Abstract Body: Background: Adverse pregnancy outcomes (APOs) are risk factors for future cardiovascular disease (CVD). APOs are more common among individuals who experience depression during pregnancy, and depression is a well-established CVD risk factor in non-pregnant populations. The purpose of the present study was to evaluate the relationship between depressive symptoms in pregnancy and future CVD risk, and to determine whether this relationship was mediated by APOs.

Methods: This secondary analysis of the multisite prospective nuMoM2b-Heart Health Study included 4,050 participants (M_age=27.6±5.6 years), with complete longitudinal data for variables from early pregnancy to 2-7 years post-delivery. Participants self-reported depressive symptoms on the Edinburgh Postnatal Depression Scale (EPDS) at 6-13 (early pregnancy) and 22-29 (mid-pregnancy) weeks of gestation. APOs were collected prospectively and adjudicated and included small-for-gestational-age birth, hypertensive disorders of pregnancy, gestational diabetes mellitus, placental abruption, and preterm birth. CVD risk factors, assessed at 2-7 years after delivery (follow-up interval M =3.2±0.9 years), were modeled as a higher order latent factor indicated by intermediate latent factors: insulin resistance (glucose and insulin), adiposity (waist circumference and BMI), blood pressure (SBP and DBP), and dyslipidemia (triglycerides and HDL cholesterol). Structural equation modeling was used to test whether APOs (present or absent) mediated the relationship between mid-pregnancy EPDS scores and latent CVD risk 2-7 years post-delivery, covarying for EPDS scores in early pregnancy (approximating pre-pregnancy), length of follow-up interval, smoking history, age, education, and income.

Results: The model adequately fit the data (CFI=.96; RMSEA=.058; SRMR=.04). The direct effects of APOs (β=.26, p<.01) and late pregnancy EPDS scores (β=.13, p<.01) on latent CVD risk were significant. BMI (r=.16), waist circumference (r=.15), and HDL cholesterol (r=-.13) were the CVD risk factors most strongly associated with late pregnancy EPDS scores (r range=|.04-.16|). The indirect effect of EPDS scores on CVD risk through APOs was not significant (p>.6).

Discussion: Depressive symptoms in mid-pregnancy were associated with higher CVD risk 2-7 years after delivery, but this effect was not mediated by experiencing APOs. Future studies should evaluate whether pregnancy interventions to improve mood reduces subsequent risk of CVD.