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Inflammatory bowel disease and new-onset psychiatric disorders in pregnancy and post partum: a population-based cohort study
  1. Simone N Vigod1,2,3,4,
  2. Paul Kurdyak2,4,5,
  3. Hilary K Brown4,6,
  4. Geoffrey C Nguyen3,4,7,8,
  5. Laura E Targownik9,10,
  6. Cynthia H Seow11,12,
  7. M Ellen Kuenzig4,13,14,
  8. Eric I Benchimol4,13,14,15
  1. 1Women’s College Hospital and Research Institute, Toronto, Ontario, Canada
  2. 2Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
  3. 3Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  4. 4ICES, Toronto, Ontario, Canada
  5. 5Centre for Addiction and Mental Health, Toronto, Ontario, Canada
  6. 6Dalla Lana School of Public Health, and Interdisciplinary Centre for Health and Society, University of Toronto, Toronto, Ontario, Canada
  7. 7Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Toronto, Ontario, Canada
  8. 8Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  9. 9University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada
  10. 10Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
  11. 11Department of Medicine, University of Calgary, Calgary, Alberta, Canada
  12. 12Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  13. 13Division of Gastroenterology, Hepatology and Nutrition, and Children’s Hospital of Eastern Ontario (CHEO) IBD Centre, CHEO, Ottawa, Ontario, Canada
  14. 14CHEO Research Institute, Ottawa, Canada
  15. 15Department of Pediatrics, and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
  1. Correspondence to Professor Eric I Benchimol, Division of Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa ON K1H 8L1, Canada; ebenchimol{at}cheo.on.ca

Abstract

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

Design This cohort study using population-based health administrative data included all women with a singleton live birth in Ontario, Canada (2002–2014). The incidence of new-onset mental illness from conception to 1-year post partum was compared between 3721 women with and 798 908 without IBD, generating adjusted HRs (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 versus 20.4% without, corresponding to incidence rates of 150.2 and 132.8 per 1000 patient-years (aHR 1.12, 95% CI 1.05 to 1.20), or one extra case of new-onset mental illness per 43 pregnant women with IBD. The risk was elevated in the post partum (aHR 1.20, 95% CI 1.09 to 1.31), but not during pregnancy, and for Crohn’s disease (aHR 1.12, 95% CI 1.02 to 1.23), but not ulcerative colitis. The risk was specifically elevated for a new-onset mood or anxiety disorder (aHR 1.14, 95% CI 1.04 to 1.26) and alcohol or substance use disorders (aHR 2.73, 95% CI 1.42 to 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 an 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.

  • inflammatory bowel disease
  • psychology
  • epidemiology

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Footnotes

  • Contributors Study concept and design: SNV, PK, HKB, GCN, LET, CHS and EIB. Acquisition of data: SNV, PK and EIB. Analysis and interpretation of data: SNV, PK, HKB, GCN, LET, CHS, MEK and EIB. Drafting of the manuscript: SNV and EIB. Critical revision of the manuscript for important intellectual content: SNV, PK, HKB, GCN, LET, CHS, MEK and EIB. Statistical analysis: SNV, PK, HKB and EIB. Obtained funding: SNV and PK.

  • Funding This study was funded by the Medical Psychiatry Alliance, a collaborative health partnership of the University of Toronto, the Centre for Addiction and Mental Health, the Hospital for Sick Children, Trillium Health Partners, the Ontario Ministry of Health and Long-Term Care (MOHLTC) and an anonymous donor. This study was supported by ICES, which is funded by an annual grant from the Ontario MOHLTC. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and information compiled and provided by Canadian Institutes for Health Research (CIHI). However, the analyses, conclusions, opinions and statements expressed herein are those of the author and not necessarily those of CIHI. The dataset from this study is held securely in coded form at ICES. While data sharing agreements prohibit ICES from making the dataset publicly available, access may be granted to those who meet prespecified criteria for confidential access, available at www.ices.on.ca/DAS. The full dataset creation plan and underlying analytic code are available from the authors upon request, understanding that the programs may rely upon coding templates or macros that are unique to ICES. Simone Vigod was supported by a CIHR New Investigator Award and the Shirley A. Brown Memorial Chair in Women’s Mental Health Research at Women’s College Hospital in Toronto, Ontario. M. Ellen Kuenzig was supported by a Post-Doctoral Fellowship Award from CIHR, Crohn’s and Colitis Canada, and the Canadian Association of Gastroenterology. Geoffrey Nguyen and Eric Benchimol were supported by New Investigator Awards from CIHR, Crohn’s and Colitis Canada, and the Canadian Association of Gastroenterology. Geoffrey Nguyen was a CIHR Embedded Clinician Researcher Award. Eric Benchimol was also supported by the Career Enhancement Program from the Canadian Child Health Clinician Scientist Program.

  • Disclaimer The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources.

  • Competing interests SNV: receives royalties from UpToDate Inc for authorship of topics focused on depression and antidepressant medication use in pregnancy. LET: received investigator-initiated funding from Janssen Canada and served on advisory boards for AbbVie Canada, Takeda Canada, Merck Canada, Pfizer Canada and Mallinckrodt USA. CHS: serves on advisory boards and as a speaker for Janssen Canada, Abbvie Canada, Shire Canada, Takeda Canada, Ferring Canada and received educational grants from Janssen Canada.

  • Ethics approval The Research Ethics Board of the Sunnybrook Health Sciences Centre (ICES logged study 2018 0904 836 000).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The dataset from this study is held securely in coded form at ICES. While data sharing agreements prohibit ICES from making the dataset publicly available, access may be granted to those who meet prespecified criteria for confidential access, available at www.ices.on.ca/DAS. The full dataset creation plan and underlying analytic code are available from the authors upon request, understanding that the programs may rely upon coding templates or macros that are unique to ICES.

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