Comparing functionality, anxiety and depression during pregnancy and postpartum in women with hypertensive disorders: Findings from the WOICE assessment.

OBJECTIVE

To describe the use of the WOICE tool for assessing non-severe maternal morbidities among pregnant and postpartum women with hypertensive disorders.

METHODS

Secondary analysis of a previously published cross-sectional study performed in Brazil, with the inclusion of women with hypertensive disorders (pre-eclampsia, chronic hypertension, and gestational hypertension), comparing them in the antenatal and postpartum periods. The WOICE tool was applied during 28 weeks of gestational age and in the 40th day after delivery. The study was conducted at a referral maternity hospital between November 2017 and December 2018. Descriptive and comparative analyses were performed using appropriate statistical tests. Prevalence ratio (PR) identified factors associated with functional impairment were assessed through multivariable analysis.

RESULTS

Of 1046 women, 238 had hypertensive disorders and were included (99 pregnant, 139 postpartum). The mean age was 30 years old in both groups. Most participants had completed secondary education and were married. Among women in the postpartum period, there was a significant decrease in the frequency of employed women (P = 0.009). Functional impairment was reported in 40.4% versus 12.2% (P < 0.001); anxiety affected 31.3% versus 14.4% (P < 0.001); depressive symptoms were present in 13.1% versus 4.3% (P < 0.001), respectively, ante- and postpartum. Substance use was similar (13.1% vs. 14.4%). Risk of violence was reported by 7.1% of pregnant and 5.0% of postpartum women (P = 0.581). Having pre-existing conditions (PR 2.40, confidence interval [CI]: 1.28-4.51, P = 0.006) and anxiety (PR 2.75, CI: 1.31-5.77, P = 0.008) were associated with impaired functioning in prenatal care. Breastfeeding protected women from impaired functioning in the postpartum period (PR 0.12, CI: 0.02-0.69, P = 0.017), while having pre-existing conditions (PR 4.40, CI: 2.29-8.74, P < 0.001) increased the risk during the postpartum period.

CONCLUSION

Anxiety, depression, and functional impairment were frequent among women with hypertensive disorders during pregnancy, occurring during antenatal and postpartum care. These findings highlight the need of routine maternal mental health screening and multidisciplinary care to identify and properly treat women affected by those conditions.