Abstract
Purpose
The association between pregnancy characteristics and risk of depression in women is poorly understood. We investigated the relationship between preeclampsia and risk of hospitalization for depression over three decades.
Methods
We carried out a longitudinal cohort study of 1,210,963 women who delivered an infant in any hospital in Quebec, Canada, between 1989 and 2016. The exposure was preeclampsia at the first or in subsequent pregnancies, including preeclampsia onset time (early < 34 weeks vs. late ≥ 34 weeks of gestation) and severity (mild, severe, superimposed). The outcome was hospitalization for depression any time after pregnancy. We used Cox proportional hazards regression models adjusted for maternal characteristics to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association of preeclampsia with depression hospitalization.
Results
Women with preeclampsia had a higher incidence of hospitalization for depression compared with no preeclampsia (1.43 vs. 1.14 per 1000 person-years). Preeclampsia was associated with 1.16 times the risk of depression hospitalization after 28 years of follow-up (95% CI 1.09–1.23). Associations were present for mild (HR 1.15, 95% CI 1.07–1.24), severe (HR 1.16, 95% CI 1.04–1.29) and late onset preeclampsia (HR 1.17, 95% CI 1.10–1.25). Risks were more pronounced after the first year postpartum.
Conclusion
Preeclampsia appears to be associated with the risk of depression hospitalization several decades after pregnancy. Clinicians who care for women with mental health disorders should be aware that a history of preeclampsia increases the risk of severe depression.
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Funding
This study was funded by the Heart and Stroke Foundation of Canada (G-18-0021776), and the Fonds de recherche du Québec-Santé (34695).
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NA, NL, GP, and WDF conceived and designed the study. AA analyzed the data under guidance of NA, with input from NL, GP, and WDF. All authors interpreted the results. NA and AA drafted the manuscript, and NL, GP, and WDF revised it critically for important intellectual content. All authors read and approved the final manuscript.
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The authors declare that they have no conflict of interest.
Ethical standards
This study received a waiver from the institutional review board of the University of Montreal Hospital Centre. The study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. As the data were anonymous, informed consent was not required.
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Auger, N., Low, N., Paradis, G. et al. Preeclampsia and the longitudinal risk of hospitalization for depression at 28 years. Soc Psychiatry Psychiatr Epidemiol 56, 429–436 (2021). https://doi.org/10.1007/s00127-020-01920-x
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DOI: https://doi.org/10.1007/s00127-020-01920-x