Association of Prenatal Depression With New Cardiovascular Disease Within 24 Months Postpartum

Abstract

Background Although depression is well established as an independent risk factor for cardiovascular disease (CVD) in the nonpregnant population, this association has largely not been investigated in pregnant populations. We aimed to estimate the cumulative risk of new CVD in the first 24 months postpartum among pregnant individuals diagnosed with prenatal depression compared with patients without depression diagnosed during pregnancy. Methods and Results Our longitudinal population-based study included pregnant individuals with deliveries during 2007 to 2019 in the Maine Health Data Organization's All Payer Claims Data. We excluded those with prepregnancy CVD, multifetal gestations, or no continuous health insurance during pregnancy. Prenatal depression and CVD (heart failure, ischemic heart disease, arrhythmia/cardiac arrest, cardiomyopathy, cerebrovascular disease, and chronic hypertension) were identified by International Classification of Diseases, Ninth Revision (ICD-9)/International Classification of Diseases, Tenth Revision (ICD-10) codes. Cox models were used to estimate hazard ratios (HRs), adjusting for potential confounding factors. Analyses were stratified by hypertensive disorder of pregnancy. A total of 119 422 pregnancies were examined. Pregnant individuals with prenatal depression had an increased risk of ischemic heart disease, arrhythmia/cardiac arrest, cardiomyopathy, and new hypertension (adjusted HR [aHR], 1.83 [95% CI, 1.20-2.80], aHR, 1.60 [95% CI, 1.10-2.31], aHR, 1.61 [95% CI, 1.15-2.24], and aHR, 1.32 [95% CI, 1.17-1.50], respectively). When the analyses were stratified by co-occurring hypertensive disorders of pregnancy, several of these associations persisted. Conclusions The cumulative risk of a new CVD diagnosis postpartum was elevated among individuals with prenatal depression and persists even in the absence of co-occurring hypertensive disorders of pregnancy. Further research to determine the causal pathway can inform postpartum CVD preventive measures.

Keywords: arrhythmia; cardiomyopathy; cerebrovascular disease; chronic hypertension; ischemic heart disease; postpartum screening; prenatal depression.

Figure 1. Analytic sample identification.

Figure 2. Weighted adjusted* cumulative hazard curves and 95% CI bands for new diagnosis of cardiovascular disease in the first 24 months postpartum among people with and without prenatal depression, deliveries in Maine from 2007 to 2019, n=119 422.

A, Heart failure. B, Ischemic heart disease. C, Cerebrovascular disease/stroke. D, Arrhythmia/cardiac arrest. E, Cardiomyopathy. F, Hypertension. G, Severe cardiac disease. ^* Adjusted for maternal age at time of delivery, prepregnancy depression, prepregnancy hypertension, prepregnancy diabetes, obesity, smoking, nulliparity, pregnancy number in data set, year of delivery, Medicaid coverage during pregnancy, county‐level measures, zip code–level measures, hypertensive disorders of pregnancy, and gestational diabetes.