Poster Presentation - SOMANZ ASM Society of Obstetric Medicine of Australia and New Zealand ASM 2023

Anxiety, depression and posttraumatic stress disorder six-months postpartum following hypertensive disorders of pregnancy and normotensive pregnancy: A P4 and BP2 sub-study. (#41)

Mary Anderson 1 , Lynne M Roberts 2 3 , Amanda Henry 2 4
  1. Women's Health, UNSW Medicine and Health, Sydney, NSW, Australia
  2. Department of Women’s and Children’s Health, St George Hospital, Sydney, NSW, Australia
  3. St George and Sutherland Clinical Campus, School of Clinical Medicine, UNSW Medicine and Health, Sydney, NSW, Australia
  4. Discipline of Women’s Health, School of Clinical Medicine, UNSW Medicine and Health, Sydney, NSW, Australia

Background

Postpartum mental health disorders are common, may be more widespread following a complicated pregnancy and/or birth, and can be detrimental to the woman and her baby. Hypertensive disorders of pregnancy (HDP) affect 5-10% of pregnancies and may be associated with mental health disorders. However, the intersection between HDP and mental health disorders is unclear. Obtaining a greater understanding of psychological consequences, especially in depression, anxiety, and posttraumatic stress disorder (PTSD) following HDP, may allow at-risk women to receive appropriate and targeted screening and support early in the postpartum period.

 

Aim

To describe the prevalence and severity of depression, anxiety, and posttraumatic stress disorder at six-months postpartum after HDP and compare this to those who had normotensive pregnancy (NP). 

 

Method 

Sub-study of the Postpartum, Physiology, Psychology and Paediatric (P4) and Blood Pressure Postpartum (BP2) studies. Baseline demographic and pregnancy data, HDP diagnosis, and birth outcomes were collected from medical records. Women enrolled in the P4 and BP2 studies completed study surveys at six-months postpartum. Surveys included the Edinburgh Perinatal Depression Scale (EPDS), Generalised Anxiety Disorder (GAD-7), and Posttraumatic Stress Disorder Scale (PDS), screening for depression, anxiety, and PTSD respectively (PTSD was only assessed in the P4 study).

 

Results

At six-months postpartum, 895 women completed questionnaires (n=415 from P4, n=480 from BP2). Of these, 27% NP were primiparous versus 73% HDP (p<.001), and HDP-group were more likely to have experienced maternal intensive/acute care (17% versus 1% NP group, p<.001) and/or baby in intensive/special nursery care (38% versus 13%, p<.001). EPDS scores were significantly higher after HDP (median 5, IQR 6) than after NP (median 2, IQR 3) (p<.001). A greater proportion after HDP had EPDS scores suggestive of depression (≥12), n=63 (11%) versus after NP, n=11 (4%), with slightly higher rates after chronic hypertension with superimposed preeclampsia (15%) and preeclampsia (11%) than gestational hypertension (10%) or chronic hypertension alone (8%). Proportion of HDP-group having anxiety scores above threshold (≥10) was also higher than NP-group, n=40 (7%) versus n=9 (3%), (p=0.02). There was no statistically significant difference in PDS scores between the groups.

 

Conclusion

Our study demonstrated significant associations between HDP and postpartum depression and anxiety at six-months postpartum. Therefore, targeted, early postpartum mental health screening and support may be useful in identifying issues with, and improving, women’s mental health following HDP.