The association between mental illness, psychotropic medication use and hypertensive disorders in pregnancy: A multicentre study.

Abstract

Women with severe mental illnesses (SMI) may have elevated rates of hypertensive disorders in pregnancy (HDP) due to an accumulation of risk factors. This study aims to determine the prevalence rate of HPD within a population of women with SMI and to report on rates within different mental illness diagnoses and types of medication exposure. A retrospective multicentre study of 521 pregnant women attending specialised antenatal clinics for the management of established SMI. Measures included sociodemographic characteristics, pregnancy complications, mental health diagnosis and psychotropic medication use. Overall, 14% of women in the study had HDP. Compared to women with non-affective psychotic and other non-psychotic disorders (10.3%), women with depression and anxiety disorders demonstrated an increased risk of having a diagnosis of HDP (18.8%; RR=1.82 [95% CI: 1.01, 3.29], p=.048). Log-binomial regression demonstrated that both a BMI in the overweight and obese range (RR=3.37 [95% CI: 1.04, 10.95], p=.044) and continuous SNRI treatment throughout pregnancy (RR=2.79 [95% CI; 1.33, 5.83], p=.006) were significant predictors of HDP, after adjusting for maternal age, gestational diabetes, and other mental health diagnoses. Women with severe mental illnesses have elevated risk of developing HPD. Management remains complex and should address their comorbid risk profiles, and weigh up the risks and benefits of psychotropic medication use, given these results provide evidence of elevated rates of HDP associated with exposure to SNRI when taken throughout pregnancy.