Perinatal Depression Tied to Increased Risk of Midlife Cardiovascular Disease

Women with perinatal depression (PND) had a higher risk of cardiovascular disease (CVD) in middle adulthood than matched parous women without PND, a Swedish nationwide study found.

Over a mean of 10.4 years, women with PND had a 36% higher risk of developing CVD compared with unaffected women (6.4% vs 3.7%, respectively, adjusted HR 1.36, 95% CI 1.31-1.42), reported Emma Bränn, PhD, of the Karolinska Institutet in Stockholm, Sweden, and colleagues.

This association was seen across all CVD subtypes but was most pronounced with hypertensive disease (HR 1.50, 95% CI 1.41-1.60), ischemic heart disease (HR 1.37, 95% CI 1.13-1.65), and heart failure (HR 1.36, 95% CI 1.06-1.74), they wrote in the European Heart Journal.

“Our findings may help healthcare providers to identify high-risk individuals and predict CVD development for early detection and intervention,” Bränn told MedPage Today.

Additionally, when compared with their sisters who also had given birth, women with PND still had a 20% higher risk of CVD (adjusted HR 1.20, 95% CI 1.07–1.34).

“The attenuated association noted in the sibling comparison suggests a sizable contribution of familial factors … to the observed association, although they cannot completely explain the association,” Bränn said.

CVD research has historically focused on male populations, leading to the identification of risk factors important for men, like hyperlipidemia, obesity, diabetes, and smoking, though these factors are also associated with CVD risk in women, the researchers noted. Research about women’s cardiovascular health has increased significantly during the past decades, but risk factors for CVD specific to females remain understudied.

Previous research has shown that reproductive history — like preeclampsia, morning sickness, and birth control use — informs future risk of CVD, so researchers sought to characterize and assess the risk of CVD following PND.

In an accompanying editorial, Amani Meaidi, MD, PhD, of the Danish Cancer Institute in Copenhagen, Denmark, pointed out that postpartum depression affects approximately 17% of women who give birth, yet the first pill for treating postpartum depression was just approved by the FDA last year, indicating “the historical neglect of women’s health in medical research.”

She also noted the study was well conducted and adjusted for several known risk factors, like body mass index and smoking. “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,” she wrote.

In this nationwide population-based matched cohort study, 55,539 women who were diagnosed with PND in Sweden from 2001 to 2014 were each matched with 10 unaffected women (n=545,567). Women were matched on age and year of conception and delivery and followed until 2020. Both PND and CVD were determined by data in the Swedish national health register. Researchers defined PND as a depression diagnosis or as a filled prescription of antidepressants.

Researchers also included a sibling-matched cohort of 13,804 women with PND and their 16,420 unaffected sisters.

The average age of PND diagnosis was 30.8. Women with PND were more likely to be born in Sweden, married, and have a history of depression compared with women who did not have PND.

Authors noted several limitations, including that they couldn’t ascertain PND diagnosis after 2014 or those from primary care that didn’t result in prescription antidepressants, or from women who didn’t seek healthcare for this reason. Antidepressants can be prescribed for other reasons than depression, they acknowledged. There also was a risk of misclassifying CVD. The mean participant age was 41 at the end of follow-up, which is before peak CVD. The authors said future research should follow-up later into adulthood, and Bränn also noted that the team wants to identify risk windows for PND.