Psychological distress during pregnancy and the development of pregnancy-induced hypertension: A prospective study

Objective
Pregnancy-induced hypertension (PIH) is associated with serious complications in both the mother and the unborn child. We examined the possible association between trajectories of maternal psychological distress symptoms and PIH separately in primiparous and multiparous women.

Methods
Pregnancy-specific negative affect (P-NA) and depressive symptoms were assessed prospectively at each trimester using the Tilburg Pregnancy Distress Scale (TPDS) pregnancy negative affect subscale (P-NA) and the Edinburg Depression Scale (EDS). Data on PIH were collected from medical records. Growth mixture modeling analysis was used to identify trajectories of P-NA and EDS. The independent role of P-NA and EDS symptom trajectories on developing PIH was examined using multivariate logistic regression models.

Results
100 (7.6%) women developed PIH and were compared to 1219 women without hypertension or other complications during pregnancy. Three P-NA trajectories were identified: low-stable (reference group, 90%), decreasing (5.2%), and increasing (4.8%). The latter two classes showed persistently and significantly higher P-NA symptoms during pregnancy compared to the reference group. In multiparous women, high P-NA scores (belonging to classes 2 and 3) were related to PIH [odds ratio (OR) = 6.91, 95% confidence interval (CI) = 2.26-21.2], independent of body mass index (OR = 1.17, 95% CI = 1.06-1.27) and previous PIH (OR = 14.82, 95% CI = 6.01-32.7). No associations between P-NA and PIH were found in primiparous women. EDS trajectories were not related to PIH in both primiparous and multiparous women.

Conclusions
In multiparous women, persistently high levels of P-NA symptoms but not depressive symptoms were independently associated with development of PIH.