Higher Levels of Postpartum Depression in Women With MS Raise Importance for Screening Efforts

Riley Bove, MD

A recently presented clinical study of women with multiple sclerosis (WwMS) identified some potential links to postpartum depression (PPD), as well as found an overall higher rate of PPD than reports in both general and MS populations. All told, these data underscored the importance of screening for PPD from late gestation until 12 months postpartum, while also suggesting that active management of MS inflammatory activity could reduce PPD burden.¹

Part of a late-breaking abstract at the 2025 Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting, the study featured 121 WwMS enrolled across 2 sites starting at gestational week 36 and followed serially until 12 months postpartum. At the conclusion of the study, PPD by any measure was associated with Black/Hispanic ancestry (OR, 1.24; 95% CI, 0.09-2.40; P = .03), pre-pregnancy depression/anxiety (OR, 2.15; 95% CI, 1.12-2.91; P = .000), and absence of exclusive breastfeeding (OR, 3.28; 95% CI, 0.19-2.18; P = .01).

Senior investigator Riley Bove, MD, an associate professor of neurology at the University of California, San Francisco, and colleagues, used several different scales to measure PPD. Among them included the Edinburgh Postnatal Depression Scale (EPDS; threshold >9/30), met by 20.7% of the cohort, the Mini International Neuropsychiatric interview (MINI)/Structured Clinical Interview for DSM Disorders (SCID), for which 18.2% met criteria, and Hospital Anxiety and Depression Scale (HADS-D, threshold >8). Overall, 40.5% of the study participants met criteria for PPD based on any measure.

In the trial, EDPS was most commonly elevated in the first month postpartium (19%), and correlated highly with HADS-D (r = 0.79; P <.05), and moderately with fatigue, lower Social Support, and worse Mother-Infant Bonding (|r|>0.37, P <0.05 for all measures). For reference, fatigue, social support, and mother-infant connections were assessed through Modified Fatigue Impact Scale, Medical Outcomes Study Social Support Survey, and Mother-to-Infant Bonding Scale, respectively.

In the trial, covariates included demographic and other MS-specific factors. Overall, results revealed that PPD was associated with higher pre-conception Expanded Disability Status Scale (EDSS) scores (OR, 2.01; 95% CI, 1.21-3.33; P = .0006), and with gestational clinical relapses (in 17% overall; OR, 5.65; 95% CI, 1.12-28.61; P = .03).

READ MORE: Real-World Analysis Shows Growing Use of Octave’s MS Disease Activity Test in Clinical Practice

It has been known as that people with MS have an increased prevalence of depression and anxiety compared with the general population. Several factors are believed to contribute, including pathobiological mechanisms of MS itself. Over the years, there has been growing literature on the occurrence of depression and anxiety in the peri- and postnatal settings.

One large-scale analysis, published in Neurology in 2021, assessed the occurrence of perinatal depression and anxiety in 114,629 pregnant women in the Norwegian Mother, Father, and Child Cohort study (1999-2008) before and after diagnosis of MS. Results revealed that WwMS diagnosed before pregnancy had an adjusted odds ratio of 2.0 (95% CI, 1.2-3.1) for depression in the third trimester, while the risk of anxiety was not increased.²

In the study, women with MS were identified from national health registries and hospital records and grouped into (1) MS diagnosed before pregnancy (n = 140) or MS diagnosed after pregnancy with (2) symptom onset before pregnancy (n = 98) or (3) symptom onset after pregnancy (n = 308). The reference group (n = 111,627) consisted of women without MS. All told, risk factors for depression included socioeconomic factors and history of psychiatric disease and physical/sexual abuse.

The analysis included a small group of women (n = 35) diagnosed with MS in the postpartum period. Similar to work by Bove et al, these women were at especially high risk of PPD. Women with MS symptom onset within 5 years after pregnancy had increased risk of both depression and anxiety during pregnancy, whereas women with more than 5 years until symptom onset did not.

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REFERENCES
1. Kim MJ, Balan A, Anderson A, et al. LBA10 - Prospective Ascertainment of Peri-Childbirth Depression and Its Relationship with Postpartum Inflammatory Activity in Women with MS. Presented at: 2025 CMSC Annual Meeting; May 28-31; Phoenix, Arizona. LBA10.
2. Eid K, Torkildsen OF, Aarseth J, et al. Perinatal Depression and Anxiety in Women With Multiple Sclerosis: A Population-Based Cohort Study. Neurology. 2021;96(23):e2789-e2800. doi:10.1212/WNL.0000000000012062