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Gut. 2019 Jan 9. pii: gutjnl-2018-317610. doi: 10.1136/gutjnl-2018-317610. [Epub ahead of print]

Inflammatory bowel disease and new-onset psychiatric disorders in pregnancy and post partum: a population-based cohort study.

Vigod SN1,2,3,4, Kurdyak P2,4,5, Brown HK4,6, Nguyen GC3,4,7,8, Targownik LE9,10, Seow CH11,12, Kuenzig ME4,13,14, Benchimol EI4,13,14,15.

Author information

1
Women's College Hospital and Research Institute, Toronto, Ontario, Canada.
2
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
3
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
4
ICES, Toronto, Ontario, Canada.
5
Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
6
Dalla Lana School of Public Health, and Interdisciplinary Centre for Health and Society, University of Toronto, Toronto, Ontario, Canada.
7
Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Toronto, Ontario, Canada.
8
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
9
University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada.
10
Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
11
Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
12
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
13
Division of Gastroenterology, Hepatology and Nutrition, and Children's Hospital of Eastern Ontario (CHEO) IBD Centre, CHEO, Ottawa, Ontario, Canada.
14
CHEO Research Institute, Ottawa, Canada.
15
Department of Pediatrics, and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.

Abstract

OBJECTIVE:

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.

DESIGN:

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.

RESULTS:

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.

CONCLUSION:

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.

KEYWORDS:

epidemiology; inflammatory bowel disease; psychology

PMID:
30630948
DOI:
10.1136/gutjnl-2018-317610

Conflict of interest statement

Competing interests: SNV: receives royalties from UpToDate Inc for authorship of topics focused on depression and antidepressant medication use in pregnancy. LET: received investigator-initiated funding from Janssen Canada and served on advisory boards for AbbVie Canada, Takeda Canada, Merck Canada, Pfizer Canada and Mallinckrodt USA. CHS: serves on advisory boards and as a speaker for Janssen Canada, Abbvie Canada, Shire Canada, Takeda Canada, Ferring Canada and received educational grants from Janssen Canada.

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