Abstract
Objective: To evaluate the association between hypertension and β-blocker (BB) use and antepartum depression risk. Patients and Methods: We conducted a retrospective cohort study of women who delivered within our integrated health system between 2009 and 2015, and completed an Edinburgh Postnatal Depression Scale (EPDS) during pregnancy. Increased depression risk was defined as EPDS score ≥ 10, or an affirmative answer to question ten, endorsing self-harm. Antepartum hypertension was determined by blood pressure measurements and provider ICD-9 codes. Regression analyses examined the independent associations of BB use and hypertension on antepartum depression risk. Results: Of 9192 deliveries during the study time frame, 5% were hypertensive. Within the hypertensive group, 103 (22%) used a single agent BB (BB Group), 325 (68%) required no antihypertensive medication (No-Med Group), and 48 (10%) used a non-BB single agent or multi-agent therapy (All-Other Group). After adjusting for covariates, compared to normotensive pregnancies, antepartum hypertension was significantly associated with both EPDS score ≥ 10 (adjusted odds ratio [aOR] 1.61, 95% confidence interval [CI] 1.17 - 2.21) and endorsement of self-harm (aOR 1.76, 95% CI 1.05 - 2.95). In further analyses of depression risk in hypertensive pregnancies, there was no difference between the BB Group and No-Med Group (EPDS score ≥ 10, aOR 1.22, 95% CI 0.56 - 2.63; self-harm, aOR 0.84, 95% CI 0.32 - 2.21), or between the All-Other Group and No-Med Group (EPDS ≥ 10, aOR 1.42, 95% CI 0.57 - 3.54; self-harm, aOR 1.04, 95% CI 0.29 - 3.74). Conclusion: Women with antepartum hypertension have increased risk for depression and thoughts of self-harm. β-Blocker use is not associated with further increased risk.
Highlights
Depression and hypertension constitute two major morbidities of pregnancy
After adjusting for covariates, compared to normotensive pregnancies, antepartum hypertension was significantly associated with both Edinburgh Postnatal Depression Scale (EPDS) score ≥ 10 and endorsement of self-harm
In further analyses of depression risk in hypertensive pregnancies, there was no difference between the between hypertension and β-blocker (BB) Group and No-Med Group (EPDS score ≥ 10, Adjusted odds ratios (aOR) 1.22, 95% confidence intervals (CI) 0.56 - 2.63; self-harm, aOR 0.84, 95% CI 0.32 - 2.21), or between the All-Other Group and No-Med Group (EPDS ≥ 10, aOR 1.42, 95% CI 0.57 - 3.54; self-harm, aOR 1.04, 95% CI 0.29 3.74)
Summary
Depression and hypertension constitute two major morbidities of pregnancy. Depression is the most frequent mood disorder in the general population, and the prevalence of depression increases during pregnancy, likely impacting more than 12% of women during the second and third trimesters [1] [2] [3]. Hypertension is estimated to impact up to 10% of pregnancies worldwide and is a major contributor to maternal mortality [4] [5]. Previous studies have suggested interplay between these morbidities, such that a diagnosis of hypertension increases risk of developing depression, and vice versa [7] [8]. Some research in non-obstetric populations suggests that β-blocker (BB) use may be associated with depression and depressive symptoms [9] [10] [11] [12]
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