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Perinatal Depression and Anxiety in Women with Multiple Sclerosis: a Population-Based Cohort Study

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Perinatal Depression and Anxiety in Women with Multiple Sclerosis: a Population-Based Cohort Study Published Ahead of Print on April 21, 2021 as 10.1212/WNL.0000000000012062 Neurology Publish Ahead of Print DOI: 10.1212/WNL.0000000000012062 Perinatal Depression and Anxiety in Women with Multiple Sclerosis: A Population-Based Cohort Study Author(s): Karine Eid, MD1,2; Øivind Fredvik Torkildsen, MD PhD1,3; Jan Aarseth, PhD3,4,5; Heidi Øyen Flemmen, MD6; Trygve Holmøy, MD PhD7,8; Åslaug Rudjord Lorentzen, MD PhD9; Kjell-Morten Myhr, MD PhD1,3; Trond Riise, PhD3,5,10; Cecilia Simonsen, MD8,11; Cecilie Fredvik Torkildsen, MD1,12; Stig Wergeland, MD PhD2,3,4; Johannes Sverre 13,14 15 1,2 1,2 Willumsen, MD ; Nina Øksendal, MD ; Nils Erik Gilhus, MD PhD ; Marte-Helene Bjørk, MD PhD Note 1. The Article Processing Charge was funded by the Western Norway Regional Health Authority. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial- NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Neurology® Published Ahead of Print articles have been peer reviewed and accepted for publication. This manuscript will be published in its final form after copyediting, page composition, and review of proofs. Errors that could affect the content may be corrected during these processes. Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology. Corresponding Author: Karine Eid [email protected] Affiliation Information for All Authors: 1. Department of Clinical Medicine, University of Bergen, Norway; 2. Department of Neurology, Haukeland University Hospital, Bergen, Norway; 3. Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway; 4. The Norwegian Multiple Sclerosis Registry and Biobank, Department of Neurology, Haukeland University Hospital, Bergen, Norway; 5. The Norwegian Multiple Sclerosis Competence Centre, Department of Neurology, Haukeland University Hospital, Bergen, Norway; 6. Department of Neurology, Telemark Hospital Trust, Skien, Norway; 7. Department of Neurology, Akershus University Hospital, Lørenskog, Norway; 8. Institute of Clinical Medicine, University of Oslo, Norway; 9. Department of Neurology and The Norwegian National Advisory Unit on Tick-borne diseases, Sørlandet Hospital, Kristiansand, Norway; 10. Department of Global Public Health and Primary Care, University of Bergen, Norway; 11. Department of Neurology, Vestre Viken Hospital Trust, Drammen, Norway; 12. Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway; 13. Department of Neurology, Møre og Romsdal Hospital Trust, Molde, Norway; 14. Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway; 15. Deparment of Neurology, Nordland Hospital Trust, Bodø, Norway Contributions: Karine Eid: Drafting/revision of the manuscript for content, including medical writing for content; Analysis or interpretation of data Øivind Fredvik Torkildsen: Drafting/revision of the manuscript for content, including medical writing for content; Major role in the acquisition of data Jan Aarseth: Drafting/revision of the manuscript for content, including medical writing for content; Major role in the acquisition of data Heidi Øyen Flemmen: Drafting/revision of the manuscript for content, including medical writing for content; Major role in the acquisition of data Trygve Holmøy: Drafting/revision of the manuscript for content, including medical writing for content; Major role in the acquisition of data Åslaug Rudjord Lorentzen: Drafting/revision of the manuscript for content, including medical writing for content; Major role in the acquisition of data Kjell-Morten Myhr: Drafting/revision of the manuscript for content, including medical writing for content; Study concept or design; Analysis or interpretation of data Trond Riise: Drafting/revision of the manuscript for content, including medical writing for content; Study concept or design; Analysis or interpretation of data Cecilia Simonsen: Drafting/revision of the manuscript for content, including medical writing for content; Major role in the acquisition of data Cecilie Fredvik Torkildsen: Drafting/revision of the manuscript for content, including medical writing for content; Major role in the acquisition of data; Study concept or design Stig Wergeland: Drafting/revision of the manuscript for content, including medical writing for content; Major role in the acquisition of data; Study concept or design Johannes Sverre Willumsen: Drafting/revision of the manuscript for content, including medical writing for content; Major role in the acquisition of data Nina Øksendal: Drafting/revision of the manuscript for content, including medical writing for content; Major role in the acquisition of data Nils Erik Gilhus: Drafting/revision of the manuscript for content, including medical writing for content; Study concept or design; Analysis or interpretation of data Marte-Helene Bjørk: Drafting/revision of the manuscript for content, including medical writing for content; Study concept or design; Analysis or interpretation of data Number of characters in title: 82 Abstract Word count: 238 Word count of main text: 4497 References: 50 Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology. Figures: 3 Tables: 4 Supplemental: STROBE checklist Revised manuscript with tracked changes Statistical Analysis performed by: Statistical analyses conducted by Karine Eid MD, University of Bergen, Norway Search Terms: [ 41 ] Multiple sclerosis, [ 239 ] Depression Acknowledgements: The Norwegian Mother, Father and Child Cohort study is supported by the Norwegian Ministry of Health and Care Services and the Ministry of Education and Research. We acknowledge Alok Bhan MD (Department of Neurology, Stavanger University Hospital, Stavanger, Norway); Britt Bruland CNS (Department of Neurology, Førde Hospital, Førde, Norway); Kathrine K. Lian MD (Department of Neurology, St. Olavs Hospital, Trondheim, Norway), Stephan Schüler MD PhD (Department of Neurology, Namsos Hospital, Namsos, Norway) for contributing with data extraction and validation of MS diagnoses. We are grateful to all the participating families in Norway who take part in this ongoing cohort study. Study Funding: We received research support from Novartis Norway, the Western Norway Regional Health Authority and the University of Bergen. Neuro-SysMed is funded by the Norwegian Research Council grant #288164. Disclosures: K. Eid has received unrestricted research grant from Novartis; Ø. Torkildsen has received speaker honoraria from and served on scientific advisory boards for Biogen, Sanofi-Aventis, Merck and Novartis; J. Aarseth reports no disclosures; H. Flemmen has received research grants and speaker honoraria from Biogen Idec and Novartis; and has received speaker honoraria from Sanofi and Merck; T. Holmøy has received lecture fees and research grants from Biogen, Roche, Novartis, Merck and Sanofi; and is on the Medical Committee of the Norwegian MS Association; Å.R. Lorentzen reports no disclosures; K.M. Myhr has received unrestricted research grants to his institution; scientific advisory board and speaker honoraria from Almirall, Biogen, Genzyme, Merck, Novartis, Roche, and Teva; and has participated in clinical trials organized by Biogen, Merck, Novartis, and Roche; T. Riise reports no disclosures relevant to the manuscript; C. S. Simonsen has received unrestricted research grant from Novartis, and has received speaker honoraria from and served on scientific advisory boards for Sanofi, Merck and Biogen Idec; C. Torkildsen has served on scientific advisory board for Astra Zeneca; S. Wergeland has received speaker honoraria from and served on scientific advisory boards for Biogen, Alexion, Sanofi-Aventis and Novartis; J. S. Willumsen has received unrestricted research grant from Novartis; N. Øksendal has received speaker and consultant honoraria from Biogen, and has served on scientific advisory board for Novartis; N.E. Gilhus has received speaker and consultant honoraria from UCB, RaPharma, Argenx, Octapharma, Alexion, Roche and Merck; M.H Bjørk has received research support, consultant honoraria and speakers honoraria from Novartis; and speakers honoraria from Teva, Lilly and Allergan. ABSTRACT Objective To assess the occurrence of perinatal depression and anxiety in women before and after diagnosis of multiple sclerosis (MS). Methods 114,629Copyright pregnant © 2021 Thewomen Author(s). were Published included by Woltersin the NorwegianKluwer Health, Mother, Inc. on behalf Father of the and American Child AcademyCohort studyof Neurology. 1999– 2008. We assessed depression and anxiety by questionnaires during and after pregnancy. Women with MS were identified from national health registries and hospital records and grouped into 1) MS diagnosed before pregnancy (n = 140), MS diagnosed after pregnancy with 2) symptom onset before pregnancy (n = 98) and 3) symptom onset after pregnancy (n = 308). Thirty-five women were diagnosed with MS in the postpartum period. The reference group (n = 111,627) consisted of women without MS. Results Women with MS diagnosed before pregnancy had an adjusted odds ratio of 2.0 (95% confidence interval 1.2–3.1) for depression in the third trimester. Risk factors were adverse socioeconomic factors, history of psychiatric disease
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