Genetics Studies

One of the main avenues of research our group has been following is trying to find genetic factors that make some women vulnerable to episodes of severe illness following childbirth. The goal of this work is to improve treatments, identification and advice for those at high risk of PP. The work on postpartum illness is an important part of the more general mood disorders work of the group.

Through fantastic help from women in the APP panel we have been able to conduct some important studies and are making progress in the difficult task of understanding more about why some women become ill at this time.

We have published studies that show that a vulnerability to episodes of illness following childbirth runs in families and have published work that has looked at the involvement of a number of specific genes.

We have identified a number of chromosomal regions that tend to be shared by those that experience PP and investigations are ongoing into genes in those areas. We have also been concentrating on examining individual genes that code pregnancy and mood related hormones or receptors.  There is a considerable amount of work that remains to be done. Find out more about taking part…

Recovery from Postpartum Psychosis – Service User led research project

Coming soon…

Living with Postpartum Psychosis

One of the avenues of research that the team would like to pursue further are studies looking at the experience of postpartum psychosis. Emma conducted in-depth interviews with 10 women from the APP and a number of key themes arose out of the interviews.

All of the women interviewed viewed childbirth as the precipitant of their illness, predominantly viewing it as biological or hormonal, with traumatic births or stressful pregnancies as further precipitants. Women viewed PP as different from other forms of mental illness, requiring separate and specialised forms of treatment.

Many described a lack of experience in health professionals compounding their fear and sense of isolation. Lack of control over treatment and their lives was discussed by many women, who felt anger that they, and their families, were sidelined from decision-making processes. Many women talked of the lack of support in place for husbands – who either became responsible for looking after their partner and baby or were separated from them.

A sense of loss and, for some, guilt arose as a key theme at being unable to fulfil the role of a new mother. An interesting issue described was of losing the privilege to feel ‘normal emotions’ without worrying, or others worrying, that this was a sign of illness.

Those interviewed described that relationships with friends and family are often strained following an episode. They felt there was a correlation between friends’ reactions and a previous awareness of psychiatric illness. For some the use of humour was useful, while in other families the illness was not spoken about and women felt denied the opportunity to discuss worries.

For most, it was described as a ‘life changing experience’, forcing a struggle with self identity, but most felt that they ‘regained their old sense of self’ and gained greater confidence, self awareness and a sense of empathy with others.

Risk of postpartum and non-postpartum recurrence of illness

We have also studied the risk of further episodes of illness for a woman that has suffered an episode of PP. As part of her PhD, Emma took the lead in conducting the largest study to date into risk of recurrence.

We found that after experiencing an episode of PP, women had a significant risk (around 57%) of becoming ill following a subsequent delivery but we also found a high risk of experiencing an episode of illness unrelated to childbirth. Our findings indicate that advising women to avoid future pregnancies if they wish to avoid further episodes of illness might not be appropriate. We are planning work to try to understand the factors involved in why some women have further episodes of illness while others just have one postpartum episode. This work will be important in advising people on their individual risks and on ways of reducing the risk of recurrence.

Obstetric factors associated with PP

We are keen to understand more about why following some pregnancies women experience PP, whilst the same women remain well after future pregnancies. Emma compared deliveries that were affected and unaffected by PP. We found that primiparity (i.e. being a first time mother) and experiencing a medical complication during delivery were significant risk factors for PP.

The next step is to design studies that can explore what biological and psychological mechanisms could account for these findings.

Early symptoms of Postpartum Psychosis

We examined the earliest symptoms reported by women in their episode of PP. Prior to this study it was believed that symptoms began on day 3-4 following delivery. Most women in our sample felt that, looking back, they could notice some mild symptoms beginning on day one, and some 10% felt that they began to feel more ‘elated or strong and important’ over the last trimester of pregnancy.  This has implications for the types of hormones we consider as good candidates for a role in PP.

The most commonly recalled symptoms were feeling ‘excited, elated or high’, feeling ‘more active and energetic, ‘talking more or feeling chatty’, ‘not being able to, or needing to sleep’ and other symptoms such as ‘feeling anxious or fearful’ or ‘confused, unreal and in a dream world.’ Health professionals rarely ask about these kinds of symptoms, even in women at very high risk of PP episodes. Indeed, they are likely to consider that such women are coping ‘ultra well’ with pregnancy and the demands of new motherhood. The team has submitted a paper to a journal suggesting that health professionals be aware that these feelings could mark the beginning of a mood disorder and deserve closer scrutiny.

Postnatal hypomania (‘the highs’)

In this study we examined symptoms of hypomania in a large sample of women who did not develop an episode of PP. We found that there was a spectrum of severity of ‘bipolar-like’ symptoms in the normal population following childbirth and that these symptoms were much more common in the first week postpartum than during pregnancy or later in the postpartum. The more extreme these high mood symptoms were, the greater the chance the women would suffer a postnatal depression.

We examined a range of risk factors for postpartum high mood. As in PP, primiparity (first delivery) was a risk factor, as was a previous history of minor mood disturbance and a family history of high mood or depression. Other interesting findings were reported with personality traits and obstetric factors that need to be replicated in larger samples. Interestingly, high mood (even though it was associated with a high risk of later depression) did not adversely affect the mother baby bond.

Further studies of mild symptoms of high mood are being developed as it is hoped that these can give insights into risk factors and mechanisms involved in postnatal triggering of more severe mood disorder episodes.