Twin pregnancy and severe maternal mental illness: a Canadian population-based cohort study.

Autor: Lapinsky SC; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. Stephanie.lapinsky@mail.utoronto.ca.; Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, 123 Edward Street, 12th floor, Toronto, Ontario, M5G 0A8, Canada. Stephanie.lapinsky@mail.utoronto.ca.; ICES, Toronto, Ontario, Canada. Stephanie.lapinsky@mail.utoronto.ca., Ray JG; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.; ICES, Toronto, Ontario, Canada.; Departments of Medicine and Obstetrics and Gynaecology, St Michael's Hospital, Toronto, Ontario, Canada., Brown HK; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.; ICES, Toronto, Ontario, Canada.; Women's College Hospital and Research Institute, Toronto, Ontario, Canada.; Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada., Murphy KE; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.; Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, 123 Edward Street, 12th floor, Toronto, Ontario, M5G 0A8, Canada.; Department of Obstetrics and Gynaecology, Sinai Health System, Toronto, Ontario, Canada., Kaster TS; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada., Vigod SN; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.; ICES, Toronto, Ontario, Canada.; Women's College Hospital and Research Institute, Toronto, Ontario, Canada.; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Jazyk: angličtina
Zdroj: Archives of women's mental health [Arch Womens Ment Health] 2023 Feb; Vol. 26 (1), pp. 57-66. Date of Electronic Publication: 2023 Jan 11.
DOI: 10.1007/s00737-023-01291-7
Abstrakt: Twin pregnancy is a risk factor for postpartum depression and anxiety. Whether this translates into a higher risk of severe maternal mental illness in the short-term or long-term is unknown. This study was a population-based retrospective cohort study, using linked health administrative databases for the entire province of Ontario, Canada. Included were primiparas aged 15-50 years with a twin vs. singleton hospital livebirth, between January 1, 2003, and March 31, 2019. Propensity-score inverse probability of treatment weights accounted for potential confounding. The primary outcome of severe mental illness comprised a composite of an emergency department visit or hospitalization for mental illness or self-injury, or death by suicide, assessed in the first year after birth, and in long-term follow-up, up to 17 years thereafter. Fifteen thousand twenty-four twin and 796,804 (15,022 weighted) singleton births were included, with a mean (IQR) duration of follow-up of 9 (5-13) years. After weighting, the mean (SD) maternal age was 31.3 (5.5) years. In the first 365 days postpartum, severe mental illness occurred at rates of 10.5 and 8.7 per 1000 person-years in twin and singleton mothers, respectively, corresponding to a hazard ratio (HR) of 1.21 (95% CI 1.07-1.47). From 366 days onward, the corresponding figures were 5.9 and 6.1 per 1000 person-years (HR 0.96, 95% CI 0.89-1.04). Individuals with a twin birth appear to experience an increased risk for severe mental illness in the first year postpartum, but not thereafter. This suggests a potential need for targeted counselling and mental health services for mothers within the first year after birth.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)
Databáze: MEDLINE
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