Pre-pregnancy cardiac status impacts risk of postpartum mood and anxiety disorders

Abstract

Objective: Our study aimed to assess whether maternal cardiac disease is an independent risk factor for postpartum mood and anxiety disorders (PPMADs) and whether higher cardiac risk scores are associated with higher risk of PPMAD. Methods: This was a retrospective matched cohort study of patients who delivered between June 2019 and February 2024 and completed PPMAD screening at a tertiary care institution. The cardiac cohort was managed by a multidisciplinary cardio-obstetrics team, and the non-cardiac cohort was identified through matching on important demographic factors. The primary outcome was a positive PPMAD screen, defined as Patient Health Questionnaire-9 (PHQ-9) or General Anxiety Disorder-7 (GAD-7) score ≥10. Relative risks (RRs) for positive PPMAD screen were obtained using binomial regression. Results: The prevalence of positive PPMAD screening was 18.2% (27/148) in the cardiac cohort and 16.2% (24/148) in the non-cardiac cohort. Cardiac disease alone did not increase risk of positive PPMAD screening (RR 1.13, 95% confidence interval (CI) 0.68–1.86). New York Heart Association class ≥ II (RR 3.12, 95% CI 1.80–5.41) and pre-pregnancy diuretic use (RR 2.98, 95% CI 1.08–8.20) were associated with increased PPMAD. Other factors that increased PPMAD risk included being from a neighborhood with greater socioeconomic disadvantage (RR 1.18, 95% CI 1.03–1.34), unplanned pregnancy (RR 2.42, 95% CI 1.46–4.0), history of antidepressant use (RR 2.19, 95% CI 1.33–3.61), and history of interpersonal violence (RR 3.05, 95% CI 1.72–5.4). Adverse pregnancy outcomes, such as hypertensive disorders of pregnancy (RR 2.60, 95% CI 1.59–4.27), peripartum transfusion (RR 2.61, 95% CI 1.39–4.9), and preterm birth (RR 2.00, 95% CI 1.09–5.43) were also associated with positive PPMAD screening. Conclusions: Cardiac disease alone was not independently associated with positive PPMAD screening, while poorly optimized cardiac status, social history, and adverse pregnancy outcomes were. Our findings stress the importance of optimizing early cardiac status and providing full-scope prenatal care to patients with cardiac disease to reduce PPMAD risk.