MS patients at higher risk of mental illness with pregnancy: Study
Researchers highlight need for mental health screening, early intervention
Women with multiple sclerosis (MS) face a significantly higher risk of mental illness during and after pregnancy than those without the disease, according to a new study that analyzed data from more than 890,000 women in Canada.
Mental health issues, mostly anxiety and depression, affected 42% of women with MS during pregnancy, which rose to 50% in the first year after giving birth, compared with 30% during pregnancy and 38% after giving birth for women without MS.
“Our findings highlight the heightened vulnerability of mothers with MS to mental illness, emphasizing the need for mental health screening and early intervention, including the use of preventive strategies,” Ruth Ann Marrie, PhD, the study’s lead author and professor of medicine at Dalhousie University, in Canada, said in a university news story.
The large-scale study, “Peripartum Mental Illness in Mothers With Multiple Sclerosis and Other Chronic Diseases in Ontario, Canada,” was published in the journal Neurology.
More women diagnosed with MS than men
Women are up to three times as likely as men to be diagnosed with MS, an inflammatory condition that affects healthy parts of the brain and spinal cord. Most cases are diagnosed during childbearing years when many women may be planning to start a family.
In the general population, mood disorders, including depression and anxiety, are the most common mental health problems women face during the peripartum period, or the time around pregnancy and childbirth.
Although more women with MS are affected by mental health issues than those without the disease, little is known about the risk of mental illness in women with MS around the peripartum period.
The “potential adverse effects of peripartum mental illness on the parent and child make it critical to understand the incidence and prevalence of a broad spectrum of peripartum mental illness in this population,” the researchers wrote.
A research team based in Canada set out to determine the proportion of MS women who had or developed new mental health issues around the peripartum period. The researchers used population-based health data from the province of Ontario to identify women with MS who had a live birth from 2002 to 2017.
Data on mothers with other chronic conditions, such as epilepsy, inflammatory bowel disease (IBD), and diabetes, as well as controls without any of these conditions were also examined.
The study included 894,852 mothers who had live births, of whom 1,745 had MS, 5,954 epilepsy, 4,924 IBD, and 13,002 diabetes. The remaining 869,227 mothers had none of these conditions.
The researchers examined cases of mental illness in women from when they conceived to childbirth (prenatal) and up to three years after giving birth (postpartum). Mood disorders assessed included depression, anxiety, bipolar disorder, psychosis, substance use disorder, suicide attempts, and any other mental illness.
Among mothers with MS, 8.4% developed a new mental illness during the prenatal period, most commonly anxiety (3.8%), depression (0.8%), and substance use (0.5%). In the first year after birth, 14.2% of the women were diagnosed with a new mental illness.
Fewer women without MS experienced mental illness during prenatal period
For mothers without MS or other chronic conditions, the incidence of any mental illness during the prenatal period was comparatively lower than in MS at 7.1%, as was anxiety at 2.3%. This trend continued for the first two years after giving birth but not for the third year.
Overall, women with MS had a 26% greater risk of experiencing a new mental illness during pregnancy and a 33% higher risk in the first year postpartum than those without MS, after adjusting for factors such as age, socioeconomic status, and obstetric complications. Women with epilepsy, IBD, and diabetes also had increased risk of mental illness before and after giving birth than those without these conditions.
More women with MS had a mood disorder than those without MS during the prenatal period (42% vs. 30%) and in the first year after giving birth (50.3% vs. 38%).
According to the researchers, several factors may influence the risk of mental illness among pregnant women with MS, including genetic risk and exposure to risk factors such as childhood trauma, inflammation, immune dysregulation, and brain lesions. Other factors, such as psychological stressors and/or hormonal changes, may also influence mood disorders around pregnancy, they suggested.
“Future studies should assess how the activity and severity of chronic diseases such as MS may affect mental health during the pregnancy and postpartum period, and how comprehensive care strategies can best support mental health during this period,” said Colleen Maxwell, PhD, senior author and a professor at the University of Waterloo, in Canada.
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