Risk factors for postpartum BPAD relapse identified
MedWire News: Risk factors for bipolar affective disorder (BPAD) relapse among women who have recently given birth include younger age, an unplanned pregnancy, previous perinatal episodes, and a family history of the mood disorder, UK research shows.
"Severe postpartum manic and psychotic episodes are a particular complication of childbirth for women with a history of BPAD," observe Jessica Heron (University of Birmingham) and team.
"Fortunately postpartum psychosis is usually very responsive to treatment but delays in identification result in longer, more severe, and difficult to treat episodes, as well as a risk of maternal suicide and of harm occurring to the infant."
To identify risk factors associated with postpartum relapse in women with BPAD, the team studied 78 women with the mood condition who were referred to perinatal mental health services before conception, during pregnancy, or during the postpartum period, between 1998 and 2009.
A clinically significant postpartum relapse was defined as the onset or exacerbation of an episode of depression, mania, schizoaffective mania, unspecified psychosis, or mixed episode within 6 weeks of childbirth.
In total, 46.5% of the women experienced a clinically significant relapse during the postpartum period, the researchers note in the journal European Psychiatry.
They found that women who relapsed were significantly younger than those who did not, at a mean 29 versus 33 years.
Furthermore, women with an unplanned pregnancy were at greater risk for relapse than those with a planned pregnancy, at 75.0% versus 38.1%, and those who were unwell at referral were more likely to relapse than those who remained well during pregnancy, at 66.7% versus 35.7%.
There was also a trend towards a higher rate of relapse in women with family history of bipolar disorder than in those without, at 75% versus 39%.
Parity, age at onset of depression, number of episodes of depression, previous suicide attempts, and number of years since last manic episode were not associated with postpartum relapse risk.
"This study has identified a number of risk factors for bipolar relapse in the postpartum," comment Heron and team.
They add: "There is still a belief that women who have remained well and medication free for the years prior to pregnancy have a low risk of illness following childbirth; this myth must be dispelled in order to make childbirth a safer time for women with a history of BPAD."
By Mark Cowen