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Maternal anxiety, depression and vascular function during pregnancy.

Melanie Bilbul1, Christina Caccese2, Kristin Horsley3

  • 1Department of Psychiatry, Icahn School of Medicine, New York, NY, USA; Department of Psychiatry, McGill University, Montreal, QC, Canada.

Journal of Psychosomatic Research
|February 3, 2022
PubMed
Summary

Early pregnancy fears about childbirth were linked to lower fetal vascular resistance, while depressive symptoms correlated with lower maternal blood pressure. These findings suggest distinct roles for psychological distress in maternal-fetal vascular health.

Keywords:
AnxietyDepressionHypertensionPre-eclampsiaPregnancy-inducedPrenatal care

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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.