From the Department of Psychiatry, Erasmus Medical Centre, Rotterdam, the Netherlands; the National Center for Register-Based Research, University of Aarhus, Aarhus, Denmark; and the Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.
Am J Psychiatry. 2016 Feb 1;173(2):117-27. doi: 10.1176/appi.ajp.2015.15010124. Epub 2015 Oct 30.
Women with a history of bipolar disorder, postpartum psychosis, or both are at high risk for postpartum relapse. The aim of this meta-analysis was to estimate the risk of postpartum relapse in these three patient groups.
A systematic literature search was conducted in all public medical electronic databases, adhering to the PRISMA guidelines. Studies were included if they reported postpartum relapse in patients diagnosed with bipolar disorder and/or a history of postpartum psychosis or mania according to DSM or ICD criteria or the Research Diagnostic Criteria.
Thirty-seven articles describing 5,700 deliveries in 4,023 patients were included in the quantitative analyses. The overall postpartum relapse risk was 35% (95% CI=29, 41). Patients with bipolar disorder were significantly less likely to experience severe episodes postpartum (17%, 95% CI=13, 21) than patients with a history of postpartum psychosis (29%, 95% CI=20, 41). Insufficient information was available to determine relapse rates for patients with bipolar disorder and a history of postpartum episodes. In women with bipolar disorder, postpartum relapse rates were significantly higher among those who were medication free during pregnancy (66%, 95% CI=57, 75) than those who used prophylactic medication (23%, 95% CI=14, 37).
One-third of women at high risk experience a postpartum relapse. In women with bipolar disorder, continuation of prophylactic medication during pregnancy appears highly protective for maintaining mood stability postpartum. In women with a history of isolated postpartum psychosis, initiation of prophylaxis immediately after delivery offers the opportunity to minimize the risk of relapse while avoiding in utero medication exposure.
有双相情感障碍、产后精神病或两者病史的女性产后复发的风险很高。本荟萃分析的目的是估计这三组患者产后复发的风险。
按照 PRISMA 指南，对所有公共医学电子数据库进行系统文献检索。只有根据 DSM 或 ICD 标准或研究诊断标准报告了双相情感障碍和/或产后精神病或躁狂病史患者的产后复发的研究才被纳入定量分析。
纳入了 37 篇描述了 4023 名患者 5700 次分娩的文章进行定量分析。总体产后复发风险为 35%（95%CI=29，41）。与有产后精神病病史的患者（29%，95%CI=20，41）相比，双相情感障碍患者产后发生严重发作的可能性明显较小（17%，95%CI=13，21）。对于有双相情感障碍和产后发作病史的患者，缺乏确定复发率的信息。在双相情感障碍女性中，怀孕期间无药物治疗的患者（66%，95%CI=57，75）产后复发率明显高于使用预防性药物的患者（23%，95%CI=14，37）。
高危女性中有三分之一经历了产后复发。在双相情感障碍女性中，怀孕期间继续预防性药物治疗似乎对维持产后情绪稳定具有高度保护作用。对于有孤立性产后精神病病史的女性，在分娩后立即开始预防治疗为最小化复发风险提供了机会，同时避免了胎儿期药物暴露。
