Antepartum mental health disorders and hypertensive disorders of pregnancy: a retrospective cohort study using the premier healthcare administrative database (2016-2020).

BACKGROUND

The relationship between mental health disorders and hypertensive disorders of pregnancy is unclear. Our objective was to examine antepartum mental health disorders as risk factors for hypertensive disorders of pregnancy in a nationwide United States database.

METHODS

We performed a retrospective cohort study using the Premier Healthcare Administrative Database in obstetric patients ≥18 years who delivered from 1/10/15 to 12/31/20. Exposures were antepartum (<20 weeks gestation) non-psychotic depressive, anxiety, and/or bipolar disorders ascertained by ICD-10 codes. Primary outcomes were hypertensive disorders (gestational hypertension, preeclampsia with and without severe features) diagnosed during birth hospitalization. A multivariable logistic regression model was used to examine associations of antepartum mental health disorders with hypertensive disorders adjusting for shared risk factors that were identified a priori.

RESULTS

861,177 patients met inclusion criteria. Compared with an incidence of 13.1% of hypertensive disorders in patients without antepartum mental health disorders, patients with antepartum mental health disorders had increased odds of having a hypertensive disorder: depressive disorders (incidence 17.1%, adjusted odds ratio (aOR) 1.06, 95% confidence interval (CI) 1.03-1.09, E-value 1.21); anxiety (incidence 15.9%, aOR 1.22, CI 1.19-1.25, E-value 1.67); both depressive and anxiety disorders (incidence 18.2%, aOR 1.19, CI 1.16-1.23, E-value 1.59); bipolar disorders (incidence 16.8%, aOR 1.09, CI 1.04-1.15, E-value 1.24).

CONCLUSIONS

Antepartum mood and anxiety disorders were associated with increased odds of hypertensive disorders, with anxiety conferring the highest odds. Our study highlights mental health disorders, particularly anxiety, as potential modifiable contributors to hypertensive disorders, offering an important yet underrecognized opportunity for intervention.