Postpartum psychosis (PPP) may manifest somewhat in a different way than psychosis occurring in other settings, with signs and symptoms of mania (similar to decreased need for sleep, impulsive/dangerous behaviors, rapid speech) or delirium (similar to confusion and inattention) which will wax and wane. Postpartum psychosis is a rare, but treatable condition that requires early hospitalization and shut monitoring and care.

 While secure and effective treatments for this condition have been established, much stays to be learned about why this condition develops in certain women. The higher we’re capable of understand this illness, the higher able we could also be to watch and screen high risk women – ideally treating the condition early and to finish remission and even stopping this condition from occurring altogether.

 A 2023 study from Albers and colleagues adds to existing literature on PPP. Using ICD-10 codes to discover postpartum psychosis, this cross-sectional study of over 12 million deliveries investigated risk aspects – patient demographics, medical, psychiatric, obstetrical, and hospital aspects – for postpartum psychosis occurring during  hospitalizations for childbirth and hospital readmissions within the two months post-delivery, using the US Nationwide Readmissions Database (NRD) from the Healthcare Cost and Utilize Project (HCUP) between 2016 and 2019.

The findings of this study are outlined on this PowerPoint presentation.

Postpartum Psychosis During Delivery Hospitalizations and Postpartum Readmissions by Rebecca Leval

While there have been many strengths and limitations of this study, it’s important to notice that a study with this design cannot prove causation. It was also unclear if these findings represent an increased disease burden, or a rise in screening and diagnosis of PPP.

 While the mechanisms of how these conditions may pose risk of PPP remain unknown, the study authors hypothesize:

• The association with traumatic obstetric events may implicate immune dysregulation in PPP.
• The association with low socioeconomic status may implicate stressors of poverty in PPP.
• The association with Medicare insurance may implicate comorbid medical conditions in PPP.

 In conclusion, PPP stays a rare, but high morbidity, event. PPP is sort of conscious of treatment with mood stabilizers, antipsychotics, and/or ECT.  Early intervention is critical as psychosis emerging in the course of the postpartum period may end in harm to mother and infant. Women with medical, psychiatric, and obstetric risk aspects ought to be closely followed inside pregnancy and the postpartum. These risk aspects are also related to multiple other adversarial pregnancy, delivery, and postpartum outcomes.

 Rebecca Leval, MD

Albers SM, Wen T, Monk C, Logue TC, D’Alton ME, Booker WA, Friedman AM. Postpartum psychosis during delivery hospitalizations and postpartum readmissions, 2016-2019. Am J Obstet Gynecol MFM. 2023 May;5(5):100905.