Search

Background: Previous research has suggested that some women are at increased risk of postpartum depression (PPD) because of an extra sensitivity to fluctuating hormones before and after parturition. This may particularly apply to women with endocrine disease, characterised by a less than optimal capability to self-regulate the hormonal feedback system. Aims: To investigate if women with endocrine disease history are at increased risk of developing PPD. Method: Based on information from Danish national registers, this nationwide cohort study included 888 989 deliveries (1995–2018). Endocrine disease history was defined as thyroid disease, pre-pregnancy diabetes, polycystic ovary syndrome and/or previous gestational diabetes within 10 years before pregnancy start. PPD was defined as use of antidepressants and/or hospital contact for depression within 6 months after childbirth. Results: Among 888 989 deliveries, 4.1% had a history of endocrine disease and 0.5% had a PPD episode. Overall, women with an endocrine disease history had a 42% (risk ratio 1.42, 95% CI 1.24–1.62) higher risk of PPD when compared with women with no endocrine disease. However, we also found the reverse association, whereby women with a PPD history had a 50% (hazard ratio 1.5, 95% CI 1.4–1.6) higher risk of endocrine disease when compared with women with no PPD history. Conclusions: Women with endocrine disease history had a 40% higher risk of PPD compared with women with no endocrine disease. More attention should be given to pregnant women with endocrine disease history to increase awareness of early signs of PPD. The bi-directionality of the association points to a common underlying factor. [ABSTRACT FROM AUTHOR]

Background and Aims: We examined the incidence and natural history of patients with very elderly-onset (herein, referred to as very late-onset) inflammatory bowel diseases (IBD) (age ≥70y at diagnosis), compared with patients diagnosed between ages 60-69y in Denmark., Methods: In the Danish National Patient Register, between 1980-2018, we identified all individuals ≥60y with newly diagnosed Crohn's disease (CD) and ulcerative colitis (UC) and examined trends in incidence, cumulative risk of hospitalization, treatment patterns, IBD-related surgery, serious infection, cancer and cardiovascular and venous thromboembolic risks among very late-onset (70-79y or 80+ years) vs. late-onset (60-69y) IBD, using non-parametric competing risk analysis treating death as competing risk., Results: We identified 3,459 patients with onset of CD at age ≥60y (47% ≥70y) and 10,774 patients with onset of UC aged ≥60y (51% ≥70y). Over the last three decades, incidence changes for very late-onset and late-onset IBD have followed the same patterns. Also, both for CD and UC, cumulative incidence of IBD-related hospitalization and corticosteroid use was comparable in very late-onset vs. late-onset patients. However, the burden of disease-modifying therapy, either immunomodulator or TNF antagonist use, and major IBD-related surgery was significantly lower in patients with very late-onset than in late-onset IBD. On the other hand, 5-year risk of serious infections and cardiovascular events was higher in patients with very late-onset IBD., Conclusion: This nationwide cohort study shows that patients diagnosed with very late-onset (≥70y) IBD have a higher relative burden of disease- and aging-related complications, with limited use of steroid-sparing strategies and surgery, compared with late-onset IBD., (Copyright © 2024. Published by Elsevier Inc.)

Objective: In utero exposure to maternal inflammation may impact immune system development and subsequent risk of disease. We investigated whether a maternal diagnosis of IBD before childbirth is linked to a higher risk of IBD in offspring compared with a diagnosis after childbirth. Further, we analysed paternal IBD status for comparison., Design: Using Danish health registers, we identified all individuals born in Denmark between 1997 and 2022 and their legal parents, as well as their IBD status. Cox proportional hazards regression analyses adjusted for calendar period and mode of delivery were used to estimate offspring IBD risk by maternal and paternal IBD status before and after childbirth., Results: Of 1 290 358 children, 10 041 (0.8%) had mothers with IBD diagnosis before childbirth and 9985 (0.8%) had mothers with IBD diagnosis after childbirth. Over 18 370 420 person-years, 3537 individuals were diagnosed with IBD. Offspring of mothers with IBD before childbirth had an adjusted HR of IBD of 6.27 (95% CI 5.21, 7.54) compared with those without maternal IBD, while offspring of mothers with IBD after childbirth had an adjusted HR of 3.88 (95% CI 3.27, 4.60). Corresponding adjusted HRs were 5.26 (95% CI 4.22, 6.56) among offspring with paternal IBD before childbirth and 3.73 (95% CI 3.10, 4.50) for paternal IBD after childbirth., Conclusion: Offspring had a greater risk of IBD when either parent was diagnosed before childbirth rather than later, emphasising genetic predisposition and environmental risk factors rather than maternal inflammation in utero as risk factors for IBD., Competing Interests: Competing interests: The corresponding author confirms on behalf of all authors that there have been no involvements that might raise the question of bias in the work reported or in the conclusions, implications, or opinions stated. The authors disclose the following: MA is supported by the National Institute of Diabetes and Digestive and Kidney Diseases (K23DK129762-03). MA reports consulting for Douglas Pharmaceutical. MJ has received research grants for other investigator-driven studies from Takeda, and the NOVO Nordisk Foundation (grant no. NNF23OC0081717), has been on the advisory board of Pharmacosmos, has received consultation fee from Ferring and Takeda, and has received speaker’s fees from Tillotts Pharma, MSD, Ferring and Takeda. JT has received grant support from Abbvie and Janssen, consulting fees from Janssen, Abbvie and Pfizer, and speaker fees from Janssen, Abbvie, Pfizer and Sandoz. TJ reports having consulted for Ferring and Pfizer. The other authors disclose no conflicts., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Low back pain (LBP) is the most common diagnosis responsible for sick leave, long-term disability payments, and early retirements. Studies have suggested that the relatively small proportion of patients referred to a specialist for treatment, either conservative or surgical, accounts for most of the total costs of back pain. However, a complete and long-term picture of the socioeconomic burden associated with these two treatment regimens is lacking., Methods: From a cohort encompassing the entire population in Denmark (5.8 million inhabitants), we identified patients with LBP referred to specialised treatment, either conservative or surgical, during 2007-2016. According to treatment modality, two different cohorts were constructed. Each patient was matched with ten background population controls based on age, sex, region of residency and time of treatment (month and year). Using extensive, nationwide register data, the healthcare costs and loss of productivity from two years before the first intervention until 2018 was investigated., Findings: A total of 56,694 patients underwent surgical treatment, and 72,915 patients conservative treatment. Both cohorts had a significantly higher baseline cost two years before treatment compared with the background population controls. These measures increased sharply during the year after treatment. Five years after treatment, healthcare costs and loss of productivity remained proportionally similarly increased for the two treatment groups compared to the background population. Multiple surgeries had detrimental effects on long term productivity for the patients, and spouses to patients had marginally increased loss of productivity., Interpretation: The results show that patients referred to specialised treatment of LBP display poor socioeconomic prognosis, regardless of conservative or surgical treatment modality. This development was reinforced in patients undergoing multiple surgeries and was also observed among spouses to the patients. Our findings of substantial loss of productivity across subgroups indicate that measures of successful treatment need to be more nuanced., Competing Interests: SS received funding from Helsefonden, Aase and Ejner Danielsens Fond for his PhD, for which this paper is included. The funds were for data collection, salary for primary investigator and statistical analysis. Both where not for profit affiliations and neither had any involvement in the study and there was therefore no conflict of interests. The other authors declare no conflict of interests., (© 2021 The Author(s).)