The risk of cardiovascular disease (CVD) in middle adulthood is increased among women with perinatal depression (PND), according to a recent study published in the European Health Journal.1
Takeaways
- Women with perinatal depression (PND) have a 36% higher risk of developing cardiovascular disease (CVD) in mid-adulthood compared to those without PND.
- The risk is slightly higher in women with postpartum depression than those with antepartum depression, with hazard ratios of 1.42 and 1.29, respectively.
- The strongest link between PND and CVD is observed in women without psychiatric comorbidities, but significant risks are also noted in those with prior depression or psychiatric disorders.
- Women with gestational diabetes and PND have a notably higher risk of CVD, with a hazard ratio of 1.80 compared to 1.36 in those without gestational diabetes.
- PND is linked to all CVD subtypes, with hypertensive disease showing the highest hazard ratio of 1.50, followed by ischemic heart disease and heart failure.
Most research about CVD risk factors has prioritized a male population, leaving information about female-specific risk factors lacking. However, data has indicated an increased risk of future CVD from miscarriage, preterm birth, stillbirth, preeclampsia, and gestational diabetes.
CVD is the leading cause of death among women worldwide, and failure to recognize the prevalence and symptoms of heart disease in this population lead to delays in seeking care, including during cardiovascular emergencies.2 This indicates a need to shift perceptions toward cardiovascular health and apply evidence-based approaches.
Pregnancy complications are linked to perinatal mental health, but mental health factors are rarely considered when evaluating reproductive health history.1 Therefore, research is needed to determine the link between PND and subsequent CVD risk.
Investigators conducted a study to characterize CVD risk following PND. Pregnancies from 2001 to 2014 were identified from the Swedish Medical Birth Register, which included information on nearly all births in the country. Deaths and emigration during follow-up until 2014 were linked from the Cause of Death Register.1
First-ever PND was identified based on a depression diagnosis or antidepressant prescription between the estimated data of conception and 1 year postpartum. The date of conception was measured based on the year and month of delivery and estimated gestational length.
Each woman with antepartum depression (APD) was matched to 10 controls free of PND based on gestational age, while those with postpartum depression (PPD) were matched to women free of PND on the same postpartum day. Follow-up occurred until CVD diagnosis, emigration, death, or December 31, 2020.
PND was reported as APD when the first diagnosis or prescription occurred during pregnancy, while a PND recorded within 1 year following pregnancy was reported as PPD. CVD diagnoses were identified from the Swedish National Patient Register (NPR) or the Cause of Death Register in cases of death because of CVD.1
Covariates included country of birth, marital status, early pregnancy body mass index, smoking 3 months before pregnancy, pregestational and gestational diabetes, and preeclampsia. Psychiatric disorders before pregnancy were also reported.
Participants were aged a mean 30.8 years when diagnosed with PND. A PND diagnosis was more common in women who were born in Sweden, married, and with a lower education level. These women also more often smoked, had a history of depression, and delivered preterm or by cesarean section.1
A first diagnosis of CVD was observed in 3533 women with PND and 20,202 without PND across a median 10.4-year follow-up. Rates of CVD diagnosis were 6.1 per 1000 person-years and 3.6 per 1000 person-years, respectively, indicating a 36% increased risk of any CVD among women with PND vs those without PND.
The increased risk was less significant in patients with APD vs those with PPD, with hazard ratios (HRs) of 1.29 and 1.42, respectively. Women without psychiatric comorbidities had the strongest association between PND and CVD, but a higher risk was also reported among women with a prior depression or psychiatric disorders, with HRs of 1.72 and 1.82, respectively.1
An increased risk of CVD was observed in women with gestational diabetes, with an HR of 1.80 vs 1.36 among those without gestational diabetes. Similar results were found for age, body mass index, parity, calendar year, and smoking.
PND was linked to all CVD subtypes, with the highest HR of 1.50 found for hypertensive disease. This was followed by an HR of 1.37 for ischemic heart disease and 1.36 for heart failure. Ischemic heart disease and heart failure were more common in women with APD than those with PPD.
These results indicated an association between PND and CVD in mid-adulthood. Investigators concluded these findings support the discussion about considering reproductive history for CVD risk assessment in women.1
Reference
- Lu D, Valdimarsdóttir UA, Wei D, et al. Perinatal depression and risk of maternal cardiovascular disease: a Swedish nationwide study. European Heart Journal. 2024. doi:10.1093/eurheartj/ehae170
- Cardiology's problem women. The Lancet. 2019;393(10175):959. doi:10.1016/S0140-6736(19)30510-0
