Background/Purpose: Chronic diseases have been shown to be a strong risk factor for postpartum depression. Although there is a 2-fold increased risk of major depression in SLE, the risk of postpartum depression in mothers with SLE is unknown. Within a large population-based cohort, we evaluated the risk of postpartum depression in women with SLE compared to unaffected women and explored potential mediators of postpartum depression in SLE pregnancies.

Methods: The “Offspring of SLE mothers Registry (OSLER)” includes all women who had ≥1 hospitalization for delivery after SLE diagnosis, identified through Quebec’s universal healthcare databases (1989-2009). OSLER also includes a randomly selected control group of women, matched at least 4:1 for age and year of delivery, without an SLE diagnosis prior up to the time of delivery. We ascertained postpartum depression based on ≥1 hospitalization or physician visit with relevant diagnostic codes, within the first 12 months after delivery. We performed multivariate analyses to adjust for maternal education, race/ethnicity, and pre-existing mood disorders in the 2 years prior to delivery. In secondary analyses, we further adjusted for pregnancy complications, including preterm birth, gestational diabetes, and stillbirth, to explore potential mediators of postpartum depression in SLE pregnancies.

Results: 509 women with SLE had 729 births, while 5824 matched controls had 8541 births. We identified postpartum depression in 11.0% (95% CI 8.8, 13.5) of SLE pregnancies versus 8.3% (95% CI 7.7, 8.9) of unexposed pregnancies. More SLE pregnancies were preceded by a mood disorder in the 2 years prior to delivery as opposed to unexposed pregnancies [15.4% (95% CI 12.9, 18.2) vs 11.0% (95% CI 10.2, 11.5)]. In primary multivariate analysis, accounting notably for pre-existing mood disorders, SLE pregnancies were at increased risk of postpartum depression versus unexposed pregnancies [OR 1.32 (95% CI 1.01, 1.73)]. The effect estimate for SLE was attenuated when we further adjusted for pregnancy complications [OR 1.20 (95% CI 0.92, 1.58)]. Preterm birth [OR 1.55 (95% CI 1.20, 2.00)] and stillbirth [OR 6.49 (95% CI 3.32, 12.67)] were independent predictors of postpartum depression. Pre-existing mood disorders in the 2 years prior to delivery also was an independent predictor of postpartum depression in both primary and secondary multivariate analyses [OR for primary analysis 4.44 (95% CI 3.73, 5.29)].

Conclusion: Compared to women from the general population, women with SLE have an increased risk of postpartum depression. Mediators of postpartum depression in SLE potentially include pregnancy complications, such as preterm birth and stillbirth. Further research is needed to evaluate the role of disease activity and/or flare during pregnancy, as well as medication exposures on the risk of postpartum depression in SLE.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/increased-risk-of-postpartum-depression-in-sle-pregnancies/