Risk of Cardiovascular Events During Delivery Hospitalization Among Pregnant Patients With Mental Health Conditions

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.