Pre-existing Hypertension May Be an Indicator of Depression Risk in Pregnant Women

A history of high blood pressure may be indicative of future physical as well as psychiatric problems, according to a new study published in General Health Psychiatry. The study found an association between preexisting hypertension, but not pregnancy-induced hypertension, and risk for depression.

Dr Wayne Katon, professor of psychiatry and behavioral sciences and adjunct professor of health services at the University of Washington, and colleagues conducted a prospective study, following 2,398 women who were receiving ongoing prenatal care at a university-based obstetrics clinic from January 2004 through January 2009. Information on use of antidepressant as well as the Patient Health Questionnaire-9 was used to determine depression prevalence. The Obstetrician International Classification of Diseases, Ninth Revision codes, was used to determine prevalence of preexisting hypertension, pregnancy-induced hypertension and preeclampsia/eclampsia.

Compared to women without hypertension, Katon and colleagues found that patients with preexisting hypertension had an increased risk of depression (odds ratio=1.55) and an increased risk of major depression and/or use of antidepressants (odds ratio =1.65). This finding was evident after adjusting for sociodemographic variables, chronic medical conditions, smoking, and prior pregnancy complications. Katon and colleagues did not find any differences in risk of depression in women with pregnancy-induced hypertension or preeclampsia/eclampsia compared to those without hypertension.

Previous studies have found a link between pregnancy-induced hypertension and depression, but pre-existing hypertension and depression had not been previously explored. This issue is of great clinical importance since women with pre-existing hypertension are likely to have issues with other chronic medical conditions, including diabetes and obesity. Since depression in patients with chronic medical conditions often lead to noncompliance, it is crucial to identify depression so appropriate treatment can ensue.

As such, Katon and colleagues noted, “Women with preexisting hypertension, but not pregnancy-induced hypertension, are more likely to meet criteria for an antenatal depressive disorder and/or to be treated with antidepressants and could be targeted by obstetricians for screening for depression and enhanced treatment.”

This is especially important since depression can also affect the postpartum process for both the woman and her child. In a statement to the press, Katon explained, “Depression during pregnancy is associated with postpartum depression, problems bonding with the baby, and overall, has a large and detrimental impact on both mom and baby.”

“To my knowledge, very few obstetricians do any formal screening for depression during prenatal check-ups,” Katon added. “They do screen for hypertension. In women with pre-existing hypertension, it is essential to screen for depression at the four month checkup, given the risk of negative birth outcomes and non-adherence to hypertension treatment.”

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References:

References:
Katon WJ, Russo JE, Melville JL, et al. Gen Hosp Psychiatry. 2011 Nov 2 [Epub].Health Behavior News Service. Pre-existing hypertension linked to depression in pregnant women. Press release. Nov. 18, 2011.