Kępińska Adrianna P, Robakis Thalia K, Humphreys Keith, Liu Xiaoqin, Kahn René S, Munk-Olsen Trine, Bergink Veerle, Mahjani Behrang
Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
medRxiv. 2024 Mar 7:2023.07.20.23292910. doi: 10.1101/2023.07.20.23292910.
Postpartum psychosis, a mood disorder triggered by childbirth, is one of the most severe psychiatric conditions, with high risks of suicide and infanticide if untreated. While it is evident that genetic factors play a crucial role in disorder risk, the exact extent of their importance is yet to be determined.
This cohort study consisted of 1,648,759 women from the Swedish nationwide registers, of whom 2,514 (0.15%) experienced postpartum psychosis within three months of their first-ever childbirth. We estimated the relative recurrence risk of postpartum psychosis for female full siblings and cousins as a measure of familial, genetic, and environmental risk.
Relative recurrence risk of postpartum psychosis in full siblings was 10.69 (95% CI=6.60-16.26) when adjusted for year of and age at childbirth. Although cousins showed an elevated relative recurrence risk, these results did not reach statistical significance (1.78, 95% CI=0.70-3.62). Despite the higher familial risk of postpartum psychosis among full siblings, the absolute risk for women with an affected sibling is relatively low, estimated at 1.55% within the entire population.
The observed increased risk of postpartum psychosis in full siblings suggests both genetic and shared environmental influences. However, the lack of significant results in cousins hampers a definitive distinction between these factors. Furthermore, despite increased relative recurrence risk in siblings, their overall likelihood of developing postpartum psychosis remains low. Our study underscores the need for further research to better understand the intricate interplay of genetics and environment in the development of postpartum psychosis.
产后精神病是一种由分娩引发的情绪障碍，是最严重的精神疾病之一，若不治疗，有很高的自杀和杀婴风险。虽然很明显遗传因素在疾病风险中起关键作用，但其确切重要程度尚待确定。
这项队列研究包括来自瑞典全国登记册的1,648,759名女性，其中2,514名（0.15%）在首次分娩后的三个月内经历了产后精神病。我们估计了女性全同胞和表亲产后精神病的相对复发风险，以此作为家族、遗传和环境风险的衡量指标。
调整分娩年份和年龄后，全同胞产后精神病的相对复发风险为10.69（95%置信区间=6.60-16.26）。虽然表亲显示出相对复发风险升高，但这些结果未达到统计学显著性（1.78，95%置信区间=0.70-3.62）。尽管全同胞中产后精神病的家族风险较高，但有患病同胞的女性的绝对风险相对较低，在整个人口中估计为1.55%。
观察到的全同胞产后精神病风险增加表明存在遗传和共同环境影响。然而，表亲研究结果缺乏显著性妨碍了对这些因素的明确区分。此外，尽管同胞中相对复发风险增加，但他们患产后精神病的总体可能性仍然较低。我们的研究强调需要进一步研究，以更好地理解遗传和环境在产后精神病发展中的复杂相互作用。
