Association Between Pre-Pregnancy Depression/Anxiety Symptoms and Hypertensive Disorders of Pregnancy

Abstract

Background: Depression and anxiety symptoms have been linked with hypertensive disorders during pregnancy, but these associations have not been fully elucidated. Our objective was to consider hypertension in pregnancy and its subtypes (chronic hypertension, gestational hypertension, preeclampsia) and evaluate whether the proximity of psychological symptoms to pregnancy informs any associations observed. Methods: Pregnancy Outcomes and Community Health Study participants who provided interview data at enrollment (16-27 weeks' gestation) and whose hypertensive disorder status was abstracted from medical records were eligible for inclusion (n = 1371). Maternal history of depression/anxiety symptoms at four time points in the life course were ascertained via self-report at enrollment (i.e., lifetime history, 1 year prior to pregnancy, since last menstrual period, and past week). Weighted logistic regression models were used to examine depression/anxiety symptom measures in relation to hypertensive disorders (overall) and subtype. Results: Following adjustment for maternal sociodemographic factors, smoking, and prepregnancy body mass index, prepregnancy depression or anxiety symptoms (i.e., lifetime history and 1 year prior to pregnancy) were associated with hypertensive disorders during pregnancy. Subtype analyses revealed that these associations were driven primarily by chronic hypertension (adjusted odds ratios = 2.7-3.5). Preeclampsia accompanied by preterm delivery was also linked to women's lifetime history of depression symptoms (odds ratio = 2.3, 95% confidence interval 1.0-5.2). Conclusion: Our results suggest that the link between maternal chronic hypertension and depression/anxiety symptoms precedes pregnancy. In addition, prepregnancy history of depression/anxiety symptoms may be considered part of a risk profile for preterm preeclampsia.

Maternal childhood cardiometabolic risk factors and pregnancy complications

“…Exposures from both the physical and social environment, air pollution (8, 9), neighborhood deprivation (9), and racial discrimination (10), for example, which occur prior to conception can alter the likelihood of a complication arising during pregnancy. Women entering pregnancy with a history of chronic disease (11, 12), stress (13), depression/anxiety (14), dyslipidemia (15), or high body mass index (16, 17) are more likely to experience adverse pregnancy health including development of GDM, PIH, and preeclampsia.…”

Associations between postpartum depression and hypertensive disorders of pregnancy

“…By contrast, a study from the USA that included 1371 pregnant women diagnosed with HDP elucidated that postpartum depression or pre‐pregnancy anxiety was associated with HDP . Furthermore, this study clarified that mild or severe pre‐eclampsia followed by preterm delivery was associated with a history of depressive symptoms, which reinforces the need for attention to pre‐eclampsia.…”

“…By contrast, a study from the USA that included 1371 pregnant women diagnosed with HDP elucidated that postpartum depression or pre‐pregnancy anxiety was associated with HDP . Furthermore, this study clarified that mild or severe pre‐eclampsia followed by preterm delivery was associated with a history of depressive symptoms, which reinforces the need for attention to pre‐eclampsia. For The authors of this study, this relationship could be established by other causal factors since depression or anxiety prior to pregnancy—in addition to the drugs used to treat these disorders—could change maternal physiology, predisposing the current gestation to a risk profile for preterm pre‐eclampsia.…”

“…3 Given both its prevalence and the potential for adverse outcomes, HDP is a serious publichealth problem. 4 Maternal mental health might also be affected by the severity of HDP in association with other perinatal factors-including prematurity, newborn hospitalization in the neonatal intensive care unit (NICU), and fetal death-which in turn could potentiate the deleterious effects and interactions of morbidities. 5 In addition to the known adverse events of HDP, there might also be a relationship between psychological status and HDP, leading to changes in the physiological inflammatory process, autonomic processes, and activity of the hypothalamic-pituitary-adrenal axis.…”

A praeeclampsia pszichoszociális vonatkozásai

“…Haelterman és mtsai vizsgálatában azoknál a nőknél, akik fokozottabb fi zikai vagy pszichés munkahelyi stressznek voltak kitéve, nagyobb eséllyel alakult ki praeeclampsia [32]. Ugyanakkor két másik kutatásban, amelyekben praeeclampsiás, gesztációs és krónikus hypertoniával diagnosztizált nők pszichés státuszát hasonlították össze, a klinikai depresszió és szorongás nagyobb arányú előfordulása csak a krónikus hypertoniás csoportban volt kimutatható, a praeeclampsiás nők körében csak koraszüléssel végződő terhesség esetén találtak hasonló összefüggést [33,34].…”