Postpartum Psychiatric Disorders Tied to Lower Chance of Subsequent Live Birth

By Lisa Rapaport

April 07, 2020

(Reuters Health) - Women who develop postpartum psychiatric disorders may be less likely to have a subsequent live birth than women who don't, especially if they have severe symptoms requiring hospitalization, a population-based study suggests.

Researchers examined data from Danish registries for 414,571 women who had their first live birth between 1997 and 2015 in Denmark. They followed the women until the next live birth, emigration, death, their 45th birthday or June 2016, whichever occurred first. The maximum follow-up was 19.5 years.

They identified women with postpartum psychiatric disorders based on prescriptions for psychotropic medications or hospital contact for psychiatric disorders during the first six months after the live birth of their first child.

A total of 4,327 (1%) of women experienced psychiatric disorders following the birth of their first child. These women were 33% less likely to have a second live birth compared to women who did not experience psychiatric disorders.

"Although fewer women with postpartum psychiatric disorders had subsequent childbirths, it is noteworthy that about 69.1% of these women chose to have a second child," said lead study author Xiaoqin Liu of the National Centre for Register-based Research at Aarhus University in Denmark.

"Given the substantial recurrent risk of postpartum psychiatric disorders, these women are recommended to have pre-pregnancy counseling, to plan prevention strategies, and to have their well-being and symptoms closely monitored and treated," Liu said by email. "For the remaining 30.9% of women, we need to differentiate the reasons for not having another child. If they avoided another pregnancy due to fear of relapse, an important clinical message to them is that prevention of relapse is possible."

Previous research has shown that, overall, around 3% of women develop psychiatric disorders in the first three months after childbirth, researchers note in Human Reproduction. These disorders encompass a wide range of mental health problems and usually involve a combination of abnormal thoughts, behaviors and relationships with other people. To date, there has been little research into whether or not this affects women's subsequent reproduction.

It's possible that some women chose to avoid another pregnancy because they didn't want to repeat the psychiatric problems they experienced with their first child, the study authors note. It's also possible that the reduction in subsequent live birth rates associated with postpartum psychiatric disorders might be due to problems with fertility or relationships with partners or something else entirely.

A limitation of the study is that, although the researchers had an almost complete follow-up of the women through the Danish registries, they did not have accurate information on stillbirths or miscarriages; only pregnancies that led to a live birth were included in the study.

Another limitation is that not all women with psychiatric disorders might have received medications or hospital treatment. In addition, it might not be possible to generalize the findings of the study to populations in other countries, particularly because Denmark offers free and easily accessible health care to all individuals, the researchers note.

It isn't clear from the study design whether lower fertility is a personal choice, said Myrna Weissman, chief of translational epidemiology at the New York State Psychiatric Institute at Columbia University in New York City.

"The take home message is clear: if you have a personal history or a family history of depression get help before, during, and after the pregnancy," Weissman, who wasn't involved in the study, said by email. "The impact (on) the offspring is serious if the depression is persistent and a strong effort should be made to prevent that."

SOURCE: Human Reproduction, online March 29, 2020.