Postpartum substance abuse, mood disorders more common with IBD

By Anne Harding

NEW YORK (Reuters Health) - 25/1/2019

Inflammatory bowel disease (IBD), and Crohn's disease in particular, is associated with an increased risk of postpartum mood disorders and substance abuse, new findings in the journal Gut show.

"It's important that physicians recognize that this is a risk in all women, but especially in women with IBD, and that they try and identify it and get it treated quickly," Dr. Eric I. Benchimol of the Children's Hospital of Eastern Ontario in Ottawa told Reuters Health in a telephone interview.

People with IBD face an increased risk of mental illness, particularly when the disease is active, Benchimol and his team note in their January 9 report.

They looked at 3,721 women with a singleton live birth in Ontario in 2002-2014 and 798,908 women without IBD who delivered a baby during the same period.

Women with IBD had a 22.7% chance of developing new onset mental illness during pregnancy or the first postpartum year, compared to 20.4% for women without IBD. They were more likely to develop mental illness during the postpartum period (adjusted hazard ratio 1.20) than women without IBD, but their risk was not increased during pregnancy. Women with Crohn's disease were at higher risk (aHR 1.12) of a postpartum diagnosis than women without IBD, but risk was not higher in women with ulcerative colitis (UC). Risk was highest during the first 90 postpartum days.

Mood and anxiety disorders (aHR 1.14) and alcohol and substance use disorders (aHR 2.73) were more frequent in the women with IBD. Subgroup analysis identified this pattern in women with CD, but not in those with ulcerative colitis (UC).

Maternal age, delivery year, pre-pregnancy Johns Hopkins Collapsed Adjusted Diagnostic Groups comorbidity score, number of prenatal visits, provider specialty and infant mortality were each associated with the risk of new-onset mental illness or a substance abuse diagnosis in the women with IBD.

Neonatal abstinence syndrome was significantly more common in babies born to women with IBD, Benchimol said, suggesting that opioids are "highly likely" to be a factor in substance abuse diagnoses.

"We really need to pay attention to what medicines we're prescribing and in women with Crohn's disease we should avoid opiates if at all possible," he said.

"It's an important thing from a provider awareness perspective to at least be aware that this might be an issue, and from a health system issue so we don't run into problems with access to mental health treatment," Benchimol said.

SOURCE: Gut 2019.

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