During the study period, 3347 women completed at least one psychosocial screening questionnaire at four months gestation, during the third trimester, or postpartum (). Staff were present to consent 2577 (77%) for study enrollment. A total of 227 (6.8%) declined to participate in this part of the study and 543 (16.2%) left the clinic before they could be consented. Of the 2577 women who consented, 2398 (93.1%) completed the psychosocial screen at four months gestation or during the third trimester and were eligible for this study. A total of 2071 (86.4%) were in the No Depression group, 327 (13.6%) were in the Any Depression group, and 235 (9.8%) were in the Major Depression group. Although 120 of 154 patients who were taking antidepressants did not meet criteria for minor or major depression, they had a higher mean depression severity score on the PHQ-9 compared to patients who did not meet minor or major depression criteria and were not taking antidepressants ( = = 4.7 ± 3.3 vs.
= 2.7 ± 2.5, t = 6.55 (df = 2189), p < 0.0001)).
The hypertension groups differed in education, number of chronic conditions, number with a prior pregnancy, gestational week at screening and past pregnancy complications (). Planned post hoc comparisons revealed that the group with pre-existing hypertension compared to those without hypertension during pregnancy had significantly less education (p = 0.005), more chronic medical conditions (p < 0.0001), were more likely to have a prior pregnancy (p < 0.0001), to be screened earlier in pregnancy (p = 0.02) and to have a history of prior pregnancy complications (p < 0.0001). Women with pregnancy-related hypertension compared to those with pre-existing hypertension had fewer prior pregnancies (p < 0.0001) and were less likely to have a history of pregnancy-related complications (p < 0.0001). Women with pregnancy-related hypertension did not differ on any variable compared to those with no hypertension.
shows that the three groups had significant differences on all of our depression outcome variables, with the exception of a trend level finding for probable major depression (p = 0.07). Planned post hoc comparisons revealed that these differences were due primarily to greater depression severity or a higher percentage using antidepressants in the pre-existing hypertension group in comparison to those without hypertension (p’s ranged from 0.02 to < 0.0001). Compared to women with pregnancy related hypertension only, women with pre-existing hypertension reported significantly higher prevalence of Any Depression (minor, major or treatment with antidepressants (p = 0.02)) and minor depression (p = 0.02). Women with pregnancy-related hypertension did not differ on any depression variable compared to those with no hypertension.
shows the result of the logistic regression analyses. After controlling for sociodemographic variables, the number of chronic medical conditions, smoking and prior pregnancy-related complications, women with pre-existing hypertension compared to pregnant women without hypertension were approximately 55% more likely to meet criteria for Any Depression (probable minor, major or use of antidepressants) and 65% more likely to meet criteria for Major Depression and/or use of antidepressants. Pregnancy-related hypertension was not associated with an increased risk of Any Depression or Major Depression.
Table 3 Odds ratios (95% CI) for any depression (probable minor or major) or antidepressant use and major depression (probable major depression or antidepressant use) among pregnant women (N = 2398) with pre-existing (N = 418) or pregnancy-related hypertension (more ...)
The sensitivity analysis that excluded patients currently taking antidepressants who did not meet criteria for minor or major depression from our depression diagnoses found similar odds ratios for the association of major depression with preexisting hypertension (OR = 1.37, 95% CI 0.79 – 2.38) and major and minor depression with preexisting hypertension (OR = 1.44, 95% CI 0.96 – 2.15), but with less certainty in confidence intervals due to lower rates of patients meeting each of these depression criteria.
shows the result of the sensitivity analysis in which we separated the pre-existing hypertension group into those with and without superimposed preeclampsia during pregnancy. Women with pre-existing hypertension without superimposed preeclampsia had an approximately 2-fold increased risk of Any Depression (OR = 1.93, 95% CI 1.08, 3.09) and also had a nonsignificant trend toward a higher rate of Major Depression and/or use of antidepressants (OR = 1.62, 95% CI 0.88, 2.98) compared to women without hypertension. Women with pre-existing hypertension with superimposed preeclampsia had a nonsignificant trend toward a higher rate of Any Depression (OR = 1.42, 95% CI 0.93, 2.16) and a significantly higher rate of Major Depression and/or use of antidepressants (OR = 1.66, 95% CI 1.04, 2.65).
Table 4 Odds ratios (95% CI) for Any Depression (Minor or Major) or Antidepressant Use and Major Depression or Antidepressant Use Among Pregnant Women with Pre-existing Only (N = 131), Pregnancy-Related Only (N=347) and Pre-existing with superimposed preeclampsia (more ...)
Our next sensitivity analyses found no association with either Any Depression or Major Depression and/or use of antidepressants with preeclampsia/eclampsia ICD-9 diagnoses (OR = 0.87, 95% CI 0.61, 1.25) and (OR = 0.94, 95% CI 0.62, 1.41), respectively) in fully adjusted models. A last sensitivity analysis found no association between SSRI use and preeclampsia (OR = 1.09, 95% CI 0.66, 1.82).