Prenatal Depression Linked to Increased Cardiovascular Risk Within First 2 Years After Delivery

Christina Ackerman-Banks, MD
Credit: American Heart Association

Prenatal depression could signal increased risk of cardiovascular disease within 2 years of delivery, according to a new study.¹

Results of the study, which included data from more than 119,000 pregnancies, indicate prenatal depression was associated with increases in risk of 30-83% for a slew of different forms of cardiovascular disease, including new hypertension, ischemic heart disease, cardiac arrest, and cardiomyopathy.¹

“We need to use pregnancy as a window to future health,” said lead investigator Christina M. Ackerman-Banks, MD, an assistant professor of obstetrics and gynecology-maternal fetal medicine at Baylor College of Medicine and Texas Children’s Hospital in Houston.² “Complications during pregnancy, including prenatal depression, impact long-term cardiovascular health. The postpartum period provides an opportunity to counsel and screen people for cardiovascular disease in order to prevent these outcomes.”

Despite the advances in modern medicine and improvements in access to care, maternal morbidity remains a leading cause of death among women in the US. Coupling known gaps in the cardiovascular care of women with the understanding of associations between depression and cardiovascular disease in nonpregnant populations, Ackerman-Banks and a team of colleagues sought to investigate the impact of depression as an independent risk factor for cardiovascular disease in pregnant populations.¹

With this in mind, investigators designed a longitudinal population-based study using data from Main Health Data Organization (MHDO)’s All Payer Claims Data. The MHDO is a state agency collecting health care data for research purposes, with claims data from both private and public insurers in Maine. Using 2007-2019 as a period of interest, investigators identified 119,422 pregnancies for inclusion in the study.¹

Among this cohort, the prevalence of prenatal depression 21.6% (n=25,837). Investigators pointed outline baseline characteristics were similar between the groups, with the exception of use of Medicaid insurance, prepregnancy depression, anxiety, and other characteristics commonly observed in patients with prenatal depression. Investigators also pointed out the cumulative risk of postpartum depression among the entire cohort was 29.0%. Among those without prenatal depression, the cumulative risk of postpartum depression was 22.5% compared to 75.2% among those with prenatal depression.¹

For the purpose of analysis, prenatal depression and cardiovascular disease were identified through ICD-9/10 codes. Cardiovascular disease outcomes of interest for the study were: heart failure, ischemic heart disease, arrhythmia/cardiac arrest, cardiomyopathy, cerebrovascular disease, and chronic hypertension. Investigators used Cox models with adjustment for potential confounding factors to estimate adjusted hazard ratios (aHRs) for each form of cardiovascular disease.¹

Upon analysis, results indicated the risk of cardiovascular disease within 2 years of delivery was significantly greater among those with prenatal depression. Specifically, those with prenatal depression had an 83% (aHR,1.83 [95, Confidence interval [CI], 1.20-2.80]), 60% (aHR, 1.60 [95% CI, 1.10-2.31]), 61% (aHR, 1.61 [95% CI, 1.15-2.24]), and 32% (aHR, 1.32 [95% CI, 1.17-1.50]) increase in relative risk of ischemic heart disease, arrhythmia/cardiac arrest, cardiomyopathy, and new hypertension, respectively. In a subgroup analysis excluding those with preeclampsia and gestational hypertension, results suggested those with prenatal depression had relative risk increase of 85% (aHR, 1.85 [95% CI, 1.26-2.72]), 84% (aHR, 1.84 [95% CI, 1.15-2.96]), 42% (aHR, 1.42 [95% CI, 1.09-1.86]), 53% (aHR, 1.02-2.31]), and 43% (aHR, 1.43 [95% CI, 1.22-1.66]) for arrhythmia/cardiac arrest, ischemic heart disease, stroke, cardiomyopathy, and new hypertension, respectively, when compared to their counters without prenatal depression.¹

“I recommend that anyone diagnosed with prenatal depression be aware of the implications on their long-term cardiovascular health, take steps to screen for other risk factors and consult with their primary care doctor in order to implement prevention strategies for cardiovascular disease,” Ackerman-Banks said.² “They should also be screened for Type 2 diabetes and high cholesterol, and implement an exercise regimen, healthy diet and quit smoking.”

References:

1. Ackerman-Banks CM, Lipkind HS, Palmsten K, Pfeiffer M, Gelsinger C, Ahrens KA. Association of Prenatal Depression With New Cardiovascular Disease Within 24 Months Postpartum [published online ahead of print, 2023 Apr 19]. J Am Heart Assoc. 2023;e028133. doi:10.1161/JAHA.122.028133
2. Prenatal depression may be linked to cardiovascular disease after childbirth. American Heart Association. https://newsroom.heart.org/news/prenatal-depression-may-be-linked-to-cardiovascular-disease-after-childbirth. Published April 19, 2022. Accessed April 27, 2023.