The first month after childbirth is related to an increased risk of psychiatric readmission for first-time mothers, according to a report in the February Archives of General Psychiatry. Mothers with mental disorders have lower readmission rates than women with mental disorders who do not have children, and women with a history of bipolar affective disorder are especially at risk for postpartum psychiatric readmission.
Trine Munk-Olsen, PhD, of the National Centre for Register-Based Research at the University of Aarhus in Denmark, and colleagues conducted a population-based cohort study that combined data from the Danish Civil Registration System and the Danish Psychiatric Central Register. The study included two partly overlapping groups; a total of 28,124 women, 10,218 of whom were mothers, were followed up from January 1, 1973, to June 30, 2005. Readmission rates during the 12 months following birth of the first live-born child were the primary outcome measure.
Ten to 19 days postpartum was the period of highest risk of readmission for new mothers (relative risk [RR], 2.71). The period of lowest risk was during pregnancy (RR, 0.54). “Childbirth was associated with an increased risk of readmission during the first postpartum month, after which risk for readmission was higher among nonmothers (RR, 1.53),” Dr. Munk-Olsen’s group stated. The strongest predictor of readmissions during the 10- to 19-day period was a previous diagnosis of bipolar affective disorder (RR, 37.22). About 27% of mothers with this diagnosis were readmitted within the first year after giving birth.
Readmissions during the postpartum period may partly result from the exacerbating effect that caring for an infant has on an existing illness, the researchers suggested. “The increased postpartum psychiatric readmission rate could imply that women with bipolar disorders are more vulnerable to puerperal triggering and that childbirth itself rather than changes in medication treatment is associated with the high postpartum risk of bipolar episodes,” Dr. Munk-Olsen and colleagues commented.
“Our findings highlight the need for careful clinical monitoring and provision of relevant psychoeducation to women with a history of bipolar disorder who are pregnant or considering pregnancy,” the researchers concluded.