Risk of perinatal psychiatric disorder among women with a history of premenstrual disorder: a nationwide register-based study from Sweden.
Level 3 - non-randomized controlled study
Nationwide non-randomized register-based cohort study
PubMed 42366011 · doi:10.1136/bmjopen-2026-116361
What was done
This nationwide register-based cohort study evaluated 1,052,977 women with 1,799,010 pregnancies recorded in the Swedish Medical Birth Register between 2003 and 2020. Premenstrual disorder (PMD) prior to pregnancy was identified through clinical diagnostic codes or filled prescriptions in healthcare registries. The primary outcome was first-onset perinatal psychiatric disorders (PNPDs) diagnosed between the start of pregnancy and 12 months postpartum across eight subgroups (depression, anxiety, stress-related disorders, bipolar disorder, psychosis, alcohol use disorder, drug use disorder, and other). Multivariable logistic regression estimated adjusted odds ratios (aORs) controlling for demographic and clinical covariates, and sibling comparisons were performed to assess familial confounding.
What was found
Pre-pregnancy PMD was identified in 13,382 women (1.3%), accounting for 17,514 (1%) pregnancies. PMD was associated with an increased risk of all psychiatric subtypes except perinatal psychosis. The strongest associations occurred for bipolar disorder (adjusted OR 3.98, 95% CI 3.15 to 5.04) and perinatal depression (adjusted OR 2.74, 95% CI 2.56 to 2.94). Elevated risks appeared across antepartum and postpartum windows and were stronger among women without a psychiatric history. Sibling comparisons showed attenuated yet statistically significant associations.
Why it matters
This study shows that PMD increases the risk across a broad spectrum of perinatal psychiatric disorders, particularly bipolar disorder and depression, rather than postpartum depression alone. Routine assessment of PMD during prenatal visits could facilitate earlier identification and targeted psychiatric intervention.
Limits
Register-based exposure assessment relies on healthcare contact and prescription data, which likely selects for more severe PMD presentations and undercounts milder unrecorded cases. Specific numerical risk estimates for anxiety, stress-related, and substance use subtypes were not reported in the abstract. Attenuation in sibling comparisons suggests residual familial and genetic confounding. Findings from Sweden may not fully generalize to populations with different healthcare access or diagnostic routines.
Cited by
- supports A history of anxiety, PTSD, depression, or premenstrual dysphoric disorder increases the risk of developing postpartum depression.