Hypertension Is Associated With Depressive Symptoms in Pregnant Women [23B

Abstract

INTRODUCTION: Hypertension and beta-blocker use have been associated with depression in the non-pregnant population. We evaluated the independent association of hypertension and beta-blocker use on antepartum depression risk. METHODS: We conducted a retrospective cohort study which included women who delivered within our health system between January 1, 2009, and March 31, 2015, who completed an Edinburgh Postnatal Depression Scale (EPDS) during pregnancy. Increased depression risk was defined as EPDS score >10, or an affirmative answer to endorsing self-harm. Hypertension was determined by blood pressure measurements and ICD-9 codes. We compared normotensive to hypertensive pregnancies, and hypertensive pregnancies requiring beta-blocker therapy to those without medication requirement. Multivariate logistic regression analyses were used to examine the influence of beta-blocker use and hypertension on antepartum depression risk. RESULTS: Of the 9192 deliveries, 95% were normotensive and 5% were hypertensive. Of the hypertensive group, 22% utilized a beta-blocker and 68% required no medication. Compared to normotensive pregnancies, antepartum hypertension was significantly associated with antepartum EPDS score ≥10 (adjusted OR 1.61, 95% CI 1.17, 2.21) and with endorsement of self-harm (adjusted OR 1.76, 95% CI 1.05, 2.95). In further analyses of hypertensive pregnancies, beta-blocker users demonstrated no difference in depression risk compared to women without medication use (EPDS score ≥10, adjusted OR 1.22, 95% CI 0.56, 2.63; endorsement of self-harm, adjusted OR 0.84, 95% CI 0.32, 2.21). CONCLUSION: Women with hypertension in pregnancy are at increased risk for depressive symptoms and thoughts of self-harm. Beta-blocker use does not appear to be associated with further increased risk.