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.

The Impact of Physical Activity and Inactivity on Cardiovascular Risk across Women’s Lifespan: An Updated Review

“…Finally, PA causes a decline in the odds and severity of maternal mental issues, i.e., anxiety and prenatal depression, related to an increased risk of new CVD within 24 months postpartum. Moreover, PA significantly improves the maternal quality of life, along with reduced stress and cortisol levels, both associated with lower maternal oxidative stress and a better long-term metabolic environment of the offspring [ 82 , 88 , 89 ]. Furthermore, PA improves fertility and assisted reproductive therapy outcomes, as well as metabolic profile in polycystic ovary syndrome, which is recognized as the leading cause of anovulatory infertility [ 90 , 91 ].…”

Maternal-Child Cardiovascular Health

“…In the first study, a systematic review study by Root and colleagues, 20 they explored the impact of mindfulness-based interventions during pregnancy on adverse pregnancy outcomes associated with future CVD risk, on both the mother and the child. The scientific premise for the review is that prenatal stress is associated with increased cardiovascular risk for mothers, as well as children, later in life [21][22][23] In the second study, Muchira and colleagues 24 explored the feasibility of evaluating cardiovascular health and risk factors in mother-child dyads, particularly focusing on arterial stiffness, BP, and ideal cardiovascular health metrics in mothers and their children aged 1 to 5 years. In their study, they used a mother-child approach to identify subclinical cardiovascular risk in young children, which is often challenging due to the difficulties in measuring traditional CVD risk factors in young children.…”

“…In the first study, a systematic review study by Root and colleagues, 20 they explored the impact of mindfulness-based interventions during pregnancy on adverse pregnancy outcomes associated with future CVD risk, on both the mother and the child. The scientific premise for the review is that prenatal stress is associated with increased cardiovascular risk for mothers, as well as children, later in life 21–23 and examines how mindfulness-based interventions might be used to alleviate prenatal stress. The mindfulness-based interventions interventions reviewed used a standard mindfulness-based stress reduction curriculum, incorporating activities such as cognitive therapy, mindful eating, yoga, or exercise interventions.…”