Depression and anxiety in pregnancy and postpartum in women with mild and severe preeclampsia

Abstract

Background:Risk for anxiety and depression is increased in women with high-risk pregnancy. The aim of this study was to evaluate anxiety and depression in women with mild and severe preeclampsia at admission and 6 weeks postpartum.Materials and Methods:In this cohort study, 122 preeclamptic women who were admitted to the Public hospital and Tamin Ejtemaee hospital of Mashhad were included. Selection was done by convenience sampling method. Beck Depression Inventory II (BDI-II) and Spielberger State-Trait Anxiety Inventory (STAI) were completed at admission and 6 weeks after delivery. Data were analyzed by SPSS 16 using Chi-square, Fisher's exact test, Mann-Whitney U test, and Repeated measurement.Results:The mean depression score was 4.81 ± 4.09 at admission and 11.17 ± 5.5 at 6 weeks postpartum. The mean of trait anxiety was 42.5 ± 10.5 at admission and 32.3 ± 6.5 at 6 weeks postpartum, and the mean of state anxiety score at admission was 43.09 ± 9.5 and at 6 weeks postpartum was 31.99 ± 5.9. There was a significant difference between the scores of depression (F = 3.8, P < 0.001), state anxiety (F = 1.52, P < 0.001), and trait anxiety (F = 1.5, P < 0.001) at admission and 6 weeks postpartum. No significant differences were found between severity of preeclampsia and the scores of depression, state anxiety, and trait anxiety at admission and 6 weeks postpartum.Conclusions:The mean score of state and trait anxiety decreased significantly in preeclamptic women from admission to 6 weeks postpartum, but the mean score of depression increased. Severity of preeclampsia was not an independent risk factor of depression and anxiety.

Preeclampsia and the brain: neural control of cardiovascular changes during pregnancy and neurological outcomes of preeclampsia

“…The indices for depression (31, 249, 250) and anxiety (31, 38, 249) are elevated in PE, while the frequency of PTSD is increased for several years after the index pregnancy (37–42). One clinical study observed that the risk for postpartum depression was associated not to the severity of PE, but rather to its consequences (e.g., perinatal death), even after adjusting for the confounding variables of age, ethnicity, and educational level of the mother (250).…”

“…While resilience shielding against psychological stress (251) and psychotherapeutic treatment (252) can attenuate the duration of the episode, a previous history of depression coupled with experiencing a preeclamptic index pregnancy can significantly contribute to the onset of PTSD and exacerbate the anxiety of planning future pregnancies (39). The deleterious effects of prenatal maternal psychosocial stressors on fetal development are well documented, where increased incidences of maternal depression (34–36) and anxiety (31–33) are significantly correlated to low fetal birth weight, IUGR, and premature birth (32–36, 38). …”

“…Furthermore, PE establishes predispositions to anxiety (31–33), depression (34–36), and PTSD (37–42) in the gravid female, which are significantly correlated to low fetal birth weight, IUGR, and premature birth (32–36, 38). This review examines the neural control of blood pressure in healthy pregnancy, and addressess the resulting neurological outcomes of PE that present both during and after the index pregnancy.…”

The impacts of air pollution on maternal stress during pregnancy

“…Additionally, the complications of pregnancy were related to maternal stress during pregnancy2425, and air pollution was associated with the development of complications of pregnancy26. However, the modifying effects of complications of pregnancy on the association between air pollution and maternal stress during pregnancy remain unclear2728.…”

Sleep disturbances and modulations in inflammation: Implications for pregnancy health

“…Numerous factors that influence a pregnancy and its subsequent outcome have been identified, including illness (Atta et al, 2016;Ellington et al, 2011;Guntupalli, Hall, Karnad, Bandi, & Belfort, 2015;Hartert et al, 2003;Lapinsky, 2010;Mouyis, Thornton, Williams, & Giles, 2017;O'Brien et al, 2014), stress (Carmichael & Shaw, 2000;Christian, 2014;Coussons-Read, Okun, & Nettles, 2007;Davis, Glynn, Waffarn, & Sandman, 2011;Livingston, Otado, & Warren, 2003;Rini, Dunkel-Schetter, Wadhwa, & Sandman, 1999;Sandman, Wadhwa, Chicz-Demet, Dunkel-Schetter, & Porto, 1997), emotional states such as depression and anxiety (Abedian, Soltani, Mokhber, & Esmaily, 2015;Diego et al, 2004;Lewis, Austin, Knapp, Vaiano, & Galbally, 2015;Orr, James, & Blackmore, 2002), and disturbed sleep (Lee, 2006;Okun, Hall, & Coussons-Read, 2007;Okun, Hanusa, Hall, & Wisner, 2009;Okun, Schetter, & Glynn, 2011;Tomfohr, Buliga, Letourneau, Campbell, & Giesbrecht, 2015). While there is an extensive literature about the immunological consequences of illness, stress, and psychopathology during gestation (Christian, 2014;Christian, Franco, Iams, Sheridan, & Glaser, 2010;Corwin & Pajer, 2008;Coussons-Read et al, 2007;Madan et al, 2009;Maes et al, 2000;Spradley, Palei, & Granger, 2015), little is known regarding the effects of chronic or persistent sleep loss/disruption during pregnancy and its impact on immune dysregulation that may impact maternal and fetal health and pregnancy outcomes.…”