Prevalence, Correlates, and Outcomes of Co-Occurring Depression and Hypertensive Disorders of Pregnancy

Background: Depression and hypertensive disorders of pregnancy (HDP) are common morbidities during pregnancy. However, our knowledge about the national prevalence, correlates, and outcomes of co-occurring depression and HDP remains unknown. Materials and Methods: Using a multiyear (2002-2014) nationwide inpatient sample, we conducted a population-based, cross-sectional study. Cases, behavioral and clinical covariates, and outcomes were identified using International Classification of Disease, 9th Revision, Clinical Modification Codes. Rates of depression and HDP were calculated across demographics, hospital characteristics, and morbidities. We estimated adjusted odds ratios that represent the unique and joint association of depression and HDP with birth outcomes. Joinpoint regression was used to describe temporal trends in depression and HDP. Results: Among the over 58-million hospitalizations, there were 2,346,619 (3.99%), 1,117,857 (1.90%), and 63,081 (0.11%) cases of HDP, depression, and co-occurring depression and HDP, respectively. Compared to pregnant women without depression and HDP, women with depression and HDP were 3.41 times (confidence interval [95% CI]: 3.15-3.68), 1.94 times (95% CI: 1.65-2.27), and 4.10 times (95% CI: 3.89-4.32) more likely to experience intrauterine growth restriction, stillbirth, and preterm labor, respectively, even after adjusting for potential demographic, socioeconomic, and clinical confounders. Depression- and HDP-related hospitalizations resulted in an additional cost of over $5 billion during the study period. Conclusion: Depression and HDP are associated with increased risk of adverse birth outcomes and significant health care cost, with HDP being the main driving factor. Screening for both HDP and depression followed by multidisciplinary care could alleviate the health and economic burden of HDP and depression.