A new study has found that women who suffer from psychiatric disorders such as depression, anxiety, mania, and schizophrenia, following the live birth of their first child are less likely to go on to have more children.
The study found that 69 percent of women who experienced postpartum psychiatric disorders within the first six months after the birth of their first baby went on to have further children compared to 82 percent of mothers who did not experience psychiatric problems.
Previous research has shown that, overall, around 3 percent of women develop psychiatric disorders in the first three months after childbirth. These disorders encompass a wide range of mental health problems and usually involve a combination of abnormal thoughts, behaviors, and relationships with other people, researchers explained. To date, there has been little research into whether this affects women’s subsequent reproduction, they add.
“We wanted to explore whether women with postpartum psychiatric disorders had a reduced possibility of having a second child. Furthermore, we considered whether a reduction in the live birth rate was due to personal choices or decreased fertility, as these are important issues to consider,” said Dr. Xiaoqin Liu, a postdoctoral researcher at the National Centre for Register-based Research at Aarhus University in Denmark, who led the study.
For the new study, the researchers analyzed data from Danish registries for 414,571 women who had their first live birth between 1997 and 2015 in Denmark. They followed the women for a maximum of 19.5 years until the next live birth, emigration, death, their 45th birthday, or June 2016, whichever occurred first.
They identified women with postpartum psychiatric disorders by seeing if they were given prescriptions for psychotropic medications or had hospital contact for psychiatric disorders during the first six months after the live birth of their first child.
According to the study’s findings, 4,327 — or 1% — of the women experienced psychiatric disorders following the birth of their first child.
These women were a third less likely to have a second live birth compared to women who did not experience psychiatric disorders, the study discovered.
If the first child died, the difference in subsequent live birth rates disappeared. However, if the psychiatric problem required hospitalization, the likelihood of a woman having a second child nearly halved and this remained the case whether the first child survived or not, the researchers reported.
“Although fewer women with postpartum psychiatric disorders had subsequent children, it is noteworthy that about 69 percent of these women still chose to have a second child,” Liu said. “For the remaining 31% of women, we need to differentiate the reasons why they did not have another child. If they avoided another pregnancy due to fear of relapse, an important clinical message to them is that prevention of relapse is possible.”
“We recommend that they seek help from their family doctors or psychiatrists if they want to have another child, so that plans for treatment that are specific for their individual needs can be made to reduce the risk of relapse, and so that their health, well-being and symptoms can be closely monitored and treated,” she continued.
The researchers noted that women whose first child died were nearly four times as likely to have a subsequent live birth as women whose first child survived.
“These findings suggest that the overall reduced rate of subsequent live births among women who experienced psychiatric disorders after the birth of their first child is, at least in part, voluntary,” Liu said.
The researchers add that other possible explanations for the reduction in the subsequent live birth rate may be that women with postpartum psychiatric disorders are less able to conceive or have more problematic relationships with partners.
“The reason why women with postpartum psychiatric disorders choose to have fewer children needs to be explored further,” said Liu.
A limitation of the study is that, although the researchers had an almost complete follow-up of the women through the Danish registries, they did not have accurate information on stillbirths or miscarriages. Only pregnancies that led to a live birth were included in the study. Another limitation is that not all women with psychiatric disorders might have received medications or hospital treatment. In addition, it might not be possible to generalize the findings of the study to populations in other countries, the researchers noted.
“Denmark offers free and easily available healthcare to all individuals, so we believe our results can inform other, similar populations, although we cannot rule out local differences,” concluded Liu.
The study was published in Human Reproduction.