Relationship between hypertensive disorders of pregnancy and postpartum mood and anxiety symptoms: P4 study

Evaluate the relationship between hypertensive disorders of pregnancy (HDP) and long-term mood and anxiety symptoms by (a) investigating prevalence at 5-years after HDP versus normotensive pregnancy (b) comparing longitudinal data 6-months, 2-years and 5-years postpartum.

Women were recruited 2013-2018 following singleton birth into an observational cohort and categorised into groups: normal blood pressure (NBP), gestational hypertension (GH) and preeclampsia (PE). Surveys measured prevalence and severity of symptoms using the following screening tools: Edinburgh Postnatal Depression Scale (EPDS > 12), 7-item Generalized Anxiety Disorder Scale (GAD-7 ≥ 10), and Posttraumatic Stress Diagnostic Scale (PDS/PDS-5 ≥ 28).

5-years postpartum, 314 participants were surveyed (normotensive n = 238(76%), gestational hypertension n = 17(5%), Preeclampsia n = 59(19%)). Mood and anxiety symptoms (EPDS > 12, GAD-7 ≥ 10, or PDS-5 ≥ 28) were present in 10.8%. Women following preeclampsia had similar prevalence of mood and anxiety symptoms at 5-years compared to NBP (normotensive 10.1% vs. preeclampsia 10.2%, p = 0.20). More women recalled childbirth as traumatic after preeclampsia (normotensive 0.4% vs. preeclampsia 5.5%, p = 0.01). Significant predictors for mood and anxiety symptoms 5-years postpartum were mental illness history and significant stress in the preceding 12-months (p < 0.001 and p = 0.01). Longitudinal analysis found higher rates of mood and anxiety symptoms 5-years (10.8%) than at 2-years and 6-months (5.4% and 4.5% respectively, p < 0.001).

Prevalence of mood and anxiety symptoms increased over time, hypertensive disorders of pregnancy were not a contributing factor. Prior mental illness and recent life stressors were key predictors.