The Complex Journey of Women in Perinatal Psychiatric Care: Susceptibility to Illness Onset, Comorbidity and Clinical Trajectories: Le parcours complexe des femmes en psychiatrie périnatale : vulnérabilité, comorbidités et trajectoires cliniques

BackgroundMore than one in five women deal with a psychiatric disorder during the perinatal period. Whereas perinatal depression is well documented, there is still little research on the full range of perinatal psychiatric disorders and their clinical evolution across this whole period. The present study investigated the susceptibility to psychiatric illness during pregnancy and up to one year postpartum. We aimed to identify the most frequent disorders and comorbidities arising in each perinatal period. We outlined the clinical trajectories of these disorders in terms of evolution across past history, pregnancy and postpartum.MethodThrough a retrospective longitudinal design, data were collected in 2019-2020 from the medical records of the cohort of 964 women who required care in a tertiary perinatal psychiatry clinic located in Quebec City (Canada) between 2004 and 2020. Incidence rates of the full range of psychiatric disorders were estimated per period and their evolution across time identified clinical trajectories.ResultsDuring pregnancy, 34 different disorders were newly diagnosed with incidence rates ranging from 0.1% to 15.5% (45.6% of women having had at least one disorder diagnosed during pregnancy) whereas, during postpartum, 36 disorders were newly diagnosed with incidence rates ranging from 0.1% to 31.0% (67.5% of women having had at least one disorder diagnosed during postpartum). For most disorders, rates were significantly higher in postpartum than in pregnancy. A woman could develop multiple disorders during a given perinatal period: this comorbidity involved various combinations of diagnoses in 28% of women during pregnancy and 38% during postpartum. We outlined 52 different clinical trajectories from past history to postpartum, underlining the heterogeneity of the perinatal course.ConclusionsPregnancy is a susceptible period for women with past psychiatric histories whereas postpartum could trigger a new illness in women without a past history or pregnancy-onset psychiatric disorder.