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Stratification of the risk of bipolar disorder recurrences in pregnancy and postpartum

  • Arianna Di Florio (a1), Katherine Gordon-Smith (a2), Liz Forty (a3), Michael R. Kosorok (a4), Christine Fraser (a3), Amy Perry (a2), Andrew Bethell (a3), Nick Craddock (a3), Lisa Jones (a2) and Ian Jones (a5)...
Abstract
Background

Pregnancy and childbirth are a period of high risk for women with bipolar disorder and involve difficult decisions particularly about continuing or stopping medications.

Aims

To explore what clinical predictors may help to individualise the risk of perinatal recurrence in women with bipolar disorder.

Method

Information was gathered retrospectively by semi-structured interview, questionnaires and case-note review from 887 women with bipolar disorder who have had children. Clinical predictors were selected using backwards stepwise logistic regression, conditional permutation random forests and reinforcement learning trees.

Results

Previous perinatal history of affective psychosis or depression was the most significant predictor of a perinatal recurrence (odds ratio (OR) = 8.5, 95% CI 5.04–14.82 and OR = 3.6, 95% CI 2.55–5.07 respectively) but even parous women with bipolar disorder without a previous perinatal mood episode were at risk following a subsequent pregnancy, with 7% developing postpartum psychosis.

Conclusions

Previous perinatal history of affective psychosis or depression is the most important predictor of perinatal recurrence in women with bipolar disorder and can be used to individualise risk assessments.

Declaration of interest

None.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Correspondence: Arianna Di Florio, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK. Email: diflorioa@cf.ac.uk
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Stratification of the risk of bipolar disorder recurrences in pregnancy and postpartum

  • Arianna Di Florio (a1), Katherine Gordon-Smith (a2), Liz Forty (a3), Michael R. Kosorok (a4), Christine Fraser (a3), Amy Perry (a2), Andrew Bethell (a3), Nick Craddock (a3), Lisa Jones (a2) and Ian Jones (a5)...
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