Issue 08

Clinical Question

Is IBD associated with a higher risk of postpartum mental illness?

Editor’s Bottom Line

This observed association between Crohn’s disease (CD) and postpartum mental health is intriguing, although the small effect size means confounding factors must be considered.

Reference

Vigod SN, Kurdyak P, Brown HK, et al. Inflammatory bowel disease and new-onset psychiatric disorders in pregnancy and post partum: a population-based cohort study. Gut. E-pub Jan 9, 2019; https://gut.bmj.com/content/early/2019/01/05/gutjnl-2018-317610

Synopsis

Both IBD and pregnancy are associated with an increased risk of mental illness. To evaluate whether the two have a compounding effect, researchers at several Canadian institutions examined data from 3,721 women with documented IBD and 798,908 without IBD who completed the live birth of a single child in Ontario between 2002–2014 and were registered in the Ontario Ministry of Health and Long-Term Care database. They compared the incidence of new-onset mental illness between the time of conception and one year following birth. Only women with IBD who received a diagnosis of CD or ulcerative colitis at least one year prior to conception were included, and none of the women had a documented prior history of mental illness.

Results showed that 22.7% of women with IBD had new-onset mental illness between conception and one-year postpartum, compared to 20.4% among those without IBD, leading to a 12% increased risk of new-onset mental illness (adjusted Hazard Ratio [aHR]: 1.12; 95% Confidence Interval [CI]: 1.05–1.20). According to subgroup analyses, the risk was significantly higher during the postpartum period (aHR: 1.20; 95% CI:1.09–1.31) and for individuals with CD (aHR: 1.12; 95% CI: 1.02–1.23), but not before labour or for women with ulcerative colitis.

There was a 14% increased risk of new-onset mood or anxiety disorders (aHR: 1.14; 95% CI: 1.04–1.26) and a nearly three-fold increased risk of new-onset alcohol or substance use disorders among women with IBD throughout the perinatal period (aHR: 2.73; 95% CI:1.42–5.26). The incidence of psychosis and rates of hospitalization or emergency department visits due to mental illness were not higher among women with IBD. Multivariate statistical analyses showed older age, more medical comorbidities, more prenatal visits, obstetrical care given by a family physician and infant mortality predicted new-onset mental illness.

The researchers posited systemic inflammation as one of the possible contributing factors to the increased risk of mental illness among those with IBD.

Details

Study Design: Population-based cohort
Funding: The Medical Psychiatry Alliance and ICES
Allocation: Not applicable
Setting: Province-wide database
Level of Evidence: 2b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.