What is the impact of maternal hypertension and mental disorders on neonatal outcomes?

In a recent study published in Affective Disorder Journal, Researchers investigated the effects of maternal hypertension and psychiatric disorders on adverse neonatal outcomes.

Background

Studies have shown that maternal psychiatric disorders and gestational hypertension (HDP) are independently associated with the incidence of low gestational age (SGA) and preterm birth. Prospective longitudinal studies have investigated the relationship between anxiety, depression, and likelihood of developing HDP, and variables leading to the former may influence HDP incidence.

Due to the increasing risks to maternal and child health, it is important to investigate mediational associations between these variables during periods of great vulnerability such as pregnancy. Previous mediation, along with mitigation model studies, have demonstrated that biological factors and physiological immaturity are associated with neonatal mortality outcomes such as preterm birth (PTB). However, the impact of maternal anxiety and hypertension on neonatal outcomes requires extensive investigation.

About research

In the current study, researchers evaluated the prevalence, correlations, and possible pathways among HDP, maternal depression and anxiety, PTB, and SGA.

The team used the International Classification of Diseases, Ninth Revision (ICD-9) Pregnancy Codes for all hospital discharge reports from 2004 to 2014 to compare them with the Health Care Costs and Utilization Project (HCUP) – National Inpatient Sample (NIS). ) data set. Also included were her ICD-9 codes for eclampsia, preeclampsia, gestational hypertension, PTB, and SGA. In addition, codes for depression and anxiety were also extracted.

Covariates relevant to this study were also extracted, including covariates related to the demographics of mothers who received and did not receive PTB and SGA. Baseline parameters included age, insurance plan type, and race. Maternal and fetal comorbidities such as smoking during pregnancy, substance abuse, obesity, thyroid disease, underlying gestational diabetes, pre-gestational diabetes, chronic hypertension, and multiple pregnancies were potential confounding factors. Older pregnancies and deliveries over 35 years of age were considered.

result

A total of 628,140 (6.9%) pregnant women were diagnosed with HDP, 82,629 (0.91%) with anxiety, 33,016 (0.36%) with depression, and 653,895 (7.2%) with PTB. 198,070 (2.1%) in SGA. Among mothers with all types of HDP, there were 95,507 PTB and her 30,057 SGA births. During the study period, the rate of PTB in anxiety-free pregnant women showed a decreasing trend, independent of the incidence of HDP. On the other hand, there was an increased incidence of SGA among women who did not suffer from anxiety, irrespective of their HDP diagnosis.In the absence of depression, the incidence of PTB and her SGA was higher than that of her HDP over the same period. A similar trend was followed, independent of presence.

Women with anxiety were more likely to have comorbidities such as smoking during pregnancy, thyroid disease, obesity, pre-gestational diabetes, and depression. distribution was observed. Women with PTB and SGA were more likely to be younger Caucasians from low-income families, and more likely to have cancers such as smoking during pregnancy, substance abuse, chronic hypertension, pre-eclampsia, anxiety, and older maternal age. had comorbidities.

Women with anxiety were more likely to experience HDP and PTB.HDP had a substantial impact on the effects of anxiety on PTB. HDP women were more likely to develop PTB. Moreover, depression markedly affected the correlation between PTB and HDP. A woman with depression and HDP had the highest predicted risk of her PTB, and a woman without these two diseases had the lowest risk.

Among non-depressed women, those with HDP were 2.355 times more likely to have PTB than those without HDP. However, among depressed women, women with HDP were 2.076 times more likely than women without HDP. Among women without HDP, those with depression were 1.44 times more likely to develop PTB compared to those without depression, and those with HDP were at higher risk She was 1.27 times taller. Additionally, anxiety increased the likelihood of developing SGA.

Moreover, HDP adjusted the relationship between SGA and anxiety. An HDP woman was more likely for her SGA. Still, depression did not affect the relationship between SGA and HDP.

Conclusion

The findings demonstrate possible correlations and mechanisms between psychiatric disorders, adverse neonatal effects, and HDP in pregnant women. HDP mediated the association between her PTB and anxiety, whereas depression moderated the association between her PTB and HDP. HDP also mediated the relationship between her SGA and anxiety, but depression had no mitigating effect on this relationship. Researchers recommend that health professionals screen pregnant women for depression and anxiety as early as possible in the first trimester of pregnancy. This facilitates timely diagnosis, management and treatment to prevent harmful complications in newborns and potential mental and developmental problems in childhood.