Departments of Medicine, and of Obstetrics and Gynaecology (Dayan, Basso, Nguyen), McGill University Health Centre; Research Institute (Dayan, Basso, Nguyen), McGill University Health Centre; Departments of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology (Velez, Pudwell), Queen's University, Kingston Health Sciences Centre; ICES Queen's (Velez, Djerboua), Kingston, Ont.; ICES Central (Vigod, Ray), Toronto, Ont.; Department of Psychiatry (Vigod), University of Toronto, Toronto, Ont.; ICES uOttawa (Fell); Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa; Better Outcomes Registry & Network (BORN Ontario) (Fell), Ottawa, Ont.; Department of Obstetrics and Gynecology (Joseph), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Medicine and Obstetrics and Gynaecology (Ray), University of Toronto, St. Michael's Hospital, Toronto, Ont.
CMAJ Open. 2022 May 17;10(2):E430-E438. doi: 10.9778/cmajo.20210269. Print 2022 Apr-Jun.
Subfertility and infertility treatment can be stressful experiences, but it is unknown whether each predisposes to postpartum mental illness. We sought to evaluate associations between subfertility or infertility treatment and postpartum mental illness.
We conducted a population-based cohort study of individuals without pre-existing mental illness who gave birth in Ontario, Canada, from 2006 to 2014, stratified by fertility exposure: subfertility without infertility treatment; noninvasive infertility treatment (intrauterine insemination); invasive infertility treatment (in vitro fertilization); and no reproductive assistance. The primary outcome was mental illness occurring 365 days or sooner after birth (defined as ≥ 2 outpatient visits, an emergency department visit or a hospital admission with a mood, anxiety, psychotic, or substance use disorder, self-harm event or other mental illness). We used multivariable Poisson regression with robust error variance to assess associations between fertility exposure and postpartum mental illness.
The study cohort comprised 786 064 births (mean age 30.42 yr, standard deviation 5.30 yr), including 78 283 with subfertility without treatment, 9178 with noninvasive infertility treatment, 9633 with invasive infertility treatment and 688 970 without reproductive assistance. Postpartum mental illness occurred in 60.8 per 1000 births among individuals without reproductive assistance. Relative to individuals without reproductive assistance, those with subfertility had a higher adjusted relative risk of postpartum mental illness (1.14, 95% confidence interval 1.10-1.17), which was similar in noninvasive and invasive infertility treatment groups.
Subfertility or infertility treatment conferred a slightly higher risk of postpartum mental illness compared with no reproductive assistance. Further research should elucidate whether the stress of infertility, its treatment or physician selection contributes to this association.
不孕和不孕治疗可能是压力很大的经历，但尚不清楚两者中哪一种会导致产后精神疾病。我们旨在评估不孕或不孕治疗与产后精神疾病之间的关联。
我们对 2006 年至 2014 年期间在加拿大安大略省分娩且无先前存在的精神疾病的个体进行了一项基于人群的队列研究，根据生育暴露情况进行分层：不孕但未经不孕治疗；非侵入性不孕治疗（宫腔内人工授精）；侵入性不孕治疗（体外受精）；无生殖辅助。主要结局是产后 365 天或更短时间内发生的精神疾病（定义为≥2 次门诊就诊、急诊就诊或因心境障碍、焦虑障碍、精神病或物质使用障碍、自伤事件或其他精神疾病住院）。我们使用多变量泊松回归和稳健方差来评估生育暴露与产后精神疾病之间的关联。
该研究队列包括 786064 例分娩（平均年龄 30.42 岁，标准差 5.30 岁），其中 78283 例未经治疗的不孕患者、9178 例接受非侵入性不孕治疗的患者、9633 例接受侵入性不孕治疗的患者和 688970 例未接受生殖辅助的患者。在未接受生殖辅助的个体中，产后精神疾病的发病率为每 1000 例分娩 60.8 例。与未接受生殖辅助的个体相比，不孕患者发生产后精神疾病的调整后相对风险更高（1.14，95%置信区间 1.10-1.17），非侵入性和侵入性不孕治疗组的风险相似。
与未接受生殖辅助的患者相比，不孕或不孕治疗导致产后精神疾病的风险略高。进一步的研究应该阐明是不孕的压力、其治疗还是医生的选择导致了这种关联。
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