Rheumatoid arthritis and the risk of postpartum psychiatric disorders: a Nordic population-based cohort study
Abstract Background Postpartum psychiatric disorders (PPD) are common complications of childbirth. A common explanation for their development is that the psychological, hormonal, and immune changes associated with pregnancy and parturition may trigger psychiatric symptoms postpartum. Rheumatoid arth...
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| Format: | Article |
| Language: | English |
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BMC
2023-04-01
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| Series: | BMC Medicine |
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| Online Access: | https://doi.org/10.1186/s12916-023-02837-3 |
| _version_ | 1797850034066161664 |
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| author | Min Luan Fen Yang Maohua Miao Wei Yuan Mika Gissler Elizabeth V. Arkema Donghao Lu Jiong Li Krisztina D. László |
| author_facet | Min Luan Fen Yang Maohua Miao Wei Yuan Mika Gissler Elizabeth V. Arkema Donghao Lu Jiong Li Krisztina D. László |
| author_sort | Min Luan |
| collection | DOAJ |
| description | Abstract Background Postpartum psychiatric disorders (PPD) are common complications of childbirth. A common explanation for their development is that the psychological, hormonal, and immune changes associated with pregnancy and parturition may trigger psychiatric symptoms postpartum. Rheumatoid arthritis (RA) is characterized by abnormalities in the activity of the hypothalamic–pituitary–adrenal axis and of the immune system, but its association with PPD is unknown. We analyzed whether women with RA before childbirth have an increased risk of PPD. Methods We conducted a large population-based cohort study including mothers of singleton births in the Danish (1995–2015), Finnish (1997–2013), and Swedish Medical Birth Registers (2001–2013) (N = 3,516,849). We linked data from the Medical Birth Registers with data from several national socioeconomic and health registers. Exposure was defined as having a diagnosis of RA before childbirth, while the main outcome was a clinical diagnosis of psychiatric disorders 90 days postpartum. We analyzed the association between RA and PPD using Cox proportional hazard models, stratified by a personal history of psychiatric disorders. Results Among women without a history of psychiatric disorders, the PPD incidence rate was 32.2 in the exposed and 19.5 per 1000 person-years in the unexposed group; women with RA had a higher risk of overall PPD than their unexposed counterparts [adjusted hazard ratio (HR) = 1.52, 95% confidence intervals (CI) 1.17 to 1.98]. Similar associations were also observed for postpartum depression (HR = 1.65, 95% CI 1.09 to 2.48) and other PPD (HR = 1.59, 95% CI 1.13 to 2.24). Among women with a history of psychiatric disorders, the incidence rate of overall PPD was 339.6 in the exposed and 346.6 per 1000 person-years in the unexposed group; RA was not associated with PPD. We observed similar associations between preclinical RA (RA diagnosed after childbirth) and PPD to those corresponding to clinical RA. Conclusions Rheumatoid arthritis was associated with an increased PPD risk in women without, but not in those with a psychiatric history. If our findings are confirmed in future studies, new mothers with RA may benefit from increased surveillance for new-onset psychiatric disorders postpartum. |
| first_indexed | 2024-04-09T18:53:51Z |
| format | Article |
| id | doaj.art-6a4ce329a71e4fd0ac303d3b44ecc34f |
| institution | Directory Open Access Journal |
| issn | 1741-7015 |
| language | English |
| last_indexed | 2024-04-09T18:53:51Z |
| publishDate | 2023-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medicine |
| spelling | doaj.art-6a4ce329a71e4fd0ac303d3b44ecc34f2023-04-09T11:18:39ZengBMCBMC Medicine1741-70152023-04-0121111110.1186/s12916-023-02837-3Rheumatoid arthritis and the risk of postpartum psychiatric disorders: a Nordic population-based cohort studyMin Luan0Fen Yang1Maohua Miao2Wei Yuan3Mika Gissler4Elizabeth V. Arkema5Donghao Lu6Jiong Li7Krisztina D. László8NHC Key Laboratory of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan UniversityDepartment of Global Public Health, Karolinska InstitutetNHC Key Laboratory of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan UniversityNHC Key Laboratory of Reproduction Regulation (Shanghai Institute for Biomedical and Pharmaceutical Technologies), Fudan UniversityDepartment of Knowledge Brokers, Finnish Institute for Health and WelfareClinical Epidemiology Division, Department of Medicine Solna, Karolinska InstitutetUnit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska InstitutetDepartment of Clinical Medicine-Department of Clinical Epidemiology, Aarhus UniversityDepartment of Global Public Health, Karolinska InstitutetAbstract Background Postpartum psychiatric disorders (PPD) are common complications of childbirth. A common explanation for their development is that the psychological, hormonal, and immune changes associated with pregnancy and parturition may trigger psychiatric symptoms postpartum. Rheumatoid arthritis (RA) is characterized by abnormalities in the activity of the hypothalamic–pituitary–adrenal axis and of the immune system, but its association with PPD is unknown. We analyzed whether women with RA before childbirth have an increased risk of PPD. Methods We conducted a large population-based cohort study including mothers of singleton births in the Danish (1995–2015), Finnish (1997–2013), and Swedish Medical Birth Registers (2001–2013) (N = 3,516,849). We linked data from the Medical Birth Registers with data from several national socioeconomic and health registers. Exposure was defined as having a diagnosis of RA before childbirth, while the main outcome was a clinical diagnosis of psychiatric disorders 90 days postpartum. We analyzed the association between RA and PPD using Cox proportional hazard models, stratified by a personal history of psychiatric disorders. Results Among women without a history of psychiatric disorders, the PPD incidence rate was 32.2 in the exposed and 19.5 per 1000 person-years in the unexposed group; women with RA had a higher risk of overall PPD than their unexposed counterparts [adjusted hazard ratio (HR) = 1.52, 95% confidence intervals (CI) 1.17 to 1.98]. Similar associations were also observed for postpartum depression (HR = 1.65, 95% CI 1.09 to 2.48) and other PPD (HR = 1.59, 95% CI 1.13 to 2.24). Among women with a history of psychiatric disorders, the incidence rate of overall PPD was 339.6 in the exposed and 346.6 per 1000 person-years in the unexposed group; RA was not associated with PPD. We observed similar associations between preclinical RA (RA diagnosed after childbirth) and PPD to those corresponding to clinical RA. Conclusions Rheumatoid arthritis was associated with an increased PPD risk in women without, but not in those with a psychiatric history. If our findings are confirmed in future studies, new mothers with RA may benefit from increased surveillance for new-onset psychiatric disorders postpartum.https://doi.org/10.1186/s12916-023-02837-3Postpartum psychiatric disordersPostpartum depressionRheumatoid arthritisCohort study |
| spellingShingle | Min Luan Fen Yang Maohua Miao Wei Yuan Mika Gissler Elizabeth V. Arkema Donghao Lu Jiong Li Krisztina D. László Rheumatoid arthritis and the risk of postpartum psychiatric disorders: a Nordic population-based cohort study BMC Medicine Postpartum psychiatric disorders Postpartum depression Rheumatoid arthritis Cohort study |
| title | Rheumatoid arthritis and the risk of postpartum psychiatric disorders: a Nordic population-based cohort study |
| title_full | Rheumatoid arthritis and the risk of postpartum psychiatric disorders: a Nordic population-based cohort study |
| title_fullStr | Rheumatoid arthritis and the risk of postpartum psychiatric disorders: a Nordic population-based cohort study |
| title_full_unstemmed | Rheumatoid arthritis and the risk of postpartum psychiatric disorders: a Nordic population-based cohort study |
| title_short | Rheumatoid arthritis and the risk of postpartum psychiatric disorders: a Nordic population-based cohort study |
| title_sort | rheumatoid arthritis and the risk of postpartum psychiatric disorders a nordic population based cohort study |
| topic | Postpartum psychiatric disorders Postpartum depression Rheumatoid arthritis Cohort study |
| url | https://doi.org/10.1186/s12916-023-02837-3 |
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