Depression during pregnancy linked to elevated risk for heart disease
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Key takeaways:
- Perinatal depression was associated with elevated risk for CVD.
- The link was strongest for high BP, ischemic heart disease and HF and remained after adjusting for genetic and environmental factors.
Depressive symptoms during pregnancy may indicate elevated cardiovascular risk for women, especially hypertension, ischemic heart disease and heart failure, according to a study published in the European Heart Journal.
“Our research group has already found that perinatal depression is linked to an increased risk of several other health issues, including premenstrual disorders, autoimmune disorders and suicidal behavior, as well as premature death,” Donghao Lu, MD, PhD, assistant professor in the unit of integrative epidemiology at the Institute of Environmental Medicine at Karolinska Institutet in Stockholm, said in a press release. “Cardiovascular disease is one of the leading causes of death globally and there has been an ongoing discussion about including reproductive health when assessing the risk among women. We wanted to know if a history of perinatal depression could help predict cardiovascular disease risk.”
To better understand long-term CVD risk after perinatal depression, Lu and colleagues utilized the Swedish Medical Birth Register to identify 878,595 women with more than 1.3 million pregnancies who gave birth from 2001 to 2014 in Sweden. Overall, 55,539 women diagnosed with perinatal depression were individually matched to 545,567 women without perinatal depression based on age and year of conception/delivery and followed up through 2020.
The average age at perinatal depression diagnosis was 30.8 years.
Perinatal depression and CV risk
Compared with matched women without perinatal depression, women with perinatal depression were more likely to be born in Sweden, to be married, to have lower educational attainment, to smoke before pregnancy, to have a history of depression and to deliver preterm or by cesarean section, according to the study.
The outcome of first-ever CVD was defined as any CVD including hypertension, ischemic heart disease, cerebrovascular disease, emboli and thrombosis, HF and arrhythmia.
Overall, 6.4% of women with perinatal depression developed CVD compared with 3.7% of unaffected women, translating to a 36% higher risk for developing CVD in women with perinatal depression (adjusted HR = 1.36; 95% CI, 1.31-1.42).
Among specific CVD subtypes, women with perinatal depression were observed to be at highest risk for hypertension (HR = 1.5; 95% CI, 1.41-1.6) followed by ischemic heart disease (HR = 1.37; 95% CI, 1.13-1.65) and HF (HR = 1.36, 95% CI, 1.06-1.74), according to the study.
To address unmeasured confounders such as genetic and environmental factors — childhood abuse, parental mental health and family stress — the researchers also conducted a sibling-matched cohort study of 14,446 women with perinatal depression who had at least one full and parous sister.
Compared with their sisters, women with perinatal depression had an approximately 20% higher risk for developing first-ever CVD (aHR = 1.2; 95% CI 1.07-1.34).
“The slightly lower difference in risk between sisters suggest that there could be genetic or familial factors partly involved,” Emma Bränn, PhD, postdoctoral researcher in the unit of integrative epidemiology at the Institute of Environmental Medicine at Karolinska Institutet, said in the release. “There could also be other factors involved, as is the case for the link between other forms of depression and cardiovascular disease. These include alterations in the immune system, oxidative stress and lifestyle changes implicated in major depression.
“It remains unclear how and through what pathways perinatal depression leads to cardiovascular disease,” Bränn said. “We need to do more research to understand this so that we can find the best ways to prevent depression and lower the risk of cardiovascular disease.”
Treating depression may have CV benefits
In a related editorial, Amani Meaidi, MD, PhD, of cancer surveillance and pharmacoepidemiology at the Danish Cancer Institute in Copenhagen, Denmark, discussed the importance of treatment of depressive symptoms during the perinatal period.
“Depression in general and cardiovascular disease are known to share genetic and pathogenic components such as inflammation, which potentially could explain the increased risk of cardiovascular disease observed among women diagnosed with perinatal depression in the current study,” Meaidi wrote. “Although signs of mood disturbances following childbirth have been noticed since the time of Hippocrates, it was not until last year, in 2023, that the [FDA] approved the first oral treatment for postpartum depression, making treatment much more accessible for the millions of women suffering from this condition. ... The future will reveal if proper perinatal depression therapy reduces the observed increased risk of developing cardiovascular morbidity.”
References:
- Meaidi A. Eur Heart J. 2024;doi:10.1093/eurheartj/ehae340.
- Women who experience depression during pregnancy or after birth have higher risk of cardiovascular disease. https://www.eurekalert.org/news-releases/1048278. Published June 18, 2024. Accessed June 20, 2024.
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