The role of the immune system in postpartum psychosis

Abstract

Postpartum psychosis is the most severe psychiatric disorder associated with childbirth. The risk is particularly high for women with a history of bipolar disorder or schizoaffective disorder, or those who have suffered a previous episode of postpartum psychosis. However, the aetiology of the illness remains unclear. Pregnancy and the early postpartum are times of significant immunological change. Furthermore, alterations to the immune system have been implicated in the onset and course of various psychopathologies, both related and unrelated to childbirth. Emerging evidence, from studies on immune related disorders, immune cells and inflammatory markers, suggests that the immune system might also be involved in the pathophysiology of postpartum psychosis. Furthermore, recent research has also begun to explore the potential mechanisms underlying immune dysfunction in postpartum psychosis (e.g., disturbances in the Treg–CCN3 protein–(re)myelination axis). Nevertheless, more research is required to understand whether immune dysfunction is a cause or consequence of postpartum psychosis and to clarify the exact mechanisms involved. The aim of this short review is to present the current findings on immune system dysregulation in postpartum psychosis, discuss possible mechanisms underlying the association, highlight potential challenges and confounders and provide suggestions for future research.

Postpartum Psychosis

“…Immune system dysfunction may also be implicated in PPP, although some have noted that it is unclear whether the immune system dysfunction is implicated in the etiology of PPP or rather a sequela of PPP [ 27 ]. Dazzan et al proposed that T cells and their effect on brain myelination may be implicated in PPP [ 28 ] based on clinical and animal studies.…”

Postpartum Psychosis or Something Else?

“…Immunologic changes during pregnancy and postpartum often lead to immune dysfunction, and studies have shown that women with postpartum psychosis display increased monocytes, decreased T-cells, and an up-regulation in immune-related genes compared to controls. 12 Similarly, immune dysfunction also increases susceptibility to autoimmune conditions and infections during the postpartum period. 13 Hormonal fluctuations are ubiquitous in pregnancy with the rise in progesterone and estrogen during pregnancy to prepare the body for growth and maturation of the fetus, and a dramatic decrease during the postpartum period.…”

Immune System Alterations and Postpartum Mental Illness: Evidence From Basic and Clinical Research

“…A role for immune dysregulation in PP is supported by evidence showing that women who experience PP have higher rates of other complications related to immune dysfunction during their pregnancy ( 130 ). For example, immune imbalance occurs in preeclampsia and preeclampsia is a significant risk factor in later developing first onset PP ( 131 ).…”

“…A growing literature points to links between immune alterations and the development of PP in otherwise healthy mothers ( 130 ). One study assessed circulating immune cell types in a population of women who were experiencing the first onset of PP, along with healthy postpartum participants and non-pregnant age-matched healthy controls ( 53 ).…”