Investigating relationships between psychological distress and hypertensive disorders of pregnancy
Date
2021-12
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Abstract
Background: Hypertensive disorders of pregnancy (HDP) are a leading cause of pregnancy-related death worldwide. Psychological distress has been implicated in the development and progression of hypertensive disorders in non-pregnant populations; however, while pregnancy is a time of increased physical and emotional stress for many people, our understanding of the role of psychological health and development of HDP is limited. This dissertation expands the literature investigating the relationship between psychosocial factors and HDP through three distinct projects. Methods: The first manuscript was a meta-analysis that systematically reviewed and analyzed all current research investigating the relationship between depression and anxiety experienced during pregnancy and associations with HDP. The second manuscript applied artificial intelligence-driven machine learning methods to create a predictive model of HDP that included biologic, demographic, and psychosocial characteristics. The third manuscript was an analysis of blood pressure trajectories over the course of pregnancy using a functional data analysis approach, with an exploratory investigation of baseline factors that could differentiate between them. Data for the second and third manuscripts was obtained through the Alberta Pregnancy Outcomes and Nutrition (APrON) study. Results: The meta-analysis literature search identified 6291 citations, and ultimately 44 studies were included that captured data from 61.2 million pregnancies. Depression and/or anxiety were associated with increased risk of HDP (RR=1.39; 95% CI, 1.25-1.54). The second analysis included 1108 participants, with 75 (6.8%) identified as having HDP at delivery. The model predicting HDP generated an average accuracy of 65% using exclusively biologic, demographic, physical and psychosocial characteristics. The highest ranked predictors were body mass index (BMI), nulliparity, weekly physical activity, stressful life events during pregnancy, and age. The third analysis of blood pressure trajectories during pregnancy detected three dominant patterns of blood pressure variation: late pregnancy (64.8% in SBP and 63.4% in DBP variance), early pregnancy (13.21% in SBP and 13.43% in DBP variance), and mid-pregnancy (8.51% in SBP and 8.63% in DBP variance). HDP were associated with a trajectory of increased blood pressure in late pregnancy. Conclusion: Understanding possible psychological contributions to hypertensive risk during pregnancy is critical given the high prevalence of these conditions and both the immediate and longstanding impact on maternal and fetal health. These investigations furthered the understanding of the relationship between psychological health and cardiovascular health during pregnancy.
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Keywords
hypertensive disorders of pregnancy, health psychology, perinatal mental health
Citation
Shay, M. (2021). Investigating relationships between psychological distress and hypertensive disorders of pregnancy (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.