Association of treatment for prenatal depression with cardiovascular disease within 24 months after delivery

While the strong association of prenatal depression with an increased risk of new cardiovascular disease (CVD) within 24 months postpartum has been demonstrated in two distinct cohorts, it is unclear if treatment of prenatal depression may mitigate this risk. We aimed to estimate the cumulative risk of new CVD and new chronic hypertension in the first 24 months postpartum among pregnant individuals with prenatal depression treated with antidepressant medications or psychotherapy compared with those with untreated prenatal depression. We hypothesized that treatment for prenatal depression may be associated with a lower risk of CVD postpartum among those with prenatal depression.

Our longitudinal population-based study included pregnant individuals with deliveries in the Maine Health Data Organization's All Payer Claims Data during 2007-2020. We excluded those individuals with any diagnosis before pregnancy of the cardiovascular conditions being examined postpartum, multifetal gestations, or no continuous health insurance during pregnancy. Prenatal depression, psychotherapy, and antidepressant medications were identified with ICD9/10 diagnosis codes, CPT codes, and pharmacy dispensing data, respectively. Primary outcomes were a dichotomous CVD composite (heart failure, ischemic heart disease, cerebrovascular disease, arrhythmia/cardiac arrest, cardiomyopathy) and chronic hypertension within 24 months postpartum. Adjusted Cox models were used to estimate hazard ratios.

Among the 17,100 pregnant individuals with depression included in our analysis (13.5% of 126,333 total eligible pregnancies), 50.0% (n = 8556) had treatment with antidepressants and/or psychotherapy visits. Among the 16,953 pregnant individuals with depression included in the composite CVD outcome analysis, treatment with antidepressant medication use and/or psychotherapy was associated with a 25% lower risk of CVD (adjusted hazard ratio [aHR],, 0.75; 95% confidence interval [CI], 0.57-0.98). However, among the 15,240 pregnant individuals with depression included in the new chronic hypertension outcome analysis, no association was observed (aHR, 1.05; 95% CI, 0.84-1.32).

The cumulative risk of new CVD within 24 months postpartum was significantly lower in patients with antidepressant and/or psychotherapy use during pregnancy compared to those with untreated prenatal depression. This suggests that treatment of prenatal depression may mitigate CVD risk; however, given the limitations of observational research, further study is warranted to elucidate the pathophysiologic mechanisms that underlie this association.