Maternal bereavement shortly before or during pregnancy and risk of postpartum psychotic illness: a population-based study from Denmark and Sweden

Clin Epidemiol. 2019 Apr 24;11:285-298. doi: 10.2147/CLEP.S195741. eCollection 2019.

Abstract

Purpose: Postpartum psychosis is a rare but severe complication following childbirth, with unknown etiology. This study investigated whether the death of a close family member - a source of severe stress - the year before or during pregnancy was associated with an increased risk of psychotic illness in the postpartum period among women without and with a history of psychiatric disorder. Methods: We studied live births in Denmark during 1978-2008 and births in Sweden during 1973-2006 (n=5,246,978). Information on death of women's relatives and partners and sociodemographic, health-, and pregnancy-related factors was obtained through linkage with nationwide registries. Results: The death of a close relative the year before or during pregnancy was not associated with psychotic illness during the first 90 days postpartum among women without (adjusted HR 1.02, 95% CI 0.76-1.37) or with a history of psychiatric disorder (HR 0.96, 95% CI 0.74-1.25). Similarly, there was no association between bereavement and risk of postpartum psychosis according to the timing of the loss (the year before or during pregnancy), the relative's cause of death (natural or unnatural), or the woman's relationship to the deceased (parent/sibling or partner/older child). Conclusions: Death of a close relative, one of the most severe sources of stress, before or during pregnancy was not associated with postpartum psychosis. Therefore, these data do not support the hypothesis that severely stressful life events, such as bereavement around the time of pregnancy, are associated with postpartum psychosis.

Keywords: bereavement; cohort study; postpartum; pregnancy; psychosis; stress.