Twin pregnancy and severe maternal mental illness: a Canadian population-based cohort study.
Stephanie C LapinskyJoel G RayHilary K BrownKellie E MurphyTyler S KasterSimone N VigodPublished in: Archives of women's mental health (2023)
Twin pregnancy is a risk factor for postpartum depression and anxiety. Whether this translates into a higher risk of severe maternal mental illness in the short-term or long-term is unknown. This study was a population-based retrospective cohort study, using linked health administrative databases for the entire province of Ontario, Canada. Included were primiparas aged 15-50 years with a twin vs. singleton hospital livebirth, between January 1, 2003, and March 31, 2019. Propensity-score inverse probability of treatment weights accounted for potential confounding. The primary outcome of severe mental illness comprised a composite of an emergency department visit or hospitalization for mental illness or self-injury, or death by suicide, assessed in the first year after birth, and in long-term follow-up, up to 17 years thereafter. Fifteen thousand twenty-four twin and 796,804 (15,022 weighted) singleton births were included, with a mean (IQR) duration of follow-up of 9 (5-13) years. After weighting, the mean (SD) maternal age was 31.3 (5.5) years. In the first 365 days postpartum, severe mental illness occurred at rates of 10.5 and 8.7 per 1000 person-years in twin and singleton mothers, respectively, corresponding to a hazard ratio (HR) of 1.21 (95% CI 1.07-1.47). From 366 days onward, the corresponding figures were 5.9 and 6.1 per 1000 person-years (HR 0.96, 95% CI 0.89-1.04). Individuals with a twin birth appear to experience an increased risk for severe mental illness in the first year postpartum, but not thereafter. This suggests a potential need for targeted counselling and mental health services for mothers within the first year after birth.
Keyphrases
- mental illness
- gestational age
- mental health
- birth weight
- preterm birth
- pregnancy outcomes
- emergency department
- early onset
- healthcare
- pregnant women
- south africa
- public health
- machine learning
- magnetic resonance imaging
- drug induced
- human health
- computed tomography
- drug delivery
- weight gain
- social media
- big data
- weight loss
- climate change
- artificial intelligence
- combination therapy
- electronic health record