title: A longitudinal study of hypomania and depression symptoms in pregnancy and the postpartum period.
abstract: OBJECTIVE
  Childbirth is a potent precipitant of severe episodes of bipolar disorder. We investigate mood longitudinally through pregnancy and the postpartum period, using the Highs Scale and the Edinburgh Postnatal Depression Scale (EPDS), to examine if the postpartum period is a time of increased risk for hypomanic symptoms in the general population.
  
  
  METHODS
  A total of 446 women were recruited at 12 weeks of pregnancy from the Birmingham Women's Hospital and four midwife-led community clinics. Women completed the Highs Scale and the Edinburgh Postnatal Depression Scale at 12 weeks of pregnancy, one week postpartum, and eight weeks postpartum.
  
  
  RESULTS
  Cases of probable depression, as defined by an EPDS score of 13 or greater, did not significantly increase from pregnancy to the postpartum period. The prevalence of 'the highs' was eightfold higher in the postpartum week than during pregnancy.
  
  
  CONCLUSIONS
  Consistent with the increased rates of severe manic illness following childbirth, we find that more minor hypomanic states are also increased. We consider the clinical relevance of postpartum hypomanic symptoms and the implications of these findings for research into postpartum-onset mood symptoms.
authors.affiliation: Perinatal Research Programme, Birmingham and Solihull Mental Health NHS Foundation Trust, The Barberry, 25 Vincent Drive, Birmingham B15 2FG, UK. j.c.heron@bham.ac.uk
authors.forename: Jessica
authors.initials: J
authors.lastname: Heron
authors.forename: Sayeed
authors.initials: S
authors.lastname: Haque
authors.forename: Femi
authors.initials: F
authors.lastname: Oyebode
authors.forename: Nick
authors.initials: N
authors.lastname: Craddock
authors.forename: Ian
authors.initials: I
authors.lastname: Jones
mesh_terms: D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000503:physiopathology*; D016001:Confidence Intervals; D003863:Depression / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D009034:Mother-Child Relations; D049590:Postpartum Period / Q000502:physiology*; D011247:Pregnancy / Q000502:physiology*; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D055815:Young Adult