Maternal anxiety, depression and vascular function during pregnancy

Area of Science:

• Obstetrics and Gynecology
• Perinatal Mental Health
• Cardiovascular Physiology

Background:

• Mental health symptoms during pregnancy, such as anxiety and depression, are common.
• These conditions are often treated with psychotropic medications.
• The independent impact of specific mental health symptoms on maternal-fetal vascular function requires clarification.

Purpose of the Study:

• To determine if the type and timing of mental health symptoms in early pregnancy uniquely affect maternal-fetal vascular function.
• To differentiate these effects from those of psychotropic medications.
• To investigate associations between early pregnancy psychological distress and outcomes predictive of hypertensive disorders of pregnancy (HDP).

Main Methods:

• Prospective cohort study of 1678 pregnant individuals.
• Assessed self-reported fears about childbirth and depressive symptoms before 16 weeks of gestation.
• Measured vascular outcomes: blood pressure (BP), uterine artery pulsatility index (UAPI), umbilical artery resistance index (UmbARI), and urine protein creatinine ratio.
• Utilized multiple linear regression and mediation models, controlling for maternal age and infertility history.

Main Results:

• Fears about childbirth in early pregnancy showed an inverse association with umbilical artery resistance index (UmbARI) in mid- to late-pregnancy.
• Early pregnancy depressive symptoms were inversely associated with maternal systolic and diastolic blood pressure (BP) during the first trimester.
• These associations were observed independent of previously identified risk factors for vascular dysfunction.

Conclusions:

• Early pregnancy fears are linked to reduced vascular resistance in the fetal-placental unit.
• Early depressive symptoms are associated with lower maternal vascular tone.
• Maternal psychological distress in early pregnancy is unlikely to be the primary driver of later HDP development.
• Pregnancy-related anxiety and depressive symptoms may have distinct influences on maternal-fetal vascular function.