Risk, Predictors of Postpartum Psychosis in Women With Bipolar Disorder

Stressed Mother holding baby
Stressed Mother holding baby
A history of mania following sleep loss may be a marker to predict postpartum psychosis.

Parous women with bipolar disorder who experience sleep loss and subsequent episodes of mania are at an increased risk for postpartum psychosis, according to study findings published in the Journal of Affective Disorders.

Using the Bipolar Disorder Research Network, a large and ongoing clinical and molecular genetic research program of mood disorders, investigators recruited a total of 870 childbearing women with bipolar disorder. The investigators assessed interview transcripts and case notes to evaluate lifetime bipolar disorder diagnoses and perinatal psychiatric episodes. In addition, the investigators assessed whether rates of postpartum psychosis were higher among women who reported mood disorders after sleep loss vs those who did not report these post-sleep-loss symptoms.

In this sample, approximately one-fourth (23.5%) of patients reported a lifetime episode of postpartum psychosis. A total of 220 women (25.3%) reported manic symptoms after sleep loss. Participants who experienced a manic response to sleep loss had a greater likelihood of experiencing postpartum psychosis than those not reporting a post-sleep-loss manic response (χ2 (1) =17.191, 36.8% vs 21.8%, respectively; P <.001).

In addition, compared with women who did not report psychiatric symptoms following sleep loss, those who did report these manic episodes had a significantly higher likelihood of having a lifetime episode of postpartum psychosis (odds ratio [OR] 2.09; 95% CI, 1.47-2.97, P <.001). These findings persisted following adjustment for number of manic episodes, age, number of deliveries, method of recruitment, and marital status (OR 2.09; 95% CI, 1.43-3.04, P <.001). A depressive response to sleep loss was not associated with higher postpartum psychosis rates compared with women who did not experience depressed mood following sleep loss (χ2 (1) =0.401, 22.8% vs 26.1%, respectively; P =.526).

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The retrospective nature of this study precluded the investigators’ ability to measure participants’ sleep loss objectively, potentially limiting the clinical applicability of the findings. In addition, interview data assessed in this study may have been unreliable or inaccurate, which necessitates the need for prospective, longitudinal studies that use primarily subjective measurements.

Asking women with bipolar disorder whether they have experienced a perinatal manic episode following sleep loss could help identify patients who are at an increased risk for postpartum psychosis and could “potentially help with difficult decisions regarding the use of medication during the perinatal period.”


Lewis KJS, Di Florio A, Forty L, et al. Mania triggered by sleep loss and risk of postpartum psychosis in women with bipolar disorder. J Affect Disord. 2018;225:624-629.