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.