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Published Online: 30 October 2015

Risk of Postpartum Relapse in Bipolar Disorder and Postpartum Psychosis: A Systematic Review and Meta-Analysis

Abstract

Objective:

Women with a history of bipolar disorder, postpartum psychosis, or both are at high risk for postpartum relapse. The aim of this meta-analysis was to estimate the risk of postpartum relapse in these three patient groups.

Method:

A systematic literature search was conducted in all public medical electronic databases, adhering to the PRISMA guidelines. Studies were included if they reported postpartum relapse in patients diagnosed with bipolar disorder and/or a history of postpartum psychosis or mania according to DSM or ICD criteria or the Research Diagnostic Criteria.

Results:

Thirty-seven articles describing 5,700 deliveries in 4,023 patients were included in the quantitative analyses. The overall postpartum relapse risk was 35% (95% CI=29, 41). Patients with bipolar disorder were significantly less likely to experience severe episodes postpartum (17%, 95% CI=13, 21) than patients with a history of postpartum psychosis (29%, 95% CI=20, 41). Insufficient information was available to determine relapse rates for patients with bipolar disorder and a history of postpartum episodes. In women with bipolar disorder, postpartum relapse rates were significantly higher among those who were medication free during pregnancy (66%, 95% CI=57, 75) than those who used prophylactic medication (23%, 95% CI=14, 37).

Conclusions:

One-third of women at high risk experience a postpartum relapse. In women with bipolar disorder, continuation of prophylactic medication during pregnancy appears highly protective for maintaining mood stability postpartum. In women with a history of isolated postpartum psychosis, initiation of prophylaxis immediately after delivery offers the opportunity to minimize the risk of relapse while avoiding in utero medication exposure.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 117 - 127
PubMed: 26514657

History

Received: 28 January 2015
Revision received: 3 June 2015
Revision received: 20 July 2015
Accepted: 30 July 2015
Published online: 30 October 2015
Published in print: February 01, 2016

Authors

Details

Richard Wesseloo, M.D.
From the Department of Psychiatry, Erasmus Medical Centre, Rotterdam, the Netherlands; the National Center for Register-Based Research, University of Aarhus, Aarhus, Denmark; and the Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.
Astrid M. Kamperman, Ph.D.
From the Department of Psychiatry, Erasmus Medical Centre, Rotterdam, the Netherlands; the National Center for Register-Based Research, University of Aarhus, Aarhus, Denmark; and the Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.
Trine Munk-Olsen, Ph.D.
From the Department of Psychiatry, Erasmus Medical Centre, Rotterdam, the Netherlands; the National Center for Register-Based Research, University of Aarhus, Aarhus, Denmark; and the Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.
Victor J.M. Pop, M.D., Ph.D.
From the Department of Psychiatry, Erasmus Medical Centre, Rotterdam, the Netherlands; the National Center for Register-Based Research, University of Aarhus, Aarhus, Denmark; and the Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.
Steven A. Kushner, M.D., Ph.D.
From the Department of Psychiatry, Erasmus Medical Centre, Rotterdam, the Netherlands; the National Center for Register-Based Research, University of Aarhus, Aarhus, Denmark; and the Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.
Veerle Bergink, M.D., Ph.D.
From the Department of Psychiatry, Erasmus Medical Centre, Rotterdam, the Netherlands; the National Center for Register-Based Research, University of Aarhus, Aarhus, Denmark; and the Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.

Notes

Address correspondence to Dr. Wesseloo ([email protected]).

Competing Interests

Dr. Munk-Olsen has received funding from NIMH (grant R01MH104468) and the Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark. Dr. Pop is supported by Stichting de Weijerhorst. Dr. Kushner has received funding from the Netherlands Organization for Scientific Research (the NWO Vidi incentive), the NeuroBasic-PharmaPhenomics consortium, and the Dutch Technology Foundation (STW, OnTime Program 12197). Dr. Bergink is supported by an Erasmus University fellowship, the Netherlands Organization for Scientific Research (the NWO Rubicon incentive), and Fonds NutsOhra. Drs. Kamperman and Wesseloo report no financial relationships with commercial interests.

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