Women with premenstrual disorders more likely to develop perinatal depression

Healthcare providers will now be able to provide better-informed advice for pregnant women, following confirmation of a link between premenstrual disorders and perinatal depression.

New research, based on a very large Swedish data set, suggests women with premenstrual disorders have a higher risk of developing perinatal depression.

And the same study, published in the journal PLOS Medicine, found women with PND are more likely to go on to develop premenstrual disorders after giving birth.

The findings support the hypothesis that both disorders share a common set of causes and risk factors.

“It is important that healthcare professionals who meet women during pregnancy are aware of the link between premenstrual disorders and perinatal depression in order to provide well-informed advice,” says Donghao Lu, an associate professor in epidemiology at the Karolinska Institute in Sweden, who is co-author of the paper.

Perinatal depression (PND) affects 11% of mothers globally and is characterised by depressive symptoms that occur during pregnancy and up to 12 months post-delivery.

Those with premenstrual disorders – like premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) – contend with physical and psychological symptoms that occur in the luteal phase of the menstrual cycle. PMDs affect 20 to 30% of women of reproductive age, with about 5 to 8% suffering severe symptoms.

These disorders coincide with natural hormonal fluctuations, so it’s been hypothesised that a history of one disorder could inform susceptibility to the other.

The new study analysed data from the Swedish Medical Birth Register, which includes information on approximately 1.8 million pregnancies between 2001 and 2018. Researchers identified nearly 85,000 women who had experienced PND and used additional national registers to identify those diagnosed with PMS or PMDD.

These were then compared to a control group of nearly 850,000 women who did not develop PND during the same period.

The findings indicate that women with premenstrual disorders were 5 times more likely to experience perinatal depression than those without.

Additionally, with an average follow-up time of 6.9 years, women who experienced perinatal depression were twice as likely to subsequently develop premenstrual disorders.

Further research will be necessary to understand the biological link between PMDs and PNDs and whether the association also applies to women with mild cases.

The researchers recommend that “pre-conception and maternity care providers should be aware of the risk of developing PND among women with a history of PMDs” and “healthcare providers may inform women with PND about the potential risk of PMDs when menstruation returns after childbirth”.

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