Pregnancy hypertension and its associations with pre-pregnancy depression, anxiety, antidepressants, and anxiolytics

Few studies have examined pre-pregnancy depression/anxiety and antidepressant/anxiolytic medication use in relation to hypertension disorders of pregnancy, i.e. chronic hypertension (CH), pre-eclampsia (PE), and gestational hypertension (GH).

This nested case-control study uses Blue Cross Blue Shield of Michigan (BCBSM) claims data of women with singleton live birth pregnancies (2010-2014) enrolled from 2 years prior to last menstrual period to ninety days after delivery. All women with ICD-9CM codes for CH, PE, GH, or unspecified hypertension were included as cases; women without hypertension were randomly sampled as controls. Linkage to Michigan birthfiles resulted in a sample of 12,647 women. Using weighted logistic regression, cases and controls were compared for depression and/or anxiety diagnoses (ICD-9CM codes) and anti-depressant and/or anxiolytic prescriptions throughout the study period. Depression and anxiety were defined as primary diagnosis in ≥1 inpatient or ≥2 outpatient visits.

Among women with hypertension disorders of pregnancy, 59% had PE or GH, referred to here as pregnancy hypertension (PH). PH was associated with anti-depressant use prior to LMP only, (aOR = 1.2 95%CI 1.0, 1.5), continued use, (aOR = 1.4 95%CI 1.1, 1.7), and initiation of anxiolytic medication during pregnancy, (aOR = 2.5 95%CI 1.6, 4.2). In this latter group, 96% started medication before PH diagnosis. CH and PH were not associated with depression or anxiety in the absence of anti-depressants/anxiolytics.

While anti-depressants/anxiolytics may be useful indicators in risk stratification for pregnancy hypertension, the same does not appear to be true for depression/anxiety without related medication use.