medwireNews: Women with perinatal depression (PND) have a significant 36% higher risk for developing cardiovascular diseases (CVD) in later life than those without PND, suggests an observational study published in the European Heart Journal.
PND was significantly associated with all subtypes of CVD studied, with the highest increased risks seen for hypertension (50%), ischemic heart disease (37%), and heart failure (36%). Additionally, PND was associated with subsequent development of CVD in women with no history of any other psychiatric disorders including depression.
“[O]ur findings lend support to the ongoing discussion on factoring in reproductive history, including PND, for CVD risk assessment and prediction in women,” say Emma Bränn (Karolinska Institutet, Stockholm, Sweden) and co-investigators.
The findings came from a matched cohort study undertaken by Bränn and colleagues, who used data from the Swedish Medical Birth Register and the Swedish National Patient Register to identify 55,539 women with a first-ever diagnosis of PND who gave birth between 2001 and 2014, including 23,871 with antepartum depression (APD) and 31,668 with postpartum depression (PPD). They were matched for age and year of delivery with 545,567 women who did not have PND.
PND was defined as a diagnosis of depression or an antidepressant prescription recorded during pregnancy or up to 1 year after birth, and the mean age of women at their PND diagnosis was 30.8 years.
All the participants were followed up until a diagnosis of CVD, emigration, death, or the last day of 2020. Analyses were adjusted for several confounders, including age, income, smoking before pregnancy, BMI, diabetes, preeclampsia, and history of depressive disorders.
After a mean follow-up of 10.4 years (up to a maximum of 20 years), a first diagnosis of any CVD was recorded in 3533 women with PND (6.1 per 1000 person–years) and 20,202 women without PND (3.6 per 1000 person–years), translating to a 36% higher risk for women with PND than those without. The risk was higher for women with PPD than for those with APD, at 42% versus 29%, suggesting “separate trajectories of CVD development depending on the timing of PND onset,” say the researchers.
When the researchers looked at the women’s psychiatric history, they found that the association between PND and subsequent CVD was strongest in women with no psychiatric comorbidities, who had a significant 43% increased risk, compared with women without PND or a history of psychiatric comorbidity. This was similar to the significant 62% increased risk seen in women who had a history of major depression but not PND, the researchers note.
In a linked editorial, Amani Meaidi (Danish Cancer Institute, Copenhagen) said that this finding underlies “the importance of detection and treatment of any depression in women and not only depression diagnosed perinatally.”
When Bränn et al compared 13,804 women with PND with their 16,420 unaffected sisters, the risk for CVD with PND was attenuated but still a significant 20% higher, which they say “suggests a sizable contribution of familial factors (eg, genetics or early environmental factors) to the observed association although they cannot completely explain the association.”
Editorialist Meaidi welcomes the study by Bränn and colleagues, given “the rise in perinatal depression and the lack of knowledge on cardiovascular disease in women.” She suggests that shared genetic and pathogenic components between depression and CVD such as inflammation may underlie the increased risk of subsequent CVD in women diagnosed with PND.
Future studies will reveal whether "proper perinatal depression therapy reduces the observed increased risk of developing cardiovascular morbidity,” Meaidi concludes.
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Eur Heart J 2024; doi:10.1093/eurheartj/ehae170
Eur Heart J 2024; doi:10.1093/eurheartj/ehae340
