Does Stress Increase Vulnerability to Postpartum Psychosis in High-Risk Women?

By | July 22, 2021

Risk for postpartum psychosis is particularly high in women with a history of bipolar disorder or schizoaffective disorder and in those who have suffered a previous episode of postpartum psychosis. While the risk is very high, many women do not develop postpartum psychosis.  In these women at high risk for postpartum psychosis, which factors increase risk?  Which factors are protective?

A recent study looks at the role of stress in the onset of postpartum psychosis.  In studies of psychosis unrelated to childbirth, there is evidence linking stress to the onset of psychosis.  However, we know much less about the role of stress in the onset of postpartum psychosis.

In a recent prospective longitudinal study, 112 pregnant women were followed from the third trimester up until 4 weeks postpartum.  In this group of women, 51 were at increased risk for postpartum psychosis based on a DSM-IV diagnosis of bipolar disorder (n = 41), schizoaffective disorder (n = 6) or a previous episode of postpartum psychosis (n = 4).  A control group of 61 women with no past or current DSM-IV diagnosis and no family history of postpartum psychosis was also recruited. 

Women at risk for postpartum psychosis who experienced a psychiatric relapse during the first four weeks postpartum (n = 22) were compared to women at risk who remained well (n = 29).  The researchers observed that higher risk for postpartum psychosis was associated with severe childhood maltreatment (OR = 4.9, 95% CI 0.5-49.2) and biomarkers of stress measured during the third trimester (i.e., higher daily cortisol levels, OR=3.7, 95% CI 1.2-11.6).  

This finding is not consistent with a larger study from Ian Jones’ group. This study included 432 pregnant women with DSM-IV bipolar I disorder who were recruited into the Bipolar Disorder Research Network (www.BDRN.org). Adverse childhood life events were assessed via self-report and medical records.   When they compared women with postpartum psychosis (n=208) to those without a lifetime history of perinatal mood episodes (n=224),  there was no evidence for an association between adverse childhood life events and the occurrence of postpartum psychosis.

Ruta Nonacs, MD PhD

Hazelgrove K, Biaggi A, Waites F, Fuste M, Osborne S, Conroy S, Howard LM, Mehta MA, Miele M, Nikkheslat N, Seneviratne G, Zunszain PA, Pawlby S, Pariante CM, Dazzan P.  Risk factors for postpartum relapse in women at risk of postpartum psychosis: The role of psychosocial stress and the biological stress system.  Psychoneuroendocrinology. 2021 Jun;128:105218.

Perry A, Gordon-Smith K, Di Florio A, Forty L, Craddock N, Jones L, Jones I.  Adverse childhood life events and postpartum psychosis in bipolar disorder.  J Affect Disord. 2016 Nov 15;205:69-72. 

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