Family Psychiatric History Increases Risk of Postpartum Psychiatric Episodes

Anna E. Bauer, PhD, Postdoctoral Research Associate, University of North Carolina School of Medicine

Anna E. Bauer, PhD

A new mother’s risk of postpartum psychiatric conditions increases when an immediate family member has a psychiatric disorder, especially bipolar disorder, according to new research.

The research, presented at the American Psychiatric Association’s 2018 Annual Meeting, studied how family history of psychiatric disorder associates with postpartum psychiatric disorders in proband mothers (first-time mothers who were born in Denmark in 1970 or later and gave birth after age 15 and before Dec. 31, 2012) with and without prior psychiatric conditions by assessing degree of relationship, type of disorder and sex of family member.

“The importance of screening for perinatal mood and anxiety disorders has been increasingly recognized in recent years, but most of these efforts rely on identifying women after they become symptomatic,” lead author, Anna Bauer, PhD, postdoctoral research associate, University of North Carolina School of Medicine, said in a statement. “We hope that additional information about family history in any first-degree relative — for example, bipolar disorder in a brother — can help clinicians predict who may benefit from increased surveillance before symptoms emerge, in order to intervene as early possible.”

Researchers examined records of birth and psychiatric treatment in national population-based cohort in Denmark which consisted of 362,462 proband mothers. The mean age of mothers was 27 years at the time of delivery.

Follow-up began at the date of childbirth for each proband mother and was followed until a postpartum psychiatric episode, 6 months postpartum (3 or 12 months in sensitivity analyses), death, emigration of Dec. 31, 2012, whichever came first.

Of the study population, 2603 (0.7%) experienced a psychiatric disorder within 6 months postpartum and 4085 (1.1%) within 12 months postpartum.

The study uniquely looked at whether familial risk varies depending on the sex of the family member and found that a history of psychiatric disorders in male relatives is just as instrumental in risk assessment of postpartum psychiatric disorders as a history in female relatives.

Researchers found that the hazard of experiencing a psychiatric disorder within the first 6 months postpartum was higher among proband mothers with a first-degree relative who experienced any psychiatric disorder compared to proband mothers whose relatives did not experience any psychiatric disorder (hazard ratio=1.45, 95% CI=1.28—1.65).

The risk for postpartum psychiatric conditions was greater when a family history of bipolar disorder (hazard ratio=2.86, 95% CI=1.88—4.35) was present than for family history of depression or psychiatric conditions more broadly.

Familial risk was also elevated for those mothers that had a first-degree relative with schizophrenia (hazard ratio=1.58, 95% CI=1.27—1.95), unipolar disorder (hazard ratio=1.52, 95% CI=1.24–1.87), or other mood disorders (hazard ratio=1.78, 95% CI=1.03–3.06), but not other psychiatric disorders (hazard ratio=0.90, 95% CI=0.70–1.16).

Authors noted that the association with family history was stronger among women with no history of psychiatric disorders.

The risk of postpartum disorders in proband mothers whose mothers had psychiatric disorders (hazard ratio=1.50, 95% CI=1.27—1.77 for mothers) was similar to the proband of mothers whose fathers had psychiatric disorders (hazard ratio=1.54, 95% CI=1.27–1.87 for fathers).

Study authors concluded that family history of psychiatric disorder, especially history in fathers and brothers, is highly valuable information to help identify women most at risk for postpartum psychiatric illness.

“Thus, when assessing risk for postpartum episodes, clinicians should inquire about family history of psychiatric disorders broadly and not limit discussion to postpartum psychiatric disorders or psychiatric disorders in female relatives,” researchers concluded.

Results provide compelling evidence that assessment of risk for postpartum psychiatric illness, with a focus on history of bipolar disorder, should include inquiring about family history of psychiatric disorders in any male or female first-degree relative in order to improve prediction of risk.

Current US Preventive Service Task Force and the American Congress of Obstetricians and Gynecologist practice guidelines do not include family history as a consideration for postpartum mental health conditions.

The study, "Familiality of Psychiatric Disorders and Risk of Postpartum Psychiatric Episodes: A Population-Based Cohort Study" was published in The Online American Journal of Psychiatry.

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