prospective pregnancy isbd - university of worcestereprints.worc.ac.uk/4918/1/isbd poster amy perry...
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Identifying Risk Factors for Postpartum Mood Episodes in Bipolar Disorder: A UK Prospective Study
Amy Perry 1, Katherine Gordon-‐Smith 1, Arianna Di-‐Florio 2, Liz Forty 2, Nick Craddock 2, Lisa Jones 1 and Ian Jones 21Department of Psychological Medicine, University of Worcester
2Division of Psychological Medicine and Clinical Neurosciences, Cardiff University
www.bdrn.org
Introduction
Background
• Womenwith bipolar disorder are at particularly high risk of experiencing severe moodepisodes following childbirth.
• Severe postpartum mood illness can have devastating consequences not only for themother, but also for her baby and wider family.
• Identifying risk factors for severe postpartum illness in women with bipolar disorder iscritical for illness prevention and management across the perinatal period.
• High quality prospective studies in this high-‐risk group are rare.
Aim
To determine risk factors for episodes of severe postpartum mental illness in women withbipolar disorder using a prospective longitudinal design.
Methods
Figure 2. Timeline of measures and data collection
Perinatal timeline
Delivery1st Trimester
2-‐3 months postpartum
2nd Trimester
3rd Trimester
12-‐40 weeks of pregnancy• Semi structured interview (SCAN)• Psychometric questionnaires• Antenatal questionnaire• Blood sample
2-‐3 months postpartum• Clinician questionnaire• Telephone interview• Case-‐note review
Figure 1. Participant recruitment methods
Prospective pregnancy sample
Systematic Non-‐systematic
SamplePregnant women with bipolar disorder are currently being recruited into the Bipolar DisorderResearch Network (BDRN, BDRN.org). Inclusion criteria: a) lifetime history of DSM-‐IV/ICD-‐10bipolar disorder, b) aged 18 years or over and c) currently pregnant.
RecruitmentParticipants are recruited via a combination of systematic and non-‐systematic methods(Figure 1.) Systematic methods include recruitment by clinicians or clinical studies officersfrom community or specialist perinatal psychiatry NHS services nationwide. Non-‐systematicmethods of recruitment include advertising via national patient support groups, the BDRNwebsite and local or national media.
Measures
• Lifetime psychopathology is assessed via a semi-‐structured interview (Schedules for ClinicalAssessment in Neuropsychiatry) during the second or third trimester of pregnancy (baseline)with a follow up interview to assess perinatal psychopathology at 12-‐weeks postpartum(Figure 2).
• Data on obstetric factors, medication use, sleep and psychosocial factors related topregnancy are obtained using a questionnaire administered by the researcher in the thirdtrimester.
• Participants also complete a battery of self-‐report questionnaires to assess lifetime historyof physical illness, current mental state and cognitive and personality styles.
• Blood sample collected for genetic analysis.
• Interview data are further supplemented by clinician questionnaires completed at 8-‐weekspostpartum and case-‐note review at 12-‐weeks postpartum.
Statistical AnalysisPotential risk factors, measured at baseline will be compared between women whoexperience episodes of perinatal illness and those who remain well.
Results
*Follow up data obtained from postpartum interview and/or clinician questionnaires or case note review
100 women interviewed during pregnancy
76 women have reached follow-‐up stage
Follow-‐up data obtained for 73 women*
Figure 3. Recruitment figures
Recruitment• 100 women with a lifetime diagnosis of bipolar disorder
have been recruited to BDRN during pregnancy (Figure 3).
• Follow up data have been obtained for 73/76 (96%) womenwho have reached the follow up stage.
Perinatal Mood Episodes• 55% (40/73) of women experienced a perinatal recurrence
by follow-‐up.
• 22% (16/73) of women relapsed during pregnancy (Figure 4).
• 33% (24/73) of women relapsed postpartum (6 women alsoexperienced an episode of illness during pregnancy).
Figure 4. Timing of relapse across the perinatal period
45%
33%
22%No perinatal episode
Postpartum
Pregnancy only
Postpartum Mood Episodes• 83% (20/24) of episodes had onset within 6 weeks
postpartum.
• 17% (12/73) of women experienced an episode of postpartumpsychosis, 8% (6/73) postnatal depression and a further 8%(6/73) hypomania (Figure 5).
• Postpartum relapse was more frequent in women with bipolarI disorder (43%, 20/46) than bipolar II disorder (15%, 4/27).
• 63% (15/24) women who relapsed postpartum tookprophylactic medication in the peripartum.
• Almost all women who relapsed postpartum were receivingcare from secondary psychiatric services (96%, 23/24).
67%17%
8%8%
No postpartum episode
PP
Hypomania
Postnatal depression
Figure 5. Prevalence of postpartum mood episodes
Main preliminaryfindingRate of postpartum relapse in our sample is high, despite the majority of participants being under the care ofspecialist psychiatric services and taking prophylactic medication in the peripartum.
Ongoing WorkWe continue to recruit a larger sample of women with bipolar disorder during pregnancy which will allow us toexamine potential risk factors for severe postpartum illness in this high-‐risk group.
ImplicationsIdentifying risk factors for severe postpartum illness using a prospective, longitudinal design will assist clinicians inproviding accurateand personalised advice to women with bipolar disorder who are considering pregnancy.
Conclusions
Acknowledgements
We would like to thank the funding sources and allmembers of the Bipolar Disorder Research Network(www.bdrn.org). We also wish to express our profoundgratitude to all the women who have so kindly given theirtime and continue to do so to participate in our research.