Background/Purpose:  There is little information regarding maternal post-partum complications in women with inflammatory arthritis conditions and none on persons with juvenile arthritis. Our objective was to evaluate the frequency of post-partum complications including depression in new mothers who had juvenile arthritis and to assess whether these differ from mothers who never had juvenile arthritis.

Methods: Our cohort study used data from physician billing and hospitalizations covering Québec, Canada. We identified all females with juvenile arthritis with a first-time birth between 01/01/1983 and 12/31/2010, and assembled a control cohort of first-time mothers without juvenile arthritis from the same administrative data source, matching 4:1 for date of first birth, maternal age and area of residence. Using a combination of physician billing codes and hospital codes and procedures, we compared the following post-partum complications: major puerperal infection, thromboembolic events, anaesthetic complications, post-partum haemorrhage, obstetrical trauma, complications of obstetrical surgical wounds, and depression in the first year following delivery, in the juvenile arthritis versus non-juvenile arthritis groups, using univariate and multivariate logistic regression analyses (adjusting for maternal age, education, caesarean delivery, hypertension, diabetes, birthweight, and adverse birth outcome).

Results:  Mean age at delivery was 24.7 years in the juvenile arthritis group (n=1681) and 25.0 for the non-juvenile arthritis group (n=6724). Mothers with juvenile arthritis were more likely to be diagnosed with depression in the first year post-partum (29.8% vs 6.7%, p<0.0001), and more had post-partum hemorrhage (10.0% vs 6.1%, p<0.0001) compared to the matched group of non-juvenile arthritis mothers. On the other hand those with juvenile arthritis had fewer major puerperal infections (1.6% vs. 2.5%, p=0.03) and less obstetrical trauma (4.3% vs. 7.2%, p<00001). In multivariate analyses, mothers with juvenile arthritis were more likely to experience depression in the first year post-partum (adjusted Risk Ratio (aRR): 4.25 95% Confidence Interval (CI) 3.78,4.77) and post-partum hemorrhage (aRR: 1.65, 95% CI 1.39,1.96). Mothers with juvenile arthritis were less likely to have a thromboembolic event (aRR 0.79, 95% CI 0.65,0.96) or obstetrical trauma (aRR 0.60, 95% CI 0.47,0.77) compared to mothers without juvenile arthritis.

Conclusion: Mothers with a history of juvenile arthritis were more likely to be diagnosed with depression in the first year post-partum and with post-partum hemorrhage. Possible explanations for the greater tendency towards depression might be higher pre-existing depression in juvenile arthritis or more frequent post-partum follow-up by physicians. Further research on these factors, and others (such as co-morbidity and medications) is warranted.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/post-partum-complications-and-depression-in-new-mothers-with-juvenile-arthritis/