Peripartum depression (PPD), i.e. depression in late pregnancy to 1 year postpartum, occurs in 7-19% of women. There are limited data on PPD in multiple sclerosis (MS).
To evaluate the prevalence of PPD in women with MS, and to evaluate risk factors for PPD in MS, both factors associated with PPD in the general population, as well as disease-related factors.
We performed retrospective analysis of prospectively collected clinical data. Women with MS followed at UCSF MS Center who became pregnant from 2015-2018 were identified in the electronic medical record. The primary outcome was PPD determined by clinical record review. Prevalence of PPD was estimated with logistic regression with generalized estimating equations (GEE), accounting for women with multiple pregnancies. Univariable analyses with GEE logistic regression evaluated predictors of PPD (age, marital status, parity, delivery season, prematurity, birth weight, delivery mode, premorbid depression/anxiety, antidepressant discontinuation, sleep disturbance, breastfeeding). Factors significant in univariable analyses were included in multivariable analysis. GEE logistic regression evaluated association between inflammatory disease activity (relapses in pregnancy/postpartum; gadolinium enhancing lesions postpartum), disease severity (Expanded Disability Status Scale, EDSS) and PPD.
We identified 143 pregnancies (age 33.1+/-4.7 years; 93% relapsing remitting MS, 7% clinically isolated syndrome; 45% premorbid depression) in 111 women who had live birth outcomes and known PPD status. PPD was present in 12.6% (95% CI 7.3-17.8) of pregnancies. In univariable analyses, statistically significant factors associated with PPD included older age (OR 1.16, 95% CI 1.03-1.32 for 1-year increase), primiparity (OR 4.02, 95% CI 1.14-14.23), premorbid depression (OR 3.70, 95% CI 1.27-10.01), postpartum sleep disturbance (OR 3.23, 95% CI 1.17-8.91) and breastfeeding difficulty (OR 3.58, 95% CI 1.27-10.08). Maternal age (OR 1.17, 95% CI 1.02-1.34), primiparity (OR 8.10, 95% CI 1.38-47.40) and premorbid depression (OR 3.89, 95% CI 1.04-14.60) remained associated with PPD in multivariable analyses. Relapses, MRI activity and EDSS were not associated with PPD.
PPD in MS was similar to the general population, but was likely underestimated due to lack of standardized screening. PPD could influence maternal self-management of MS. Prospective evaluation with screening for PPD is needed.