Daily Dose: Prenatal Depression & Risk of New CVD Postpartum

Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On April 19, 2023, we reported on a study published in the Journal of the American Heart Association that examined the association of prenatal depression with new cardiovascular disease (CVD) within 24 months postpartum.

The study

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.

The findings

Within the cohort, the prevalence of prenatal depression was 21.6%. 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).

Clinical implications

"In response to the American Heart Association's call to action to implement postpartum cardiovascular disease screening, all clinicians, including cardiologists, should consider reviewing a patient's pregnancy‐specific risk factors, including prenatal depression. Future prospective interventional studies are needed to examine possible pharmacotherapeutic and lifestyle interventions that can target comorbid prenatal depression and cardiovascular disease in the pregnant and postpartum population. A comprehensive understanding of all the pregnancy‐specific risk factors for cardiovascular disease is needed to reduce preventable pregnancy‐related morbidity and mortality attributable to cardiovascular disease."

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