). Proportional hazard regression models were used to estimate relative risks of psychoses during and after the first 90 d postpartum, among mothers without any previous psychiatric hospitalization and among all mothers. Within 90 d after delivery, 892 women (1.2 per 1,000 births; 4.84 per 1,000 person-years) were hospitalized due to psychoses and 436 of these (0.6 per 1,000 births; 2.38 per 1,000 person-years) had not previously been hospitalized for any psychiatric disorder. During follow-up after the 90 d postpartum period, the corresponding incidence rates per 1,000 person-years were reduced to 0.65 for all women and 0.49 for women not previously hospitalized. During (but not after) the first 90 d postpartum the risk of psychoses among women without any previous psychiatric hospitalization was independently affected by: maternal age (35 y or older versus 19 y or younger; hazard ratio 2.4, 95% confidence interval [CI] 1.2 to 4.7); high birth weight (≥ 4,500 g; hazard ratio 0.3, 95% CI 0.1 to 1.0); and diabetes (hazard ratio 0).ConclusionsThe incidence of psychotic illness peaks immediately following a first childbirth, and almost 50% of the cases are women without any previous psychiatric hospitalization. High maternal age increases the risk while diabetes and high birth weight are associated with reduced risk of first-onset psychoses, distinctly during the postpartum period.
Highlights
A psychotic illness starting shortly after childbirth is a relatively rare condition [1,2]
High maternal age increases the risk while diabetes and high birth weight are associated with reduced risk of first-onset psychoses, distinctly during the postpartum period
Few studies have addressed the influence of the mother’s background and obstetric characteristics on the risk of postpartum psychosis while controlling for previous psychiatric vulnerability, e.g., psychiatric hospitalizations. It remains to be investigated whether episodes of psychosis during the 90 d postpartum period have risk factors distinct from psychoses occurring at later times during motherhood
Summary
A psychotic illness starting shortly after childbirth is a relatively rare condition [1,2]. Some women have their first and sometimes their only psychotic episode during the postpartum period [9,10] It is not known if this is solely due to a biological vulnerability for psychoses, or if psychosocial or obstetric factors influence the risk. Few studies have addressed the influence of the mother’s background and obstetric characteristics on the risk of postpartum psychosis while controlling for previous psychiatric vulnerability, e.g., psychiatric hospitalizations. It remains to be investigated whether episodes of psychosis during the 90 d postpartum period have risk factors distinct from psychoses occurring at later times during motherhood. Treatment for postpartum psychosis includes antipsychotic drugs, counseling, and hospital admission if the woman is a danger to herself or others
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