(696) Association between prenatal depression and new cardiovascular disease within 24 months’ postpartum

While it is well established that depression is an independent risk factor for cardiovascular disease (CVD) and even sudden cardiac death in the non-pregnant population, this association has not been explored in the pregnant population. We aimed to estimate the cumulative risk of new CVD in the first 24 months’ postpartum among patients with prenatal depression (PPD) compared with patients without depression during pregnancy.

Study Design:

Our longitudinal population-based study included pregnant individuals with deliveries during 2007-2019 in the Maine Health Data Organization’s All Payer Claims Data. We excluded those with pre-existing CVD, multifetal gestations, or no continuous insurance during pregnancy. PPD and CVD (categorized by specific condition: heart failure, ischemic heart disease, arrhythmia/cardiac arrest, cardiomyopathy, cerebrovascular disease/stroke, and chronic hypertension (HTN)) was identified by ICD9/10 codes. Cox models were used to estimate hazard ratios, adjusting for potential confounding factors. Analyses were stratified by hypertensive disorder of pregnancy (HDP).

Results:

Of the 123,125 pregnancies examined (Table 1), the cumulative risk of new CVD within 24 months’ postpartum were 0.2% for heart failure, ischemic heart disease, and arrhythmia/cardiac arrest (respectively); 0.3% for cardiomyopathy; 0.7% for cerebrovascular disease/stroke; and 2.1% for HTN. Adjusted hazard ratios for new CVD within the first 24 months’ postpartum among those with PPD were 26% to 78% higher than among those without PPD (Table 2). Statistically significant associations persisted after the analysis was stratified by HDP vs non-HDP. In the non-HDP group, those with PPD had increased risk for HTN, cardiomyopathy, and ischemic heart disease (aHR 1.45 (95% CI 1.24-1.68), aHR 1.53 (95% CI 1.02-2.31), and aHR 1.68 (95% CI 1.03-2.74), respectively).

Conclusion: The cumulative risk of new CVD postpartum was significantly elevated among patients with PPD and persists even in the absence of co-occurring HDP. Further research to determine the causal pathway can inform postpartum CVD preventive measures.