Developmental Biology - Brain Link in Gut|
Gut Link to Brain Disorders in Pregnancy
Women with inflammatory bowel disease (IBD) have increased risk for mental illness after giving birth...
New research shows women with IBD at increased risk for mental illness. With every 43 pregnancies, there is one case of mental illness in a woman with inflammatory bowel disease
A study published today in the journal Gut shows that women with inflammatory bowel disease (IBD) have an increased risk of developing a mental illness after giving birth compared to the overall population. The study used healthcare data on women who gave birth between 2002 and 2014 in Ontario, Canada to analyze the frequency of new mental illness diagnosis in women during and up to one year following a pregnancy.
Inflammatory bowel diseases, or IBD, are a group of chronic gastrointestinal disorders in which people have ulceration, inflammation, and bleeding of their gastrointestinal tract putting them at risk for complications in other parts of their body. The two main subtypes are Crohn's disease and ulcerative colitis. Likewise, people with IBD have an elevated risk for mental illness, especially anxiety and depression, potentially related to gut inflammation affecting their brain.
"There's increasing awareness about mental illness in women during pregnancy and postpartum. Because of the elevated risk of mental illness in people with IBD, we felt it was important to study if women with IBD were at greater risk of developing a new mental illness during pregnancy and after giving birth compared to the overall population. We found the risk to be elevated during the post-partum period for women with IBD, particularly in the first 90 days after birth. We did not find an elevated risk during pregnancy."
Eric Benchimol, senior author on the paper, and Senior Scientist at the CHEO Research Institute, Core Scientist at ICES, Associate Professor of Pediatrics and Epidemiology at the University of Ottawa, and a Pediatric Gastroenterologist at the CHEO Inflammatory Bowel Disease Centre.
In the study, pregnant women with IBD had: • an elevated 22.7 per cent risk of developing a new-onset mental illness postpartum as compared to women without IBD at a 20.4 per cent risk and • women with IBD were at increased risk of two out of four mental illness categories i.e. mood disorders (anxiety and depression) and substance abuse disorders (such as opioid dependency).
These women were primarily treated by doctors as outpatients, and did not need to be hospitalized. There was no evidence of increased risk for psychotic disorders (such as schizophrenia or hallucinations). However, the risk appeared elevated in women with Crohn's disease, and not for ulcerative colitis.
"There is a small but significantly increased risk of new-onset mental illness in women with IBD. Women with IBD face increased health challenges during pregnancy and after giving birth — and not just physical challenges. We need to look at both the physical and mental health needs of women and ensure they are getting the best treatment and support."
Simone Vigod, Chief, Department of Psychiatry, and lead author of the study, Scientist, Women's College Hospital Research Institute, and Adjunct Scientist at ICES."
"These findings are very important for both patients and healthcare providers in the IBD community. If a pregnant woman with IBD knows that there's an elevated risk of mental illness during the post-partum period, she should discuss this potential risk with her healthcare provider. It's important that healthcare providers are aware of this increased risk in women with IBD. Together, women and their healthcare providers can look for opportunities to prevent mental illness during pregnancy and after birth as well as identify and treat it earlier."
Mina Mawani, President & CEO, Crohn's and Colitis, Canada.
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.
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.
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.
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.
Simone N Vigod, Paul Kurdyak, Hilary K. Brown, Geoffrey C. Nguyen, Laura E. Targownik, Cynthia H. Seow, M. Ellen Kuenzig, Eric I Benchimol.
About Women's College Hospital
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Jan 10, 2018 Fetal Timeline Maternal Timeline News News Archive
Pregnant women with IBD have an elevated risk of developing a new-onset mental illness postpartum as compared to women without IBD — 22.7 per cent compared to 20.4 per cent. The increased risk of two out of the four mental illness categories includes: mood disorders such as anxiety and depression; and, substance use disorders (such as opioid dependency). Image: MouseWorks