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Mood instability during pregnancy and postpartum: a systematic review

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Abstract

Perinatal mood instability (MI) is a common clinical observation in perinatal women, and existing research indicates that MI is strongly associated with a variety of mental disorders. The purpose of this study is to review the evidence of perinatal MI systematically, with a focus on perinatal MI, its relation to perinatal depression, and its effects on children. A systematic search of the literature using PRISMA guidelines was conducted on seven academic health databases to identify any peer-reviewed articles published in English from 1985 to July 2017. Studies were screened, data were extracted, and quality of the selected studies was assessed. A total of 1927 abstracts were returned from the search, with 1063 remaining for abstract screening after duplicate removal, and 4 quantitative studies were selected for final analysis. The selected studies addressed perinatal MI (n = 2), the relation of perinatal MI to perinatal depression (n = 1), and the effects of perinatal MI on children (n = 1). The selected studies identified that perinatal women experienced a significantly higher level of MI than non-perinatal women, MI is a prominent feature in perinatal women with and without depression, mood lability during the early postpartum predicts psychopathology up to 14 months postpartum, and maternal emotion dysregulation, rather than maternal psychopathology, increases the risk of heightened facial affect synchrony in mother-infant interaction. The study reveals a significant gap in the literature of perinatal MI.

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Authors and Affiliations

  1. College of Nursing, University of Saskatchewan, Health Sciences Building, E-Wing, Room 4248, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada

    Hua Li

  2. College of Nursing, University of Saskatchewan, Health Sciences Building, E-Wing, Room 4246, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada

    Angela Bowen

  3. College of Medicine, University of Saskatchewan, Ellis Hall, RUH, Room 112, Saskatoon, SK, S7N 0W8, Canada

    Rudy Bowen

  4. College of Medicine, University of Saskatchewan, Ellis Hall, RUH, Room 104, Saskatoon, SK, S7N 0W8, Canada

    Lloyd Balbuena

  5. School of Public Health, University of Saskatchewan, Health Sciences Building, E-Wing, Room 3338, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada

    Cindy Feng

  6. College of Nursing, University of Saskatchewan, Health Sciences Building, E-Wing, Room 4348, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada

    Jill Bally

  7. Department of Community Health and Epidemiology, University of Saskatchewan, Health Sciences Building, E-Wing, Room 3246, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada

    Nazeem Muhajarine

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  1. Hua Li
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  2. Angela Bowen
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Correspondence to Hua Li.

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The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

This systematic review included studies that involved human participants.

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All reviewed studies obtained informed consent from participants.

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Appendix. Search strategy

Appendix. Search strategy

Search strategy

Database search

A systematic search for recent literature relevant to perinatal mood instability (MI) was conducted by a health sciences librarian and a PhD student.

List of databases searched

Seven databases were searched: Cumulative Index to Nursing and Allied Health (CINAHL), Cochrane Library (Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials), Embase, PubMed, MEDLINE, PsychINFO, and Scopus.

Research question

What is the state of the literature related to perinatal MI, its relation to perinatal depression, and its effects on children?

Inclusion criteria

The following criteria were used to guide the search:

  • A primary focus of the article is on the topic area: MI in pregnant women or women with a newborn or infant less than 24 months, MI in relation to perinatal mood disturbances, and effects of perinatal MI on children

  • Study methodology limited to all types of primary studies: quantitative, qualitative, mixed methods, and reviews

  • Published between January 1985 and July 2017

  • Published in English

  • Accessible for retrieval

Exclusion criteria

The following criteria were used to exclude literature from the search:

  • Topic not related to perinatal MI or in relation to perinatal MI (e.g., antennal and postpartum depression, and antenatal and postpartum anxiety only).

  • Dissertations, commentaries, narrative, anecdotal articles, letters to the editor, editorials, expert reports, consensus documents, and discussion papers

  • Non-English studies

  • Unpublished (e.g., gray literature)

  • Studies involving animals

  • Articles focusing only on antenatal and postpartum depression, and antenatal and postpartum anxiety

Table 2 Search terms
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Li, H., Bowen, A., Bowen, R. et al. Mood instability during pregnancy and postpartum: a systematic review. Arch Womens Ment Health 23, 29–41 (2020). https://doi.org/10.1007/s00737-019-00956-6

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