Depressive Symptoms During Pregnancy, Postpartum Depression Common in Women with Rheumatic Disease

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Research presented at the European Congress of Rheumatology (EULAR) 2023 annual meeting is calling attention to an apparent increase in risk of postpartum depression among women with rheumatic disease.

A pair of studies, one leveraging data from the US and the other with data from patients in Italy, results of both underline the elevated risk of postpartum depression in women with rheumatic disease, with the Italian study also purporting rheumatic disease was associated with anxiety and depressive symptoms during pregnancy.

“The rate of postpartum depression is significantly higher in women of reproductive age with [axial spondyloarthritis], [rheumatoid arthritis], or [psoriatic arthritis] compared to those without [rheumatic disease],” wrote investigators of the US-based study.¹ “Results from this study demonstrate that strategies to monitor postpartum depression after delivery in patients with RD must be developed and implemented to assure prompt referral of affected mothers for appropriate evaluation and treatment."

Postpartum Depression Among US Women with Rheumatic Disease¹

Led by a team from the Mass Chan Medical School and UMass Chan Medical Center, the population-based matched cohort study was launched with the intent of exploring the risk of postpartum depression among women with axial spondyloarthritis, rheumatoid arthritis, or psoriatic arthritis compared to a matched population without rheumatic disease within the US. With this in mind, investigators designed their retrospective analysis to leverage data from the IBM MarketScan Commercial Claims and Encounters Database for the time period lasting from 2013-2018.

Overall, investigators identified a cohort of 2667 women with axial spondyloarthritis, rheumatoid arthritis, and psoriatic arthritis and a cohort of 10,668 patients without any rheumatic disease. The overall cohort had a mean age of 33 (SD, 5.0) years at baseline, with investigators calling attention to the fact nearly 2 in 5 women were older than 35 years of age.

Of note, investigators restricted their cohorts to women aged 55 years of age or less with continued enrollment of at least 6 months before date of the last menstrual period and throughout pregnancy. Investigators matched every patient with rheumatic disease to 4 controls based on maternal age at delivery, prior history of depression, and duration of depression before delivery.

The primary outcome of interest for investigators was a diagnosis of depression within 1 year of delivery. Investigators noted Cox frailty proportional hazards models were used to estimate adjusted hazard ratios (aHRs) for incident postpartum depression.

Results of the study suggested development of postpartum depression was more common among those with rheumatic disease relative, occurring among 17.2% of the group compared to 12.8% of the matched controls (aHR, 1.22 [95% CI, 1.09-1.36]). Further analysis suggested the presence of pre-existing comorbidities, maternal complications during pregnancy were also associated with an increased risk of developing postpartum depression.¹

Postpartum Depressive Symptomatology in Women with Rheumatic Disease

The study of patients from Italy, which was led by investigators at the University of Brescia, was launched with the intent of exploring the frequency of depressive symptoms in postpartum women. With this in mind, investigators prospectively followed patients with rheumatic disease during pregnancy during a period lasting from May 2018 to June 2022.²

For the purpose of analysis, depressive symptoms were assessed using the Edinburgh Post-Natal Depression Scale (EPDS). Investigators also expressed an interest in exploring potential relationships in patients with arthritis and connective tissue diseases.²

During the study period, 129 women completed at least 1 EPDS. Among this cohort, 22% (n=28) had at least 1 positive EPD, but investigators highlighted there were no apparent differences in health and demographic variables between those with and without a positive EPDS. Subgroups analysis suggested a positive EPDS occurred among 24% (n=12 of 50) of the patients with arthritis, with these patients experiencing a shorter disease duration (P = .04), a lower patient global health in their first trimester (P = .03), and a higher frequency of anxious/depressive symptoms during pregnancy than their counterparts who screened negative.²

Additionally, among those with connective tissue diseases, 23% (n=16 of 69) had at least 1 positive EPDS. Investigators pointed out this group had a greater frequency of anxious and depressive symptoms during their third trimester compared to their counterparts who screened negative (P = .004).²

“Self-reported symptoms of anxiety and depression should be evaluated during pregnancy and patients could be offered a psychological interview,” wrote investigators from the University of Brescia.² “Our study underlines the need for a closer monitoring of mental health of pregnant women with [rheumatic disease] and the opportunity for further studies to identify risk factors and screening procedures.”

References:

1. Shridharmurthy D, Lapane K, Nunes A, et al. POSTPARTUM DEPRESSION AMONG REPRODUCTIVE-AGE WOMEN WITH AND WITHOUT RHEUMATIC DISEASE: A POPULATION-BASED MATCHED COHORT STUDY. Paper presented at: European Congress of Rheumatology (EULAR) 2023. Milan, Italy. May 31 – June 3, 2023.
2. Crisafulli F, Pedretti E, Andreolassi I, et al. RATES OF HIGH LEVELS OF POST-PARTUM DEPRESSIVE SYMPTOMATOLOGY IN WOMEN WITH RHEUMATIC DISEASES FOLLOWED DURING PREGNANCY, AND ASSOCIATIONS WITH TYPE OF DISEASE: A STUDY BY A MULTIDISCIPLINARY TEAM. Paper presented at: European Congress of Rheumatology (EULAR) 2023. Milan, Italy. May 31 – June 3, 2023.