Depressed mood and anxiety as risk factors for hypertensive disorders of pregnancy: a systematic review and meta-analysis

Abstract

Background Psychosocial factors have been implicated as both a cause and consequence of hypertension in the general population but are less understood in relation to hypertensive disorders of pregnancy (HDP). The aims of this review were to (1) synthesize the existing literature examining associations between depression and/or anxiety in pregnancy and HDP and (2) assess if depression and/or anxiety in early pregnancy was a risk factor for HDP. Methods A comprehensive search of Medline, Embase, CINAHL, and PsycINFO was conducted from inception to March 2020 using terms related to ‘pregnancy’, ‘anxiety’, ‘depression’, and ‘hypertensive disorders’. English-language cohort and case-control studies were included if they reported: (a) the presence or absence of clinically significant symptoms of depression/anxiety, or a medical record diagnosis of depression or an anxiety disorder in pregnancy; (b) diagnosis of HDP; and/or (c) data comparing the depressed/anxious group to the non-depressed/anxious group on HDP. Data related to depression/anxiety, HDP, study characteristics, and aspects related to study quality were extracted independently by two reviewers. Random-effects meta-analyses of estimated pooled relative risks (RRs) were conducted for depression/anxiety in pregnancy and HDP. Results In total, 6291 citations were retrieved, and 44 studies were included across 61.2 million pregnancies. Depression and/or anxiety were associated with HDP [RR = 1.39; 95% confidence interval (CI) 1.25–1.54]. Conclusions When measurement of anxiety or depression preceded diagnosis of hypertension, the association remained (RR = 1.27; 95% CI 1.07–1.50). Women experiencing depression or anxiety in pregnancy have an increased prevalence of HDP compared to their non-depressed or non-anxious counterparts.

Hypertensive disorders in pregnancy and child development at 36 months in the All Our Families prospective cohort study

“…Such over-adjustments can degrade precision and/or open biasing pathways that distort the estimated association [ 35 , 47 ]. Given emerging research on the bi-directional relationship between HDP and depression [ 48 , 49 ] and established research on the impact of maternal mental health on toddler development [ 50 ], we included maternal depression covariates in our analysis expecting it to positively confound (prenatal depression) or lie on the causal pathway (postpartum depression) between HDP and child development. Importantly, maternal mental health has not been integrated into previous studies addressing this topic.…”

Effectiveness of psychosocial interventions for hypertensive disorders in pregnancy: A systematic review and meta-analysis

“…Although depression and anxiety are common among pregnant women, leading to postpartum depression and/or anxiety and other mental health problems, combining these conditions with HDP is especially detrimental to maternal and infant health. A meta-analysis of 61.2 million pregnancies suggested that depression and anxiety were clinically associated with HDP [11]. Specifically, this study reported that women who met the clinical cut-off score for depression and/or anxiety symptoms had a 39% increased relative risk of HDP diagnosis than those without these conditions [11].…”

“…A meta-analysis of 61.2 million pregnancies suggested that depression and anxiety were clinically associated with HDP [11]. Specifically, this study reported that women who met the clinical cut-off score for depression and/or anxiety symptoms had a 39% increased relative risk of HDP diagnosis than those without these conditions [11].…”

Perinatal Behavioral Health, the COVID-19 Pandemic, and a Social Determinants of Health Framework

“…Women with perinatal depression are more likely to engage in risky health behaviors such as poor nutrition, substance use, or limited attendance at prenatal care ( Klawetter et al, 2020 ). Perinatal depression was also linked to a variety of poor pregnancy outcomes, including gestational diabetes ( Lee et al., 2020 ), hypertensive disorders ( Shay et al., 2020 ), preterm birth, and low birth weight ( Jarde et al, 2016 ). After birth, women affected by perinatal mood and anxiety disorders were at risk for postpartum depression ( Aris-Meijer et al., 2019 ; Grigoriadis et al., 2018 ), anxiety ( Aris-Meijer et al., 2019 ), psychosis, and suicide ( Van Niel & Payne, 2020 ).…”