TOPLINE:

The rates of maternal psychiatric disorders diagnosed before, during, and after pregnancy increased over time from 2003 to 2019 in Sweden. While the risks for most psychiatric conditions reduced during pregnancy and postpartum compared to that during preconception, depression and psychosis risk increased shortly after delivery.

METHODOLOGY:

• Researchers conducted a nationwide cohort study involving 1,799,010 pregnancies in 1,052,977 women who gave birth during 2003-2019 in Sweden, using the Medical Birth Register, which virtually covers all births in the country.
• Analysis focused on incident diagnoses of psychiatric disorders recorded during three periods: the preconception year, pregnancy, and postpartum year, with cases identified through the National Patient Register and regional primary care registers.
• Investigators calculated age and calendar year standardized incidence rate of psychiatric disorders annually and by week across the three periods using the rate during corresponding preconception weeks as reference.
• Data collection included records from primary care registers in Stockholm, Skåne, and Västra Götaland counties in Sweden, covering 54.2% (1,005,886) of pregnancies during the study period.

TAKEAWAY:

• The standardized incidence rate of maternal psychiatric disorders showed an increasing trend from 2003 to 2019, particularly for preconception disorders.
• The weekly standardized incidence rate remained stable at approximately 25 per 1000 person-years during the preconception period and gradually decreased to 4 per 1000 person-years during pregnancy, before returning to preconceptional levels in the postpartum year.
• Distinct patterns were observed for depression and psychosis, with increased incidence rates at 5-15 weeks postpartum for depression and 0-20 weeks postpartum for psychosis.
• According to the authors, the findings suggest that the risk for most psychiatric disorders reduced during and after pregnancy compared to before pregnancy, except for depression and psychosis risk, which increased shortly after delivery.

IN PRACTICE:

“Throughout all stages of life, perinatal periods are the vital points that women are in frequent contact with the healthcare system. Potential practical approaches can be adopted for education, risk assessment, and early detection and intervention, with the goal of improving maternal mental health for the well-being of the mothers and families,” the authors of the study wrote.

SOURCE:

The study was led by Emma Brinn, PhD, Institute of Environmental Medicine, and Donghao Lu, MD, PhD, Clinical Epidemiology Division, Department of Medicine, both at Karolinska Institutet, Stockholm, and was published online on September 25 in Molecular Psychiatry.

LIMITATIONS:

While primary care data was sourced from the three most populated counties in Sweden, covering over 50% of the study population, psychiatric disorders diagnosed by general practitioners in other counties and within maternity care might have been missed. The study population consisted only of women who became pregnant and maintained their pregnancies, potentially excluding those who chose not to become pregnant or terminated their pregnancy due to newly diagnosed psychiatric disorders. As the research was conducted in Sweden, a high-income country with tax-funded universal healthcare, the findings may not be generalizable to countries with different healthcare settings and screening strategies.

DISCLOSURES:

The study received funding from Uppsala Faculty of Medicine’s foundation for psychiatric and neurological research and Karolinska Institutet’s Research Foundation Grants. Additional support came from Forte, the Karolinska Institutet Strategic Research Area in Epidemiology and Biostatistics, the Swedish research council, and the Icelandic Research Fund. Yi Lu declared receiving support from European Research Council grant and US National Institutes of Mental Health.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.