麻豆传媒

Mothers with multiple sclerosis (MS) had a higher risk of peripartum mental illness than comparator mothers, administrative health data from Canada showed.

Incident mental illness -- most commonly, depression and anxiety -- affected 8.4% of mothers with MS prenatally and 14.2% during the first postpartum year, reported Ruth Ann Marrie, MD, PhD, of Dalhousie University in Halifax, and co-authors.

The incidence of mental illness was higher among women with MS during both the prenatal period (incidence ratio [IR] 1.26, 95% CI 1.11-1.44) and the postpartum period (IR 1.33 for the first year, 95% CI 1.20-1.47) versus comparator mothers, the researchers wrote in .

The first postpartum year was a higher risk period than the prenatal months (IR 1.27, 95% CI 1.08-1.50), Marrie and colleagues said.

Mothers with MS had an increased risk of all specific mental illnesses except suicide attempts. Of note, substance use increased in women with MS, from 0.54% during pregnancy to 6% after giving birth.

Compared with mothers who had other chronic diseases -- epilepsy, inflammatory bowel disease (IBD), or diabetes -- mothers with MS had higher risks of peripartum depression, anxiety, and psychosis.

These findings have several implications, Marrie and colleagues noted. "Untreated maternal depression is associated with substance use, increased risk of future depressive episodes, and suicide," they wrote.

Maternal mental illness also has important effects on the physical and mental health of a child, they added. "Mothers with depression breastfeed for shorter periods, and their children receive less preventive care and undergo more emergency department visits," they pointed out. "Infants and older children may suffer from behavioral disturbances, developmental delays, and social withdrawal."

Screening and referrals for mental health treatment can't be left to ob/gyn providers because mothers with MS may not have adequate perinatal care, observed Lindsay Ross, MD, of the Cleveland Clinic in Ohio.

"In a population database study in France, only 42% of women with MS had adequate perinatal visits and ultrasounds, but over half of the women with MS saw a neurologist during pregnancy and 43% saw a neurologist in the 6-month postpartum period," she noted in an .

"As such, clinicians caring for women with MS should consider implementation of validated screening tools of peripartum mental illness and substance abuse, such as the Edinburgh Postnatal Depression Scale and Substance Use Risk Profile-Pregnancy (SURP-P) scale, or include regular discussion of mental health and substance use as part of family planning, pregnancy, and postnatal visits," Ross suggested.

Clinicians caring for women with MS also should be familiar with local resources to treat peripartum mental illness, or should connect with a patient's ob/gyn or primary care provider if mental health care is needed, Ross added.

Marrie and colleagues evaluated records for 894,852 pregnant women in Ontario who had a live birth with index dates between 2002 and 2017. The sample included 1,745 women with MS, 5,954 with epilepsy, 4,924 with IBD, 13,002 with diabetes, and 869,227 comparator mothers.

Mean maternal age at conception was 28.6 years. Women were followed during pregnancy and for 3 years postpartum.

Prevalence estimates showed that mental illness affected 42% of mothers with MS during pregnancy, and 50.3% of mothers with MS in the first postpartum year.

The analysis may underestimate the burden of mental illness because administrative records capture only those conditions for patients who seek care, the researchers acknowledged. Administrative data also lacked information about mental illness characteristics, including severity, treatment status, and health behaviors.

The analysis did not examine risk factors of mental illness other than the disease cohort, Marrie and co-authors noted. "Future work should explore the impact of MS disease activity and severity on peripartum mental illness and whether the intensity of mental health disorders varies among mothers with different disease states," they wrote.

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