Postpartum psychiatric disorders are common in new mothers, and a new Danish study has suggested that women who experience psychiatric disorders after the birth of their first child are less likely to go on to have more children.
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The study, led by Dr. Xiaoqin Liu, a postdoctoral researcher at the National Centre for Register-based Research at Aarhus University in Denmark, is the first of its kind to investigate the probability of conception within five years of the mother experiencing a postpartum psychiatric disorder.
Published in Human Reproduction, which is one of the world’s leading journals on reproductive medicine, discovered that 69 percent of women who experienced postpartum psychiatric disorders within the first six months of giving birth did go on to have more children. This is in contrast to the 82 percent of women who did not experience any postpartum psychiatric disorders.
Dr. Liu was keen to express that psychiatric disorders after the birth of a child can be prevented, saying:
“An important message to women who have a history of severe postpartum psychiatric disorders is that it is possible to prevent relapse. We recommend that they seek help from their family doctors or psychiatrists if they want to have another child so that plans for treatment that are specific for the individual needs can be made to reduce the risk of relapse, and so that their health, well-being, and symptoms can be closely monitored and treated.”
Common postpartum psychiatric disorders include depression and anxiety, but more rarely women can also experience postpartum psychosis, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD) and eating disorders.
A paper published in Nature Reviews Disease Primers, discussing the range of disorders experienced by new mothers and the importance of effective global treatment delivery described the causes of postpartum psychiatric disorders as a “complex interaction of psychological, social and biological factors, in addition to genetic and environmental factors.”
Earlier research into the rates of postpartum psychiatric disorders found that approximately three percent of women experience a psychiatric disorder in the first three months after giving birth, but until now, there have been no investigations into whether these disorders discourage women from conceiving again.
Speaking on the motivation behind the study, Dr. Liu said, “We wanted to explore whether women with postpartum psychiatric disorders had a reduced possibility of having a second child. Furthermore, we considered whether a reduction in the live birth rate was due to personal choices or decreased fertility, as these are important issues to consider.”
To conduct the study, Liu and her colleagues analyzed data from Danish registries for 414, 571 women who had had their first child between 1997 and 2015 in Denmark. They then followed the women for up to 19.5 years, until another child was born, the mother emigrated, passed away, had their 45th birthday, or until June 2016, ending the study at the point when any of these events occurred first.
To identify which women had experienced a postpartum psychiatric disorder, they saw whether they were prescribed psychotropic medication or engaged in hospital support for psychiatric disorders within the first six months of their child being born.
In total, 4,327 (1 percent) of women did experience a psychiatric disorder after their first live birth. These women were a third less likely to have a second child compared to women who did not develop a psychiatric disorder after childbirth. If the mother was hospitalized because of her psychiatric disorder, the probability of her conceiving again almost halved, irrespective of whether she had a live- or stillbirth.
Some limitations of the study include the fact that the researchers did not have accurate data on miscarriages and stillbirths and only live births were included in the study, and not all women who experienced a psychiatric disorder after childbirth received medication or sought treatment in hospital. Therefore, it might not be possible to apply the discoveries from this particular study to other populations around the world.
“Although fewer women with postpartum psychiatric disorders had subsequent children, it is noteworthy that about 69% of these women still chose to have a second child,” Dr. Liu said. “For the remaining 31% of women, we need to differentiate the reasons why they did not have another child. If they avoided another pregnancy due to fear of relapse, an important clinical message to them is that prevention of relapse is possible.
“Women whose first child died were nearly four times as likely to have a subsequent live birth as women whose first child survived. These findings suggest that the overall reduced rate of subsequent live births among women who experienced psychiatric disorders after the birth of their first child is, at least in part, voluntary.”
The researchers offered a possible explanation for the lower birth rates following episodes of postpartum psychiatric disorders, but believe more work needs to be done in this area. The reasons included difficulties in conceiving after experiencing a disorder and problems in relationships with their partners.
“The reason why women with postpartum psychiatric disorders choose to have fewer children needs to be explored further,” Dr. Liu said.
“Denmark offers free and easily available healthcare to all individuals, so we believe our results can inform other, similar populations, although we cannot rule out local differences.”
Meltzer-Brody, S., Howard, L., Bergink, V. et al. (2018) Postpartum psychiatric disorders. Nature Review Disease Primers, 18022(4). https://doi.org/10.1038/nrdp.2018.22
Liu, X. et al. (2020). Postpartum psychiatric disorders and subsequent live birth: a population-based cohort study in Denmark. Human Reproduction. doi:10.1093/humrep/deaa016