Risk of Post-Diagnosis Psychiatric Illnesses Following Gestational Trophoblastic Disease

INTRODUCTION: Despite the multifactorial stressors associated with gestational trophoblastic disease (GTD), this population has received limited attention from postpartum mental health research. Notably, in a small retrospective cohort study of patients with GTD, women reported emotional distress, anxiety, and depression related to diagnosis, treatment, and fertility concerns. Furthermore, postpartum psychiatric screening protocols, typically used for spontaneous abortion, term, uncomplicated deliveries, may overlook patients with GTD, creating a potential blind spot in clinical literature and detection. OBJECTIVE: This study evaluated the risk of post-diagnosis psychiatric illnesses in patients with gestational trophoblastic disease (GTD) compared to those experiencing spontaneous abortion (SAB), ectopic pregnancy, or uncomplicated term delivery. METHODS: The TriNetX Research Network (TriNetX, LLC, Cambridge, MA) is a large, retrospective database of de-identified electronic patient health records compiled in accordance with the HIPAA Privacy Rule. We used the US Collaborative Network, which includes 130,858,330 patients across 69 healthcare organizations. This data was used to evaluate 1-year psychiatric outcomes following GTD, SAB, ectopic pregnancy, or uncomplicated term delivery. Patients with a history of psychiatric diagnosis or medication use were excluded. Cohorts were balanced using propensity score matching (Figure 1). The primary outcome was new psychiatric diagnoses and psychiatric medications. Statistical analysis included percent risk difference (RD) and 95% confidence intervals for RD, with a P-value of <0.05 defining statistical significance (Figure 1). Methods seen in Figure 1 were performed for SAB and ectopic pregnancy. RESULTS: Compared to uncomplicated term delivery, GTD was associated with a significantly increased risk of depression (RD: 0.64, RR (risk ratio): 1.596, P=0.003, CI: 0.22, 1.05), psychiatric diagnoses (RD: 1.10, RR: 1.39, P=0.001, Cl: 0.46, 1.75), mood disorder (RD 1.13, RR: 1.52, P<0.001, Cl: 0.54, 1.71), and anxiety (RD 0.64, RR 1.42, P=0.009, 0.16, 1.11). Compared to SAB and ectopic pregnancy, GTD had no significant difference in risk of new psychiatric diagnoses or new psychiatric medications. CONCLUSIONS: Compared to uncomplicated term delivery, GTD is associated with a significantly increased risk of depression within 1 year. Compared to SAB or ectopic pregnancy, GTD had no difference in risk of depression. These findings highlight a vulnerable population. This may be due to GTD not being viewed as part of the delivery spectrum and therefore not meeting the criteria for PPD, although there may be a benefit to closer mental health follow-up.Figure 1Table 1