Adverse life events increase risk for postpartum psychiatric episodes: A population-based epidemiologic study

Background: Trauma histories may increase risk of perinatal psychiatric episodes and other comorbidity. We designed an epidemiological population-based cohort study to explore if adverse childhood experiences (ACE) in girls increases risk of later postpartum psychiatric episodes. Methods: Using Danish registers, we identified women born in Denmark between January 1980 and December 1998, (129,439 childbirths). Exposure variables were ACE between age 0-15 including: (1) family disruption, (2) parental somatic illness, (3) parental labor market exclusion, (4) parental criminality, (5) parental death, (6) placement in out-of-home care, and (7).parental psychopathology excluding substance use disorders and (8) parental substance use disorder. The primary outcome was first occurrence of in- or outpatient contact 0-6 months (0-182 days) postpartum at a psychiatric treatment facility with any psychiatric diagnoses, ICD-10, F00-F99 (N=651). We conducted survival analyses using Cox proportional hazard regressions of postpartum psychiatric episodes. Results: Approximately 52% of the sample experienced ACE that significantly increased risk of any postpartum psychiatric diagnosis. Highest risks were observed among women who experienced out of home placement, hazard ratio (HR) 2.57 (95% CI: 1.90-3.48). Women experiencing 2 adverse life events had higher risks of postpartum psychiatric diagnosis HR: 1.88 (95% CI: 1.51-2.36), compared to those with 1 ACE, HR: 1.24 (95% CI: 1.03-49) and no ACE, HR: 1.00 (reference group). Conclusions: ACE primarily due to parental psychopathology and disability contributes to increased risk of postpartum psychiatric episodes; and greater numbers of ACE increases risk for postpartum psychiatric illness with an observed dose-response effect. Future work should explore genetic and environmental factors that increase risk and/or confer resilience.