Risk of perinatal psychiatric disorder among women with a history of premenstrual disorder: a nationwide register-based study from Sweden.

objectiveWomen with premenstrual disorder (PMD) display heightened sensitivity to hormonal changes and may be at risk for psychiatric disorders during other hormonally dynamic periods such as pregnancy and postpartum. While PMD has been linked to perinatal depression, associations with the full spectrum of perinatal psychiatric disorders (PNPDs), including anxiety and psychosis, remain largely unexplored. This study aimed to investigate whether a history of PMD is associated with increased risk of a first-onset PNPD.

designNationwide register-based cohort study from 2003 to 2020.

settingSwedish national and regional population and healthcare registers.

participants1 052 977 women with 1 799 010 pregnancies recorded in the Swedish Medical Birth Register. Individuals with PMD prior to pregnancy were identified through clinical diagnoses or prescribed medications in Swedish healthcare registers. PRIMARY AND SECONDARY OUTCOME MEASURES: First-onset PNPDs diagnosed from pregnancy start to 12 months postpartum were identified through Swedish healthcare registers. PNPDs were categorised into eight subgroups: depression, anxiety, stress-related disorders, bipolar disorder, psychosis, alcohol use disorder, drug use disorder and other. Multivariable logistic regression models were used to estimate ORs and 95% CIs, adjusting for demographic and clinical covariates. Sibling analyses were also conducted to address potential familial confounding.

resultsAmong the 1 052 977 women included, 13 382 women (1.3%), corresponding to 17 514 (1%) pregnancies, had a diagnosis of PMD prior to pregnancy. In the type-specific analysis, an increased likelihood was found for all subtypes of disorders, except for perinatal psychosis. The strongest associations were observed for bipolar disorder (adjusted OR 3.98, 95% CI 3.15 to 5.04), followed by perinatal depression (adjusted OR 2.74, 95% CI 2.56 to 2.94). Associations were present in both antepartum and postpartum periods and were stronger among women without psychiatric history. Sibling comparisons showed attenuated but statistically significant associations.

conclusionOur findings highlight that women with a history of PMD face an increased likelihood of developing PNPDs, particularly depression and bipolar disorder, both during pregnancy and postpartum. Given frequent perinatal healthcare contact, these findings may help inform targeted risk identification and early intervention strategies.