Women with adverse pregnancy outcomes such as hypertension, preeclampsia, diabetes, and preterm delivery are at significantly higher risk than women without these complications of developing early cardiovascular morbidity later in life. Depression is a neglected dimension of maternal morbidity and women with depression are 5 times as likely to progress from maternal morbidity (illness) to mortality (death). Depression is common, 8-13% of pregnant women are diagnosed with depression, and prenatal depression is associated with gestational diabetes, preeclampsia and low birth weight. A growing literature supports links between depression, anxiety and stress and cardiovascular disease (CVD) in older women. As you can see in #6, #10, #13, #15 and #17, all related to CVD below, it is important that women make efforts to reduce stress in their lives as early as possible!
In order to provide clinical cardiovascular screening and preventive care to women who had an adverse pregnancy outcome, we instituted a Postpartum Heart Health Program in January 2015 within the Barbra Streisand Women’s Heart Center (BSWHC). The clinic is tailored to offer a comprehensive cardiovascular risk screening and risk stratification to patients who had an adverse pregnancy outcome. The purpose of the practice is to screen women with adverse pregnancy outcomes for CVD, teach them about cardiovascular health, stress reduction, and offer annual follow-up if desired.
Minissian, M. B., Kilpatrick, S., Eastwood, J. A., Robbins, W. A., Accortt, E. E., Wei, J., & Merz, C. N. B. (2018). Association of spontaneous preterm delivery and future maternal cardiovascular disease. Circulation, 137(8), 865-871.
Fraser, A., Nelson, S. M., Macdonald-Wallis, C., Cherry, L., Butler, E., Sattar, N., & Lawlor, D. A. (2012). Associations of pregnancy complications with calculated CVD risk and cardiovascular risk factors in middle age: the Avon Longitudinal Study of Parents and Children. Circulation, CIRCULATIONAHA-111.
Rich-Edwards, J. W., Fraser, A., Lawlor, D. A., & Catov, J. M. (2014). Pregnancy characteristics and women's future cardiovascular health: an underused opportunity to improve women's health? Epidemiologic reviews,36(1), 57-70.
ACOG Task Force on Hypertension in Pregnancy. Hypertension in Pregnancy. Obstet Gynecol 2013; 122: 1122-31
Burt, V. K., & Stein, K. (2001). Epidemiology of depression throughout the female life cycle. The Journal of clinical psychiatry, 63, 9-15.
Kozhimannil, K. B., Pereira, M. A., & Harlow, B. L. (2009). Association between diabetes and perinatal depression among low-income mothers. Jama,301(8), 842-847.
Furuta, M., Sandall, J., Cooper, D., & Bick, D. (2014). The relationship between severe maternal morbidity and psychological health symptoms at 6–8 weeks postpartum: a prospective cohort study in one English maternity unit. BMC pregnancy and childbirth, 14(1), 133.
Hu, R., Li, Y., Zhang, Z., & Yan, W. (2015). Antenatal Depressive Symptoms and the Risk of Preeclampsia or Operative Deliveries: A Meta-Analysis. PloS one, 10(3).
Grote, NK, Bridge, JA, Gavin, AR, Melville, JL, Iyengar, S, Katon, WJ. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Archives of General Psychiatry. 2010; 67(10), 1012-1024. 23.
Accortt, E.E., Cheadle, A., & Dunkel Schetter, C. (2014). Prenatal depression and adverse birth outcomes; an updated systematic review. Maternal and child health journal, 19(6), 1306-1337
Chapman, D. P., Perry, G. S., & Strine, T. W. (2005). The vital link between chronic disease and depressive disorders. Prev Chronic Dis, 2(1), A14.
Vaccarino, V., Johnson, B. D., Sheps, D. S., Reis, S. E., Kelsey, S. F., Bittner, V., ... & Merz, C. N. B. (2007). Depression, inflammation, and incident cardiovascular disease in women with suspected coronary ischemia: the National Heart, Lung, and Blood Institute–sponsored WISE study. Journal of the American College of Cardiology, 50(21), 2044-2050.
Whang, W., Kubzansky, L. D., Kawachi, I., Rexrode, K. M., Kroenke, C. H., Glynn, R. J., ... & Albert, C. M. (2009). Depression and risk of sudden cardiac death and coronary heart disease in women: results from the Nurses' Health Study. Journal of the American College of Cardiology, 53(11), 950-958.
Jones DJ, Bromberger JT, Sutton-Tyrrell K, Matthews KA. Lifetime history of depression and carotid atherosclerosis in middle-aged women. Arch Gen Psychiatry 2003;60(2):153–60.
Baune, B. T., Stuart, M., Gilmour, A., Wersching, H., Heindel, W., Arolt, V., & Berger, K. (2012). The relationship between subtypes of depression and cardiovascular disease: a systematic review of biological models. Translational psychiatry, 2(3), e92.
Dr. Accortt in the News
9/11/18: USC Center for Health Journalism, Cedars-Sinai PPD Screening Program May be Model for State
Summer 2018: Cedars-Sinai Catalyst Magazine, The Helping Hand of Los Angeles Funds Postpartum Depression Screening Program, scroll down to page 40 of magazine
5/18/18: TODAY.com, Alyssa Milano on Postpartum Anxiety
5/3/18: Cedars-Sinai Maternal Mental Health Research
10/19/17: Cedars-Sinai Postpartum Depression Screening Program
3/24/17: MomCo. App for Social Support
Dr. Accortt is a California licensed clinical psychologist. When she isn't seeing patients in private practice she conducts research in the OBGYN department at Cedars-Sinai. She will update this page with important maternal mental health news and research.