On 2017 Feb 13, David Reardon commented:

This analysis of perinatal psychiatric episodes by Munk-Olsen T, 2016¹ is flawed by the failure to examine the effects of prior pregnancy losses. Numerous studies have shown that prior fetal loss, either from miscarriage, stillbirth, or induced abortion, increases the risk psychiatric disorders during and after subsequent pregnancies.^2-7 There is even a dose effect, with multiple losses associated with elevated rates compared to a single loss.²

Notably, the heightened risk of mental illness following miscarriage and abortion have also been confirmed by several of Munk-Olsen’s own studies.^8-10 Unfortunately, while abortion was used as a control variable in two cases, the effects were not described.^8,10

In light of the literature, Munk-Olsen T, 2016's conclusion that it is not possible to “predict which women will become ill postpartum”¹ is an overstatement. There is strong evidence that prior fetal loss is risk factor.

It is strongly recommended that the authors of this most recent study¹ should publish a reanalysis showing the effects of prior pregnancy loss relative to (a) one or more abortions and (b) one or more miscarriages or other natural losses. These results could lead to improved screening to identify women who may benefit from additional care.

Editors and peer reviewers should be alert to the recommendation that all studies relative to the intersection between mental and reproductive health should always consider the effects of prior pregnancy loss.^11-13 In particular, both the Royal College of Psychiatrists¹⁴ and the American Psychological Association¹⁵ have lamented the lack of high quality studies examining the statistical associations between abortion and mental health. Record linkage studies from national data sets, such as that examined by Munk-Olsen, can help to fill this gap of knowledge . . . but only if they include analyses examining these effects.

References

1) Munk-Olsen T, Maegbaek ML, Johannsen BM, et al. Perinatal psychiatric episodes: a population-based study on treatment incidence and prevalence. Transl Psychiatry. 2016;6(10):e919. doi:10.1038/tp.2016.190.

2) Giannandrea SAM, Cerulli C, Anson E, Chaudron LH. Increased risk for postpartum psychiatric disorders among women with past pregnancy loss. J Womens Health (Larchmt). 2013;22(9):760-768. doi:10.1089/jwh.2012.4011.

3) Gong X, Hao J, Tao F, et al. Pregnancy loss and anxiety and depression during subsequent pregnancies: data from the C-ABC study. Eur J Obstet Gynecol Reprod Biol. 2013;166(1):30-36. doi:10.1016/j.ejogrb.2012.09.024.

4) Blackmore ER, Côté-Arsenault D, Tang W, et al. Previous prenatal loss as a predictor of perinatal depression and anxiety. Br J Psychiatry. 2011;198(5):373-378. doi:10.1192/bjp.bp.110.083105.

5) Räisänen S, Lehto SM, Nielsen HS, Gissler M, Kramer MR, Heinonen S. Risk factors for and perinatal outcomes of major depression during pregnancy: a population-based analysis during 2002-2010 in Finland. BMJ Open. 2014;4(11):e004883. doi:10.1136/bmjopen-2014-004883.

6) Montmasson H, Bertrand P, Perrotin F, El-Hage W. Facteurs prédictifs de l’état de stress post-traumatique du postpartum chez la primipare. J Gynécologie Obs Biol la Reprod. 2012;41(6):553-560. doi:10.1016/j.jgyn.2012.04.010.

7) McCarthy F, Moss-Morris R, Khashan A, et al. Previous pregnancy loss has an adverse impact on distress and behaviour in subsequent pregnancy. BJOG An Int J Obstet Gynaecol. 2015;122(13):1757-1764. doi:10.1111/1471-0528.13233.

8) Munk-Olsen T, Bech BH, Vestergaard M, Li J, Olsen J, Laursen TM. Psychiatric disorders following fetal death: a population-based cohort study. BMJ Open. 2014:1-6. doi:10.1136/bmjopen-2014-005187.

9) Meltzer-Brody S, Maegbaek ML, Medland SE, Miller WC, Sullivan P, Munk-Olsen T. Obstetrical, pregnancy and socio-economic predictors for new-onset severe postpartum psychiatric disorders in primiparous women. Psychol Med. 2017:1-15. doi:10.1017/S0033291716003020.

10) Munk-Olsen T, Agerbo E. Does childbirth cause psychiatric disorders? A population-based study paralleling a natural experiment. Epidemiology. 2015;26(1):79-84. doi:10.1097/EDE.0000000000000193.

11) Reardon DC. Lack of pregnancy loss history mars depression study. Acta Psychiatr Scand. 2012;126(2):155. doi:10.1111/j.1600-0447.2012.01880.x.

12) Sullins DP. Abortion, substance abuse and mental health in early adulthood: Thirteen-year longitudinal evidence from the United States. SAGE Open Med. 2016;4(0):2050312116665997. doi:10.1177/2050312116665997.

13) Coleman PK. Abortion and mental health: Quantitative synthesis and analysis of research published 1995-2009. Br J Psychiatry. 2011;199(3):180-186.

14) National Collaborating Centre for Mental Health. Induced Abortion and Mental Health: A Systematic Review of the Mental Health Outcomes of Induced Abortion, Including Their Prevalence and Associated Factors. London, UK: Academy of Medical Royal Colleges; 2011. http://www.aomrc.org.uk/wp-content/uploads/2016/05/Induced_Abortion_Mental_Health_1211.pdf.

15) Major B, Appelbaum M, Beckman L, Dutton MA, Russo NF, West C. Report of the APA Task Force on Mental Health and Abortion. Washington, DC: American Psychological Association; 2008. http://www.apa.org/pi/women/programs/abortion/mental-health.pdf.

On 2016 Dec 06, David Reardon commented:

None

On 2016 Dec 05, David Reardon commented:

None

On 2016 Dec 05, David Reardon commented:

None

On 2016 Dec 06, David Reardon commented:

None

On 2017 Feb 13, David Reardon commented:

This analysis of perinatal psychiatric episodes by Munk-Olsen T, 2016¹ is flawed by the failure to examine the effects of prior pregnancy losses. Numerous studies have shown that prior fetal loss, either from miscarriage, stillbirth, or induced abortion, increases the risk psychiatric disorders during and after subsequent pregnancies.^2-7 There is even a dose effect, with multiple losses associated with elevated rates compared to a single loss.²

Notably, the heightened risk of mental illness following miscarriage and abortion have also been confirmed by several of Munk-Olsen’s own studies.^8-10 Unfortunately, while abortion was used as a control variable in two cases, the effects were not described.^8,10

In light of the literature, Munk-Olsen T, 2016's conclusion that it is not possible to “predict which women will become ill postpartum”¹ is an overstatement. There is strong evidence that prior fetal loss is risk factor.

It is strongly recommended that the authors of this most recent study¹ should publish a reanalysis showing the effects of prior pregnancy loss relative to (a) one or more abortions and (b) one or more miscarriages or other natural losses. These results could lead to improved screening to identify women who may benefit from additional care.

Editors and peer reviewers should be alert to the recommendation that all studies relative to the intersection between mental and reproductive health should always consider the effects of prior pregnancy loss.^11-13 In particular, both the Royal College of Psychiatrists¹⁴ and the American Psychological Association¹⁵ have lamented the lack of high quality studies examining the statistical associations between abortion and mental health. Record linkage studies from national data sets, such as that examined by Munk-Olsen, can help to fill this gap of knowledge . . . but only if they include analyses examining these effects.

References

1) Munk-Olsen T, Maegbaek ML, Johannsen BM, et al. Perinatal psychiatric episodes: a population-based study on treatment incidence and prevalence. Transl Psychiatry. 2016;6(10):e919. doi:10.1038/tp.2016.190.

2) Giannandrea SAM, Cerulli C, Anson E, Chaudron LH. Increased risk for postpartum psychiatric disorders among women with past pregnancy loss. J Womens Health (Larchmt). 2013;22(9):760-768. doi:10.1089/jwh.2012.4011.

3) Gong X, Hao J, Tao F, et al. Pregnancy loss and anxiety and depression during subsequent pregnancies: data from the C-ABC study. Eur J Obstet Gynecol Reprod Biol. 2013;166(1):30-36. doi:10.1016/j.ejogrb.2012.09.024.

4) Blackmore ER, Côté-Arsenault D, Tang W, et al. Previous prenatal loss as a predictor of perinatal depression and anxiety. Br J Psychiatry. 2011;198(5):373-378. doi:10.1192/bjp.bp.110.083105.

5) Räisänen S, Lehto SM, Nielsen HS, Gissler M, Kramer MR, Heinonen S. Risk factors for and perinatal outcomes of major depression during pregnancy: a population-based analysis during 2002-2010 in Finland. BMJ Open. 2014;4(11):e004883. doi:10.1136/bmjopen-2014-004883.

6) Montmasson H, Bertrand P, Perrotin F, El-Hage W. Facteurs prédictifs de l’état de stress post-traumatique du postpartum chez la primipare. J Gynécologie Obs Biol la Reprod. 2012;41(6):553-560. doi:10.1016/j.jgyn.2012.04.010.

7) McCarthy F, Moss-Morris R, Khashan A, et al. Previous pregnancy loss has an adverse impact on distress and behaviour in subsequent pregnancy. BJOG An Int J Obstet Gynaecol. 2015;122(13):1757-1764. doi:10.1111/1471-0528.13233.

8) Munk-Olsen T, Bech BH, Vestergaard M, Li J, Olsen J, Laursen TM. Psychiatric disorders following fetal death: a population-based cohort study. BMJ Open. 2014:1-6. doi:10.1136/bmjopen-2014-005187.

9) Meltzer-Brody S, Maegbaek ML, Medland SE, Miller WC, Sullivan P, Munk-Olsen T. Obstetrical, pregnancy and socio-economic predictors for new-onset severe postpartum psychiatric disorders in primiparous women. Psychol Med. 2017:1-15. doi:10.1017/S0033291716003020.

10) Munk-Olsen T, Agerbo E. Does childbirth cause psychiatric disorders? A population-based study paralleling a natural experiment. Epidemiology. 2015;26(1):79-84. doi:10.1097/EDE.0000000000000193.

11) Reardon DC. Lack of pregnancy loss history mars depression study. Acta Psychiatr Scand. 2012;126(2):155. doi:10.1111/j.1600-0447.2012.01880.x.

12) Sullins DP. Abortion, substance abuse and mental health in early adulthood: Thirteen-year longitudinal evidence from the United States. SAGE Open Med. 2016;4(0):2050312116665997. doi:10.1177/2050312116665997.

13) Coleman PK. Abortion and mental health: Quantitative synthesis and analysis of research published 1995-2009. Br J Psychiatry. 2011;199(3):180-186.

14) National Collaborating Centre for Mental Health. Induced Abortion and Mental Health: A Systematic Review of the Mental Health Outcomes of Induced Abortion, Including Their Prevalence and Associated Factors. London, UK: Academy of Medical Royal Colleges; 2011. http://www.aomrc.org.uk/wp-content/uploads/2016/05/Induced_Abortion_Mental_Health_1211.pdf.

15) Major B, Appelbaum M, Beckman L, Dutton MA, Russo NF, West C. Report of the APA Task Force on Mental Health and Abortion. Washington, DC: American Psychological Association; 2008. http://www.apa.org/pi/women/programs/abortion/mental-health.pdf.