Pregnancy hypertension and its association with maternal anxiety and mood disorders: A population-based study of 9 million pregnancies

• Published in: Journal of affective disorders Vol. 281; pp. 533 - 538
• Main Authors: Raina, Jason, El-Messidi, Amira, Badeghiesh, Ahmad, Tulandi, Togas, Nguyen, Tuong-Vi, Suarthana, Eva
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.02.2021
• Subjects: Anxiety; Depression; Eclampsia; Female; Gestational hypertension; Humans; Hypertension, Pregnancy-Induced - epidemiology; Mood disorder; Mood Disorders - epidemiology; Pre-Eclampsia; Preeclampsia; Pregnancy; Psychiatric/Mental Health; Retrospective Studies; Risk Factors; Mood disorder; Depression; Anxiety; Gestational hypertension; Preeclampsia; Eclampsia; gestational hypertension; anxiety; eclampsia; mood disorder; preeclampsia; depression
• ISSN: 0165-0327; 1573-2517; 1573-2517
• DOI: 10.1016/j.jad.2020.10.058

•We used HCUP-NIS database containing 9 million records of hospitalized pregnant women in the United States between 2004 and 2014 to analyze the association between mental disorders and hypertensive disorders of pregnancy (HDP).•There were increasing trends of anxiety, depression, bipolar disorder and mood disorder among hospitalized pregnant women.•There were strong associations between HDP and anxiety, but not between HDP and depression. This suggests that the differences in treatment may account for the association between mental disorders and HDP.  Future studies are needed to confirm and explain these findings. Evidence on whether anxiety or mood disorders increases the risk of hypertensive disorders of pregnancy (HDP) has been conflicting. We aimed to evaluate the prevalence of maternal mental disorders over time and their associations with HDP. This was a population-based retrospective study involving 9,097,355 pregnant women using Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) data from 2004 through 2014. We calculated the prevalence of maternal anxiety, depression, bipolar disorder and mood disorder and trends of gestational hypertension, preeclampsia and eclampsia during the study period. Multivariate logistic regression was used to examine the association between each mental disorder and HDP. Mental disorders showed increasing trends among pregnant women, with anxiety showing the greatest increase in rates. Unadjusted associations suggest all mental disorders increase the likelihood of HDP. When adjusted for sociodemographic characteristics and comorbidities, only anxiety showed consistently increased risk of gestational hypertension (adjusted odds ratio (aOR) 1.324, 95% CI 1.255-1.397), preeclampsia (aOR 1.522, 95% CI 1.444-1.604), with the strongest association with eclampsia (aOR 1.813, 95% CI 1.260-2.610). Information on medication use is not available in the HCUP-NIS database and might have been contributory to our findings. Rates of maternal psychopathology are rising in the United States. Our study suggests that pregnant women with anxiety are at increased risk of HDP. Targeted screening for mental disorders as possible clinical risk markers may allow for timely prophylaxis and surveillance for the development of HDP.