In a recent study published in the Journal of Affective Disorders, researchers explored the impact of maternal hypertension and mental disorders on harmful neonatal outcomes.
Studies have demonstrated that maternal mental illnesses and hypertensive disorders of pregnancy (HDP) are independently related to the occurrence of small for gestational age (SGA) and preterm birth. Prospective longitudinal studies have investigated the relationships between anxiety, depression, and the likelihood of developing HDP, where variables leading to the former may impact HDP incidence.
Due to the increased danger to the mother and child's health, it is crucial to investigate mediating associations among these variables during extremely vulnerable times such as pregnancy. Prior mediation, along with moderation model research, has demonstrated that biological factors and physiological immaturity are connected with newborn mortality outcomes, such as preterm birth (PTB). However, the effect of maternal anxiety and hypertension on newborn outcomes needs extensive investigation.
About the study
In the present study, researchers assessed the prevalence, correlations, and possible pathways between HDP, maternal depression and anxiety, PTB, and SGA.
The team analyzed all hospital discharge reports from 2004 to 2014 in the Healthcare Cost and Utilization Project (HCUP) – Nationwide Inpatient Sample (NIS) dataset utilizing the pregnancy codes from the International Classification of Diseases, Ninth Revision (ICD-9). ICD-9 codes for eclampsia, preeclampsia, gestational hypertension, PTB, and SGA were also included. Additionally, codes for depression and anxiety were also extracted.
Covariates pertinent to this investigation, including those associated with mother demographics who did and did not give PTB and SGA, were also extracted. Included among the baseline parameters were age, insurance plan type, and race. Maternal and fetal comorbidities, like smoking during pregnancy, drug misuse, obesity, thyroid illness, underlying gestational diabetes mellitus, pregestational diabetes mellitus, chronic hypertension, and multiple pregnancies, were potential confounders. In addition, advanced maternal age pregnancy at the age of over 35 and parity were considered.
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, 653,895 (7.2%) with PTB; and 198,070 (2.1%) with SGA. There were 95,507 PTBs and 30,057 SGA births among mothers with any kind of HDP. During the research period, PTB rates among pregnant women without anxiety, independent of HDP incidence, showed a declining trend. On the other hand, irrespective of HDP diagnosis, the incidence of SGA increased among women who did not suffer from anxiety. In the absence of depression, the incidence of PTB and SGA followed a similar trend, independent of the existence of HDP over the same period.
Women with anxiety were more likely to have comorbidities, including smoking during pregnancy, thyroid illness, obesity, pregestational diabetes mellitus, and depression. Comparable distributions were observed for depressed and non-depressed women. Women who suffered PTB and SGA were more likely to be Caucasian, younger, of low-income families, and had a greater number of comorbidities, including smoking during pregnancy, drug misuse, chronic hypertension, preeclampsia, anxiety, and advanced maternal age.
Women having anxiety had higher odds of experiencing HDP and PTB. HDP considerably impacted the influence of anxiety on PTB. Women with HDP had an increased probability of developing PTB. Additionally, depression remarkably affected the correlations between PTB and HDP. Women with depression and HDP displayed the highest projected risk of PTB, whereas women without these two diseases had the lowest risk.
Among women who did not have depression, people with HDP had a 2.355 times higher chance of having PTB than those without HDP. However, among women with depression, those with HDP were 2.076 times more likely than those who did not experience HDP. Among women who did not have HDP, those having depression had a 1.44 times higher chance of developing PTB as compared to those who did not have depression. Also, among those with HDP, the risk was 1.27 times greater. Furthermore, anxiety elevated the likelihood of developing SGA.
Additionally, HDP modulated the relationship between SGA and anxiety. Women with HDP were more likely to have SGA. Yet, depression did not affect the relationship between SGA and HDP.
The findings indicated probable correlations and mechanisms between mental illnesses, adverse neonatal consequences, and HDP in pregnant women. HDP mediated the links between PTB and anxiety, whereas depression moderated the association between PTB and HDP. HDP also mediated the relationship between SGA and anxiety, although depression had no moderating effect on this relationship. The researchers recommend medical professionals screen pregnant women for depression and anxiety as early as feasible in the first trimester. This would facilitate timely diagnosis, management, and therapy to prevent adverse neonatal complications and potential mental and developmental issues during childhood.
- Jason Raina, Guillaume Elgbeili, Tina Montreuil, Tuong-Vi Nguyen, Marc Beltempo, Dian Kusuma, Togas Tulandi, Natalie Dayan, Femmy Yunia Bahroen, Christina Caccese, Ahmad Badageish, Eva Suarthana. (2023). The effect of maternal hypertension and maternal mental illness on adverse neonatal outcomes: A mediation and moderation analysis in a U.S. cohort of 9 million pregnancies. Journal of Affective Disorders. doi: https://doi.org/10.1016/j.jad.2023.01.052 https://www.sciencedirect.com/science/article/pii/S0165032723000629