Mood disorders in pregnant women and future cardiovascular risk

BACKGROUND: The link between mood disorders and cardiovascular disease in women is unclear. We studied the association of mood disorders around pregnancy with the future risk of cardiovascular disease. METHODS: We analyzed a cohort of 1,028,109 women who were pregnant between 1989 and 2012 in Quebec, Canada. We identified women hospitalized for bipolar disorder or depression before, during, or in the 5 years after delivery, and tracked them over time to identify cardiovascular hospitalizations up to 23 years later. We calculated the incidence of cardiovascular hospitalization per 1,000 person-years, and used Cox regression to compute hazard ratios (HR) and 95% confidence intervals (CI) for the association with mood disorders. RESULTS: Incidence of cardiovascular events was higher for bipolar disorder (4.4 per 1,000 person-years) and depression (4.2 per 1,000) than no mental illness (1.8 per 1,000). Compared with no mental disorder, bipolar disorder was associated with 3.0 times the risk of cardiovascular disease (95% CI 1.92-4.73), and depression with 2.3 times the risk (95% CI 1.34-3.99). The risk of cardiovascular disease was elevated for bipolar hospitalization before pregnancy (HR 2.42, 95% CI 1.90-3.09), during pregnancy (HR 3.78, 95% CI 2.32-6.17), in the first year postpartum (HR 2.20, 95% CI 1.54-3.12), and 1-5 years postpartum (HR 2.42, 95% CI 2.04-2.86). Similar associations were found for depression. LIMITATIONS: We could only assess mood disorders that required hospitalization, and certain covariates might be underreported. CONCLUSIONS: Women with bipolar disorder or depression before, during, or after pregnancy may benefit from early prevention of cardiovascular disease.