Vol.:(0123456789) 1 3 Social Psychiatry and Psychiatric Epidemiology https://doi.org/10.1007/s00127-020-01920-x ORIGINAL PAPER Preeclampsia and the longitudinal risk of hospitalization for depression at 28 years Nathalie Auger 1,2,3  · Nancy Low 4  · Gilles Paradis 2,3  · Aimina Ayoub 1,2  · William D. Fraser 5 Received: 12 November 2019 / Accepted: 4 July 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020 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 Que- bec, Canada, between 1989 and 2016. The exposure was preeclampsia at the frst 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% confdence 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 frst 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. Keywords Depression · Longitudinal studies · Mood disorders · Postpartum period · Preeclampsia · Pregnancy Introduction Evidence is emerging that preeclampsia, a hypertensive disorder of pregnancy associated with acute morbidity and mortality in the mother and fetus [1], may be linked with depression in the months following delivery [2]. The asso- ciation of preeclampsia with the long-term risk of depression has received less attention, although current data suggest that these disorders have common features [3, 4]. Endothe- lial dysfunction, oxidative stress, and systemic infamma- tion are present in both preeclampsia and depression [3–5]. Women with preeclampsia have altered levels of angiogenic biomarkers associated with endothelial pathology that may persist many years after pregnancy [6, 7]. Similarly, chronic low-grade endothelial dysfunction may exacerbate risk of depression late in life [4]. An immuno-infammatory compo- nent has been hypothesized in both preeclampsia and depres- sion [8]. Moreover, preeclampsia is associated with adverse Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00127-020-01920-x) contains supplementary material, which is available to authorized users. * Nathalie Auger nathalie.auger@inspq.qc.ca 1 University of Montreal Hospital Research Centre, Montreal, QC, Canada 2 Institut national de santé publique du Québec, 190 Cremazie Blvd E., Montreal, QC H2P 1E2, Canada 3 Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada 4 Department of Psychiatry, McGill University, Montreal, QC, Canada 5 Department of Obstetrics and Gynecology, Sherbrooke University Hospital Research Centre, Sherbrooke, Canada