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Shridharmurthy D, Lapane KL, Nunes AP, Baek J, Weisman MH, Kay J, Liu SH. Postpartum Depression in Reproductive-Age Women With and Without Rheumatic Disease: A Population-Based Matched Cohort Study. J Rheumatol 2023; 50:1287-1295. [PMID: 37399461 DOI: 10.3899/jrheum.2023-0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To examine postpartum depression (PPD) among women with axial spondyloarthritis (axSpA), psoriatic arthritis (PsA), or rheumatoid arthritis (RA) in comparison with a matched population without rheumatic disease (RD). METHODS A retrospective analysis using the 2013-2018 IBM MarketScan Commercial Claims and Encounters Database was conducted. Pregnant women with axSpA, PsA, or RA were identified, and the delivery date was used as the index date. We restricted the sample to women ≤ 55 years with continuous enrollment ≥ 6 months before date of last menstrual period and throughout pregnancy. Each patient was matched with 4 individuals without RD on: (1) maternal age at delivery, (2) prior history of depression, and (3) duration of depression before delivery. Cox frailty proportional hazards models estimated the crude and adjusted hazard ratios (aHR) and 95% CI of incident postpartum depression within 1 year among women with axSpA, PsA, or RA (axSpA/PsA/RA cohort) compared to the matched non-RD comparison group. RESULTS Overall, 2667 women with axSpA, PsA, or RA and 10,668 patients without any RD were included. The median follow-up time in days was 256 (IQR 93-366) and 265 (IQR 99-366) for the axSpA/PsA/RA cohort and matched non-RD comparison group, respectively. Development of PPD was more common in the axSpA/PsA/RA cohort relative to the matched non-RD comparison group (axSpA/PsA/RA cohort: 17.2%; matched non-RD comparison group: 12.8%; aHR 1.22, 95% CI 1.09-1.36). CONCLUSION Postpartum depression is significantly higher in women of reproductive age with axSpA/PsA/RA when compared to those without RD.
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Affiliation(s)
- Divya Shridharmurthy
- D. Shridharmurthy, MMBS, MPH, Division of Epidemiology, Department of Population and Quantitative Health Sciences, and Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, UMass Chan Medical School, Worcester, Massachusetts
| | - Kate L Lapane
- K.L. Lapane, PhD, A.P. Nunes, PhD, Division of Epidemiology, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
| | - Anthony P Nunes
- K.L. Lapane, PhD, A.P. Nunes, PhD, Division of Epidemiology, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
| | - Jonggyu Baek
- J. Baek, PhD, Division of Biostatistics and Health Services Research, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
| | - Michael H Weisman
- M.H. Weisman, MD, Division of Immunology and Rheumatology, School of Medicine, Stanford University, Palo Alto, California
| | - Jonathan Kay
- J. Kay, MD, Division of Epidemiology, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Division of Rheumatology, Department of Medicine, UMass Chan Medical School, and Division of Rheumatology, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Shao-Hsien Liu
- S.H. Liu, PhD, Division of Epidemiology, Department of Population and Quantitative Health Sciences, and Division of Rheumatology, Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts, USA.
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Nalli C, Manfredi L, Fredi M, Crisafulli F, Bertocchi S, Khizroeva J, Bitsadze V, Makatsariya A, Zatti S, Andreoli L, Franceschini F, Tincani A. Managing puerperium in patients with systemic autoimmune diseases: an update. Expert Rev Clin Immunol 2022; 18:391-399. [PMID: 35255770 DOI: 10.1080/1744666x.2022.2050216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Puerperium is a critical period for patients affected by autoimmune rheumatic diseases for the risk of disease's flares and difficulties in treating lactating mothers. We want to summarize the literature data about psychological and pharmacological management of these patients and possible risk factors of disease's flares. AREAS COVERED We made a narrative review on recent studies about puerperium in rheumatic autoimmune diseases patients. EXPERT OPINION The physicians involved in management of patients during puerperium and in the follow-up of babies need to agree on maternal treatment because they need to reassure mothers about the safety of the prescribed medications. Furthermore, women with rheumatic diseases could present some musculoskeletal limitations and psychological problems, such as postpartum depression, which can lead to a sense of inadequacy to the mother's task. Families and physicians should be aware of these possible complications and support the new mothers providing correct counseling and practical help.
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Affiliation(s)
- Cecilia Nalli
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Lucia Manfredi
- Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Micaela Fredi
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Francesca Crisafulli
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Stefania Bertocchi
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Jamilya Khizroeva
- Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Victoria Bitsadze
- Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Alexander Makatsariya
- Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Sonia Zatti
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Laura Andreoli
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Franco Franceschini
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili di Brescia, Brescia, Italy
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