Journal of the American Heart Association · 2025
Risk of Cardiovascular Events During Delivery Hospitalization Among Pregnant Patients With Mental Health Conditions.
СтатьяПоддержка NIH: внешняя программаНазвание и аннотация: Перевод в очереди
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Parekh Kavya, Waken R J, Avula Khavya, Nickel Katelin B, Lindley Kathryn J, Rogers Cynthia, Joynt Maddox Karen E
Аннотация
BACKGROUND: Cardiovascular disease remains the leading cause of maternal mortality. Mental health disorders are risk factors for cardiovascular disease in nonpregnant populations, but their association with delivery outcomes is unknown.
METHODS: This cross-sectional study used delivery hospitalizations from the 2021 National Inpatient Sample. We used generalized estimating equations to fit quasi-Poisson regression models for cardiovascular severe maternal morbidity and mortality (SMM) events as defined by the Centers for Disease Control and Prevention, and non-SMM cardiovascular conditions or complications as defined by the Alliance for Innovation on Maternal Health. Incidence rate ratios were calculated for depression, anxiety, psychosis, bipolar, obsessive-compulsive disorder, posttraumatic stress disorder, and other mental health conditions. Results were adjusted for clinical risk, social risk, and pregnancy characteristics, and clustered by hospital.
RESULTS: Of 667 502 delivery hospitalizations, 82 543 (12.4%) had a mental health diagnosis. Patients with mental health diagnoses were more likely to be White and from suburban areas. Overall, 791 (0.1%) patients had >1 SMM event and 9007 (1.3%) had a non-SMM cardiovascular condition or complication. Patients with mental health conditions had higher adjusted rates of cardiovascular SMM (adjusted incidence rate ratio, 2.36 [95% CI, 2.00-2.80], P<0.001) and other cardiovascular conditions and complications (adjusted incidence rate ratio, 1.94 [95% CI, 1.83-2.06], P<0.001). Stratifying by mental health conditions, depression, anxiety, and posttraumatic stress disorder were each associated with elevated rates of cardiovascular conditions and complications.
CONCLUSION: Mental health conditions may be risk factors for adverse cardiovascular events at the time of delivery. Future studies should aim to understand the physiological underpinnings of this relationship.
METHODS: This cross-sectional study used delivery hospitalizations from the 2021 National Inpatient Sample. We used generalized estimating equations to fit quasi-Poisson regression models for cardiovascular severe maternal morbidity and mortality (SMM) events as defined by the Centers for Disease Control and Prevention, and non-SMM cardiovascular conditions or complications as defined by the Alliance for Innovation on Maternal Health. Incidence rate ratios were calculated for depression, anxiety, psychosis, bipolar, obsessive-compulsive disorder, posttraumatic stress disorder, and other mental health conditions. Results were adjusted for clinical risk, social risk, and pregnancy characteristics, and clustered by hospital.
RESULTS: Of 667 502 delivery hospitalizations, 82 543 (12.4%) had a mental health diagnosis. Patients with mental health diagnoses were more likely to be White and from suburban areas. Overall, 791 (0.1%) patients had >1 SMM event and 9007 (1.3%) had a non-SMM cardiovascular condition or complication. Patients with mental health conditions had higher adjusted rates of cardiovascular SMM (adjusted incidence rate ratio, 2.36 [95% CI, 2.00-2.80], P<0.001) and other cardiovascular conditions and complications (adjusted incidence rate ratio, 1.94 [95% CI, 1.83-2.06], P<0.001). Stratifying by mental health conditions, depression, anxiety, and posttraumatic stress disorder were each associated with elevated rates of cardiovascular conditions and complications.
CONCLUSION: Mental health conditions may be risk factors for adverse cardiovascular events at the time of delivery. Future studies should aim to understand the physiological underpinnings of this relationship.