Perinatal depression linked to heart disease risk

Women diagnosed with depression either during pregnancy or after giving birth have a higher risk of heart problems later in life, a new study shows.

Those diagnosed with perinatal depression – which includes postnatal depression and antenatal depression – appear to be at higher risk of heart problems including high blood pressure, heart disease and heart failure for up to 20 years afterwards.

The Swedish study, published in the European Heart Journal, examined data on almost 56,000 women diagnosed with perinatal depression between 2001 and 2014. The data was drawn from the Swedish Medical Birth Register and covered women who gave birth during 2001–2014.

This data was matched to almost 546,000 women who had babies during the same time period who were not diagnosed with perinatal depression. Both affected and unaffected women were individually matched on age and year of conception or delivery. All women were followed up to 2020.

The association between perinatal depression and long-term cardiovascular disease risk was determined after adjusting for potential confounding factors, including demographic characteristics, smoking habits, body mass index (BMI), presence of preeclampsia, diabetes, or other psychiatric disorders, and adverse pregnancy outcomes.

Of the women with perinatal depression, 6.4% were diagnosed with cardiovascular disease during the follow up, compared to 3.7% of those who were not diagnosed with depression.

The researchers found that women diagnosed with antenatal depression had a 29% increased risk, while those diagnosed with postnatal depression had a 42% increased risk. The highest risk of cardiovascular disease was observed in women who were diagnosed with perinatal depression between four and six months after giving birth.

The results were “most pronounced” in women who had not suffered depression before pregnancy, the authors said.

They elevated risk was present for all types of cardiovascular disease. The researchers drew particular attention to the increased risk of women developing ischemic heart disease, heart failure and high blood pressure.

“Our findings may help identify people who are at a higher risk of cardiovascular disease so that steps can be taken to reduce this risk,” said Dr Emma Bränn, from the Karolinska Institutet, Stockholm.

“We know that perinatal depression is both preventable and treatable, and for many people it’s the first episode of depression they’ve ever experienced,” she added.

“Our findings provide more reason for ensuring maternal care is holistic, with equal attention on both physical and mental health. It remains unclear how and through what pathways perinatal depression leads to cardiovascular disease. 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.”

Lower difference in risk between sisters

The researchers also analysed data on sisters, where available, and found that the increased risk of developing cardiovascular disease remained in the sister who experienced perinatal depression compared to the sister who had not experienced perinatal depression.

Women who suffered perinatal depression had a 20% higher risk of heart disease compared to their sisters.

“The slightly lower difference in risk between sisters suggest that there could be genetic or familial factors partly involved,” Bränn said.

“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.”

One of the possible limitations of the study is that it could not include perinatal depression diagnosed after 2014, perinatal depression diagnosed in primary care without prescription of antidepressants, and women with perinatal depression symptoms who did not seek help from the health care system. The researchers might therefore have missed some women with perinatal depression.

The authors conclude that women with postnatal depression “are at higher risk of CVD in middle adulthood” and that “reproductive history, including PND, should be considered in CVD risk assessments of women.”