Cardiovascular health and depression among postpartum women in the United States

Background The postpartum period is a critical time period for both cardiovascular health (CVH) and psychosocial health among women. While depression is a recognized cardiovascular risk factor in non-pregnant populations, the association between depression and CVH in the postpartum period has been understudied. Objectives To examine the association between depression and CVH among reproductive-age women and whether postpartum status modifies this association. Methods We analyzed cross-sectional data from non-pregnant women aged 20-44 years in the National Health and Nutrition Examination Survey (NHANES) 2007-2020. We evaluated whether CVH scores varied by postpartum status and depression status (Patient Health Questionnaire-9 [PHQ-9] scores ≥10). CVH was defined using the American Heart Association’s Life’s Essential 8 framework (blood pressure, glucose, lipids, body mass index [BMI], diet, physical activity, nicotine exposure, sleep; scores 0-100). We evaluated CVH scores by postpartum and depression status and tested for effect modification, adjusted for age and sociodemographics. Results The study population included 7,208 women, representing 47,249,817 women at the population level (weighted n=4,253,164 postpartum; n=42,996,653 not postpartum). Most postpartum women had an overall CVH score that was moderate (67%) or high (28%). Postpartum women had significantly worse CVH scores for physical activity (48.7 vs. 54.3, p-value 0.017) and BMI (57.3 vs. 63.3, p-value 0.014) compared to non-postpartum women. Among reproductive-age women, depression status was associated with lower scores for overall CVH and for most of the individual CVH metrics. Postpartum status modified the association between depression and CVH for sleep only (p-value 0.005). Conclusion Postpartum women had similar overall CVH compared to reproductive-age women who were not postpartum, but lower CVH scores for physical activity and BMI. Multi-component interventions that also target depression along with health behaviors may have a greater impact on CVH promotion in reproductive-age women.