Hypertensive disorders during pregnancy and perinatal mental health symptoms

Abstract

Existing evidence regarding the association between hypertensive disorders of pregnancy (HDP) and the risk of maternal mental illness is inconclusive. This study sought to investigate (a) whether HDP (pre-eclampsia and gestational hypertension) are independently associated with depressive and anxiety symptoms during pregnancy and in the postpartum period, and (b) whether parity moderates any observed associations. The study cohort consisted of more than 8300 mothers who participated in the Avon Longitudinal Study of Parents and Children (ALSPAC). Maternal antenatal and postnatal depressive and anxiety symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) and the Crown-Crisp Experiential Index (CCEI), respectively. Univariable and multivariable logistic and linear regression analyses were used to examine the associations. Mothers with pre-eclampsia had a 53% (aOR = 1.53; 95% CI, 1.06–2.23) increased risk of antenatal depressive symptoms compared with those without pre-eclampsia. Having pre-eclampsia and being a nulliparous woman resulted in the highest risk of antenatal depressive symptoms (aOR = 2.75; 95% CI, 1.09–6.96). Pre-eclampsia was associated with a 56% increased risk of antenatal anxiety symptoms among nulliparous women. We also found associations between gestational hypertension and antenatal depressive and anxiety symptoms. No associations between pre-eclampsia and/or gestational hypertension and postnatal anxiety and depressive symptoms were observed. Conclusions : Mothers with HDP were at higher risk of clinically significant antenatal depressive and anxiety symptoms. Nulliparous women with pre-eclampsia are a higher risk group for mental ill-health and should be routinely screened for anxiety and depressive symptoms and provided with interventions when indicated.