Perinatal depression linked to higher long-term cardiovascular disease risk in women

Women diagnosed with perinatal depression are more likely to develop cardiovascular disease in the following 20 years compared to women who have given birth without experiencing perinatal depression, according to research published in the European Heart Journal today (Wednesday).

Perinatal depression, meaning depression during pregnancy or after birth is believed to affect one in five women giving birth worldwide.

The study is the first of its kind to look at cardiovascular health after perinatal depression and included data on around 600,000 women. It found the strongest links with risks of high blood pressure, ischemic heart disease and heart failure.

The research was by Dr. Emma Bränn, Dr Donghao Lu and colleagues from the Karolinska Institutet, Stockholm, Sweden.

Our research group has already found that perinatal depression is linked to an increased risk of several other health issues, including premenstrual disorders, autoimmune disorders and suicidal behavior, as well as premature death.

Cardiovascular disease is one of the leading causes of death globally and there has been an ongoing discussion about including reproductive health when assessing the risk among women. We wanted to know if a history of perinatal depression could help predict cardiovascular disease risk."

Dr. Emma Bränn, Karolinska Institutet, Stockholm, Sweden

The study was based on the Swedish Medical Birth Register, 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 that time but were not diagnosed with perinatal depression. All the women were followed up through to 2020 to assess if they developed any cardiovascular disease.

Among the women with perinatal depression, 6.4% developed cardiovascular disease compared to 3.7% of women who had not suffered with perinatal depression. This equates to a 36% higher risk of developing cardiovascular disease. Their risk of high blood pressure was around 50% higher, the risk of ischemic heart disease around 37% higher, and the risk of heart failure around 36% higher.

Dr. Bränn, the senior author, said: "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. This study also adds to the established health risks of perinatal depression. 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. 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.

Researchers also compared the women who suffered perinatal depression with their sisters and found they had a 20% higher risk of cardiovascular disease.

"The slightly lower difference in risk between sisters suggest that there could be genetic or familial factors partly involved," Dr 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."

In an accompanying editorial Dr. Amani Meaidi from the Danish Cancer Society: Kraeftens Bekaempelse, Copenhagen, Denmark said: "Although signs of mood disturbances following childbirth have been noticed since the time of Hippocrates, it was not until last year, in 2023, that the US Food and Drug Administration approved the first oral treatment for postpartum depression, making treatment much more accessible for the millions of women suffering from this condition. The late and lack of development of effective, safe, and accessible treatment options for perinatal depression is unmistakably a manifestation of the historical neglect of women's health in medical research. The future will reveal if proper perinatal depression therapy reduces the observed increased risk of developing cardiovascular morbidity.

"Considering the rise in perinatal depression and the lack of knowledge on cardiovascular disease in women, the study by Bränn and colleagues is much needed and welcomed."