Summary: Researchers report an elevated risk of women with inflammatory bowel disease being diagnosed with mental health problems after giving birth. The study reports that for every 43 pregnancies, there is one case of a new mental illness diagnosis for women with IBD compared to women without the condition.
Source: CHEO Hospital.
A study published today in the journal Gut shows that women with inflammatory bowel disease (IBD) are at greater risk of developing a mental illness after giving birth compared to the overall population. Study authors found that more than one-fifth of pregnant women with IBD had a new-onset mental health diagnosis. For every 43 pregnancies, there is one extra case of mental illness in a woman with IBD, compared to other women. The study used healthcare data on women who gave birth between 2002 and 2014 in Ontario, Canada to analyze the frequency of a new mental illness diagnosis in these women during and up to one year after a pregnancy.
Inflammatory bowel disease, or IBD, are a group of chronic gastrointestinal disorders in which people have ulceration, inflammation, and bleeding of their gastrointestinal tract, and are at risk for complications in other parts of the body. The two main subtypes are Crohn’s disease and ulcerative colitis. People with IBD have an elevated risk of mental illness, especially anxiety and depression, potentially related to the inflammation in the gut affecting their brain.
“There’s increasing awareness about mental illness in women during pregnancy and postpartum,” said Dr. Eric Benchimol, senior author on the paper, and Senior Scientist at the CHEO Research Institute, Core Scientist at ICES, Associate Professor of Pediatrics and Epidemiology at the University of Ottawa, and a Pediatric Gastroenterologist at the CHEO Inflammatory Bowel Disease Centre. “Because of the elevated risk of mental illness in people with IBD, we felt it was important to study if women with IBD were at greater risk of developing a new mental illness during pregnancy and after giving birth compared to the overall population. We found the risk to be elevated during the post-partum period for women with IBD, particularly in the first 90 days after birth. We did not find an elevated risk during pregnancy.”
In the study population, pregnant women with IBD had an elevated risk of developing a new-onset mental illness postpartum when compared to women without IBD – 22.7 per cent compared to 20.4 per cent. The women with IBD were at increased risk of two out of the four mental illness diagnostic categories: mood disorders (such as anxiety and depression) and substance use disorders (such as opioid dependency). These women were primarily treated by doctors in the outpatient setting, and did not need to be hospitalized. There was no evidence of increased risk for psychotic disorders (such as schizophrenia or hallucinations). The risk appeared elevated in women with Crohn’s disease, but not ulcerative colitis.
“This is a small but significantly increased risk of new-onset mental illness in women with IBD,” says Dr. Simone Vigod, lead author of the study, Scientist at the Women’s College Hospital Research Institute, Chief, Department of Psychiatry, Women’s College Hospital, and Adjunct Scientist at ICES. “Women with IBD face increased health challenges during pregnancy and after giving birth, and it’s not just physical challenges. We need to look at both the physical and mental health needs of women and ensure they are getting the best treatment and support.”
“These findings are very important for both patients and healthcare providers in the IBD community,” says Mina Mawani, President and CEO of Crohn’s and Colitis Canada. “If a pregnant woman with IBD knows that there’s an elevated risk of mental illness during the post-partum period, she should discuss this potential risk with her healthcare provider. It’s important that healthcare providers are aware of this increased risk in women with IBD. Together, women and their healthcare providers can look for opportunities to prevent mental illness during pregnancy and after birth as well as identify and treat it earlier.”
Funding: The research was funded by the Medical Psychiatry Alliance.
Source: Aynsley Morris – CHEO Hospital
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Original Research: Abstract for “Inflammatory bowel disease and new-onset psychiatric disorders in pregnancy and post partum: a population-based cohort study” by Simone N Vigod, Paul Kurdyak, Hilary K Brown, Geoffrey C Nguyen, Laura E Targownik, Cynthia H Seow, M Ellen Kuenzig, and Eric I Benchimo in Gut. Published January 10 2019.
Inflammatory bowel disease and new-onset psychiatric disorders in pregnancy and post partum: a population-based cohort study
Patients with inflammatory bowel disease (IBD) have an elevated risk of mental illness. We determined the incidence and correlates of new-onset mental illness associated with IBD during pregnancy and post partum.
This cohort study using population-based health administrative data included all women with a singleton live birth in Ontario, Canada (2002–2014). The incidence of new-onset mental illness from conception to 1-year post partum was compared between 3721 women with and 798 908 without IBD, generating adjusted HRs (aHR). Logistic regression was used to identify correlates of new-onset mental illness in the IBD group.
About 22.7% of women with IBD had new-onset mental illness versus 20.4% without, corresponding to incidence rates of 150.2 and 132.8 per 1000 patient-years (aHR 1.12, 95% CI 1.05 to 1.20), or one extra case of new-onset mental illness per 43 pregnant women with IBD. The risk was elevated in the post partum (aHR 1.20, 95% CI 1.09 to 1.31), but not during pregnancy, and for Crohn’s disease (aHR 1.12, 95% CI 1.02 to 1.23), but not ulcerative colitis. The risk was specifically elevated for a new-onset mood or anxiety disorder (aHR 1.14, 95% CI 1.04 to 1.26) and alcohol or substance use disorders (aHR 2.73, 95% CI 1.42 to 5.26). Predictors of a mental illness diagnosis were maternal age, delivery year, medical comorbidity, number of prenatal visits, family physician obstetrical care and infant mortality.
Women with IBD were at an increased risk of new-onset psychiatric diagnosis in the postpartum period, but not during pregnancy. Providers should look to increase opportunities for prevention, early identification and treatment accordingly.