Epidemiology
Poster Session 1
.jpeg.jpg "Christina M. Ackerman-Banks, BA, MD photo")
Christina M. Ackerman-Banks, BA, MD
Assistant Professor
Baylor College of Medicine
Houston, TX, United States
Kristin Palmsten, ScD, DSc
Health Partners Institute
Health Partners Institute, MN, United States
Heather S. Lipkind, MD, MS
Weill Cornell
New York, NY, United States
Katherine Ahrens, MPH, PhD
Assistant Research Professor
Muskie School of Public Health, ME, United States
Prenatal depression is associated with an increased risk of new cardiovascular disease (CVD). However, It is unclear how treatment of prenatal depression impacts CVD risk. We sought to determine if treatment of prenatal depression reduces the risk of new CVD within 24 months postpartum.
Study Design:
Our longitudinal population-based study included pregnant individuals with deliveries in the Maine Health Data Organization's All Payer Claims Data, 2007-2019. We excluded those with pre-pregnancy CVD, multifetal gestations, or no continuous health insurance during pregnancy. Prenatal depression was identified with ICD9/10 diagnosis codes, psychotherapy was identified with CPT procedure codes, and antidepressant medications were identified from pharmacy dispensing data. All were identified using claims with service dates between 6 and 34 weeks' gestation. Primary outcomes were a composite CVD outcome (heart failure, ischemic heart disease, cerebrovascular disease, arrythmia/cardiac arrest, and cardiomyopathy) and new chronic hypertension (cHTN). Cox models were used to estimate hazard ratios, adjusting for potential confounding factors. Censoring events were loss of health insurance or next pregnancy, whichever was earlier.
Results:
Of the 15,895 pregnancies with prenatal depression, 54% (n=8517) had antidepressants or psychotherapy visits (34% had antidepressants and 30% had psychotherapy). The cumulative risk of the composite CVD outcome and new cHTN within 24 months postpartum was 1.9% and 3.3%, respectively. Antidepressant medications and/or psychotherapy visits were associated with a decreased risk of the composite CVD outcome (aHR 0.73 [95% CI 0.56-0.96]). (Figure) The risk of new cHTN within 24 months postpartum was not impacted (aHR 1.04 [95% CI 0.83-1.32]).
Conclusion:
The cumulative risk of new cardiovascular disease within 24 months postpartum was decreased in patients with antidepressant and/or psychotherapy use. This association requires further exploration, but suggests that prioritizing treatment of prenatal depression both improves mood and mitigates cardiovascular disease risk.