Perinatal Mood Symptoms Are Associated with Incident Cardiovascular Disease Among Women with Hospitalized Deliveries in California

Introduction: Chronic depression is a recognized risk factor for cardiovascular disease (CVD) in both women and men. However, it is uncertain whether perinatal mood disorders are also associated with CVD. In this study, we assessed whether perinatal mood symptoms are associated with an increased risk of CVD (myocardial infarction [MI], heart failure [HF], stroke) and examined effect modification by race/ethnicity. Materials and Methods: We analyzed statewide data from women aged 18 years and older with a hospitalized delivery in California, 2005–2015. Women with prior CVD, congenital heart disease, or prior depression were excluded. Results: Among 2,758,572 women, 64,094 (2.3%) had a documented diagnosis of perinatal mood symptoms. Perinatal mood symptoms were positively associated with CVD in models adjusted for other CVD risk factors (hazard ratio [HR]: 2.47, 95% confidence interval [CI]: 2.26–2.69). The mean time-to-event for CVD was 6.4 years. Black women had the highest incidence of CVD. In a stratified analysis by race/ethnicity, the effect of perinatal mood symptoms on the hazards of developing HF was highest among Hispanic women (HR: 3.21, 95% CI: 2.61–3.94) and lowest among Black women (HR: 1.80, 95% CI: 1.46–2.22). Conclusions: In a large, diverse cohort of previously pregnant women, perinatal mood symptoms were associated with an increased risk of CVD after adjustment for other CVD risk factors. This study supports the need for adequate screening for and treatment of perinatal depression and other mood disorders, awareness around the increased future CVD risk among women with perinatal mood symptoms, and understanding of underlying mechanisms.