The Relationship Between Early Pregnancy Depression, Social Support, and Hypertensive Disorders of Pregnancy: A Prospective Cohort Study in Xuzhou, China.

BACKGROUND

Hypertensive disorders of pregnancy (HDP) are major causes of maternal-neonatal morbidity/mortality. Emerging evidence links early pregnancy depression to HDP, but the interaction of social support, including its potential mediating and moderating roles remains understudied. This prospective cohort study explored the associations between early pregnancy depression, social support, and HDP risk in Xuzhou, China.

METHODS

A cohort of 1,406 pregnant women at ≤12weeks gestation were recruited from a hospital in Xuzhou, China, between July 2024 and July 2025. Depression symptoms and social support were assessed using the Edinburgh Postnatal Depression Scale (EPDS) and the Social Support Rating Scale (SSRS), respectively. HDP was diagnosed according to ISSHP-2021 criteria following participants until delivery. Associations were evaluated using multivariate logistic regression, mediation, and interaction analyses.

RESULTS

Among the participants, 122 (8.6%) cases of HDP were diagnosed. After adjusting for confounders, early pregnancy depression (EPDS ≥13) significantly increased the risk of HDP (aOR = 2.63, CI: 1.67-4.09, p < 0.001). Conversely, high social support (SSRS ≥45) was a protective factor against HDP (aOR = 0.42, 95% CI: 0.20-0.85, p < 0.001). Mediation analysis further revealed that social support partially mediated the depression-HDP association, accounting for 13.6% of the total effect.

CONCLUSION

This prospective study demonstrates that first-trimester depressive symptoms increase the risk of HDP, and social support not only directly protects women but also partially mediates the adverse effect of depression. Our findings highlight that early psychological screening and enhancing social support during the first trimester could be crucial strategies for HDP prevention.