Prenatal Depression Associated with New CVD Diagnosis Postpartum, According to New Data

Pregnant individuals with a diagnosis of prenatal depression are more likely to be diagnosed with new cardiovascular disease (CVD) in the 24 months after delivery, even without co-occurring hypertensive disorders of pregnancy, according to new research published in the Journal of the American Heart Association.

In a study of more than 100 000 pregnant persons in the US, prenatal depression was most strongly associated with ischemic heart disease (IHD), with persons with prenatal depression having an 83% higher risk of developing IHD than those without a diagnosis of prenatal depression.

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

In a longitudinal, population-based study, researchers analyzed data from 119 422 pregnant persons with deliveries between 2007 and 2019, using the Maine Health Data Organization’s All Payer Claims Data.

Patients with prepregnancy CVD, multifetal gestations, or no continuous health insurance during pregnancy were excluded. Ackerman-Banks and colleagues assessed associations between prenatal depression and CVD, including heart failure (HF), IHD, arrhythmia/cardiac arrest, cardiomyopathy, cerebrovascular disease, and chronic hypertension (HTN). Analyses were stratified by hypertensive disorder of pregnancy status.

Findings

Within the cohort, the prevalence of prenatal depression was 21.6%, according to the study. The cumulative risks for new diagnoses for CVD in the first 24 months postpartum were 0.2% for HF, IHD, cardiomyopathy, and arrhythmia; 0.5% for stroke; and 2.1% for HTN. The cumulative risk for severe cardiac disease—defined for the purpose of the study as a composite of HF, stroke, or cardiomyopathy—was 0.8%.

Researchers observed that pregnant persons with prenatal depression had an increased risk for IHD (adjusted HR [aHR] 1.83, 95% CI 1.2-2.8), as well as arrhythmia/cardiac arrest (aHR 1.6, 95% CI 1.1-2.31), cardiomyopathy (aHR 1.61, 95% CI 1.15-2.24), and HTN (aHR 1.32, 95% CI 1.17-1.5).

In analyses stratified by co-occurring hypertensive disorders of pregnancy, several associations persisted.

Investigators also noted that associations between prenatal depression and some CVD outcomes were attenuated after adjusting for anxiety during pregnancy, “suggesting that prenatal depression alone may not increase the risk for these CVD diagnoses.”

“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,” said Ackerman-Banks in the release. “They should also be screened for type 2 diabetes and high cholesterol and implement an exercise regimen, healthy diet and quit smoking.”

Reference: Ackerman-Banks CM, Lipkind HS, Palmsten K, et al. Association of prenatal depression with new cardiovascular disease within 24 months postpartum. J Am Heart Assoc. Published online April 19, 2023. doi:10.1161/JAHA.122.028133.