Women Who Suffer From Depression During Pregnancy or After Giving Birth have a Higher Risk of Cardiovascular Disease

Women diagnosed with perinatal depression have a higher risk of developing cardiovascular disease in the following 20 years than women who have given birth without experiencing perinatal depression. The study is the first of its kind to look at cardiovascular health after perinatal depression and includes data from around 600,000 women. It found the strongest associations with risk of hypertension, ischemic heart disease and heart failure. The study was published in the European Heart Journal. Perinatal depression, i.e. depression during pregnancy or after childbirth, is thought to affect one in five women who give birth worldwide.

The research was conducted by Dr. Emma Bränn, Dr. Donghao Lu and colleagues from the Karolinska Institutet in Stockholm, Sweden. The research group has previously found that perinatal depression is associated with an increased risk of several other health problems, including premenstrual disorders, autoimmune diseases and suicidality, as well as premature death.

How Perinatal Depression and Cardiovascular Disease are Linked

Cardiovascular disease is one of the leading causes of death worldwide, and there is an ongoing debate about the inclusion of reproductive health in risk assessment in women. The researchers wanted to know whether perinatal depression could predict the risk of cardiovascular disease. The study was based on the Swedish Medical Birth Registry, which records all births in the country. The researchers compared 55,539 Swedish women who were diagnosed with perinatal depression between 2001 and 2014 with another group of 545,567 Swedish women who had also given birth during this period but were not diagnosed with such depression. All women were followed up until 2020 to determine whether they developed cardiovascular disease.

Of the women with perinatal depression, 6.4% developed cardiovascular disease, compared to 3.7% of women who had not suffered from this type of depression. This corresponds to a 36% higher risk of developing cardiovascular disease. The risk of high blood pressure was about 50% higher, the risk of ischemic heart disease was 37% higher and the risk of heart failure was 36% higher.

According to Dr. Bränn, the lead author, their findings could help identify people who are at higher risk of cardiovascular disease so that measures can be taken to reduce this risk. This study also adds to the known health risks of perinatal depression. Perinatal depression is known to be both preventable and treatable, and for many people it is the first depression they have ever experienced. The findings are yet another reason to provide holistic care for mothers, taking into account both physical and mental health.

Changes in the Immune System, Oxidative Stress and Lifestyle Changes

It is still unclear how and through which pathways perinatal depression leads to cardiovascular disease. Therefore, more research is needed to understand this so that the best ways can be found to prevent depression and reduce the risk of cardiovascular disease.

The researchers also compared the women who suffered from perinatal depression with their sisters and found that they had a 20% higher risk of cardiovascular disease. According to the experts, the slightly lower difference in risk between the sisters suggests that genetic or familial factors could play a role. However, other factors could also play a role, as is the case with the link between other forms of depression and cardiovascular disease. These include changes in the immune system, oxidative stress and lifestyle changes that play a role in major depression.

In an accompanying editorial, Dr. Amani Meaidi of the Danish Cancer Society: Kraeftens Bekaempelse, Copenhagen, Denmark, explains: “Although signs of postpartum mood disorders have been known since Hippocrates, it was not until last year 2023 that the US Food and Drug Administration approved the first oral treatment for postpartum depression, making treatment much more accessible to the millions of women who suffer from this condition. The late and lack of development of effective, safe and accessible treatment options for perinatal depression is unmistakably a reflection of the historical neglect of women’s health in medical research. The future will show whether adequate treatment of perinatal depression will reduce the observed increased risk of developing cardiovascular morbidity.”