Aker Amira M, Vigod Simone N, Dennis Cindy-Lee, Brown Hilary K
Department of Health & Society, University of Toronto Scarborough, Toronto, Canada.
ICES, Toronto, Canada.
J Womens Health (Larchmt). 2022 Apr;31(4):564-572. doi: 10.1089/jwh.2021.0014. Epub 2021 Jun 2.
Chronic disease is associated with increased risk of postpartum mental illness, but the mechanisms underlying this association are unclear. Our aim was to explore the mediating role of perinatal complications in the association between chronic disease and postpartum mental illness. This was a population-based retrospective cohort study of all women in Ontario, Canada, from 2005 to 2015 with a singleton live birth and no recent history of mental illness during or 2 years before pregnancy. The outcome was mental illness diagnosis between delivery and 365 days postpartum, with perinatal complications, including pregnancy, delivery, and neonatal complications. Modified Poisson regression models were used to examine the association between chronic disease and perinatal mental illness, with generalized estimating equations for the calculation of total, direct, and indirect effects. All models were adjusted for sociodemographic characteristics and remote history of mental health care. Of the 792,972 women, 21.1% had a chronic disease. Chronic disease was associated with an increased risk of postpartum mental illness (adjusted relative risk [aRR] 1.15 [95% confidence interval, CI 1.14-1.16]). There was no evidence of an indirect effect of chronic disease on postpartum mental illness perinatal complications (aRR 1.003, 95% CI 1.002-1.003). Perinatal complications explained only 1.5% of the association between chronic disease and postpartum mental illness. Results were consistent by type of perinatal complication and chronic disease diagnosis. We observed no clinically meaningful mediating effect of perinatal complications in the association between chronic disease and postpartum mental illness. Future research should investigate alternative mechanisms explaining this association.
慢性病与产后精神疾病风险增加有关，但这种关联背后的机制尚不清楚。我们的目的是探讨围产期并发症在慢性病与产后精神疾病关联中的中介作用。这是一项基于人群的回顾性队列研究，研究对象为2005年至2015年在加拿大安大略省所有单胎活产且孕期或孕前2年内无近期精神疾病史的女性。结局指标是分娩至产后365天内的精神疾病诊断情况，以及围产期并发症，包括妊娠、分娩和新生儿并发症。采用修正泊松回归模型来检验慢性病与围产期精神疾病之间的关联，并使用广义估计方程来计算总效应、直接效应和间接效应。所有模型均对社会人口学特征和心理健康护理的既往史进行了调整。在792,972名女性中，21.1%患有慢性病。慢性病与产后精神疾病风险增加相关（调整后相对风险[aRR]为1.15[95%置信区间，CI 1.14 - 1.16]）。没有证据表明慢性病通过围产期并发症对产后精神疾病有间接影响（aRR 1.003，95% CI 1.002 - 1.003）。围产期并发症仅解释了慢性病与产后精神疾病之间关联的1.5%。按围产期并发症类型和慢性病诊断结果来看，结果是一致的。我们观察到围产期并发症在慢性病与产后精神疾病的关联中没有具有临床意义的中介作用。未来的研究应调查解释这种关联的其他机制。
