Inflammatory bowel disease and new-onset psychiatric disorders in pregnancy and post partum: a population-based cohort study

Objective — Patients with inflammatory bowel disease (IBD) have elevated risk of mental illness.We determined the incidence and correlates of new-onset mental illness associated with IBD during pregnancy and postpartum.

Design — This cohort study using population-based health administrative data included all women with a singleton live birth in Ontario, Canada (2002-2014). Incidence of new-onset mental illness from conception to 1 year postpartum was compared between 3721 women with and 798908 without IBD, generating adjusted hazard ratios (aHR). Logistic regression was used to identify correlates of new-onset mental illness in the IBD group.

Results — About 22.7% of women with IBD had new-onset mental illness vs. 20.4% without, corresponding to incidence rates of 150.2 and 132. 8 per 1,000 patient-years (aHR 1.12, 95%CI1.05-1.20), or one extra case of new-onset mental illness per 43 pregnant women with IBD. Risk was elevated in the postpartum (aHR 1.20, 95%CI 1.09-1.31), but not during pregnancy, and for Crohn’s disease (aHR 1.12, 95%CI 1.02-1.23), but not ulcerative colitis. Risk was specifically elevated for a new-onset mood or anxiety disorder (aHR 1.14, 95%CI 1.04-1.26) and alcohol or substance use disorders (aHR 2.73, 95%CI 1.42-5.26). Predictors of a mental illness diagnosis were maternal age, delivery year, medical comorbidity, number of prenatal visits, family physician obstetrical care, and infant mortality.

Conclusion — Women with IBD were at increased risk of new-onset psychiatric diagnosis in the postpartum period, but not during pregnancy. Providers should look to increase opportunities for prevention, early identification and treatment accordingly.