title: The combined association of psychosocial stress and chronic hypertension with preeclampsia.
abstract: OBJECTIVE
  This study aims to evaluate perceived lifetime stress, perceived stress during pregnancy, chronic hypertension, and their joint association with preeclampsia risk.
  
  
  METHODS
  This study includes 4314 women who delivered a singleton live birth at the Boston Medical Center from October 1998 through February 2008. Chronic hypertension was defined as hypertension diagnosed before pregnancy. Information regarding lifetime stress and perceived stress during pregnancy was collected by questionnaire. Preeclampsia was diagnosed by clinical criteria.
  
  
  RESULTS
  Lifetime stress (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.6-2.9), perceived stress during pregnancy (OR, 1.7; 95% CI, 1.3-2.2), and chronic hypertension (OR, 10.4; 95% CI, 7.5-14.4) were each associated with an increased risk of preeclampsia. Compared to normotensive pregnancy with low lifetime stress, both normotensive pregnancy with high lifetime stress (OR, 2.1; 95% CI, 1.6-2.9) and pregnancy with chronic hypertension and low lifetime stress (OR, 10.2; 95% CI, 7.0-14.9) showed an increased risk of preeclampsia, while pregnancy with high lifetime stress and chronic hypertension yielded the highest risk of preeclampsia (OR, 21.3; 95% CI, 10.2-44.3). The joint association of perceived stress during pregnancy and chronic hypertension with preeclampsia was very similar to that of the joint association of lifetime stress and chronic hypertension with preeclampsia.
  
  
  CONCLUSIONS
  This finding indicates that high psychosocial stress and chronic hypertension can act in combination to increase the risk of preeclampsia up to 20-fold. This finding underscores the importance of efforts to prevent, screen, and manage chronic hypertension, along with those to reduce psychosocial stress, particularly among women with chronic hypertension.
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University, Hangzhou, Zhejiang, China.
authors.forename: Yunxian
authors.initials: Y
authors.lastname: Yu
authors.forename: Shanchun
authors.initials: S
authors.lastname: Zhang
authors.forename: Guoying
authors.initials: G
authors.lastname: Wang
authors.forename: Xiumei
authors.initials: X
authors.lastname: Hong
authors.forename: Eric B
authors.initials: EB
authors.lastname: Mallow
authors.forename: Sheila O
authors.initials: SO
authors.lastname: Walker
authors.forename: Colleen
authors.initials: C
authors.lastname: Pearson
authors.forename: Linda
authors.initials: L
authors.lastname: Heffner
authors.forename: Barry
authors.initials: B
authors.lastname: Zuckerman
authors.forename: Xiaobin
authors.initials: X
authors.lastname: Wang
mesh_terms: D000328:Adult; D002908:Chronic Disease; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000523:psychology; D016017:Odds Ratio; D011225:Pre-Eclampsia / Q000453:epidemiology* / Q000523:psychology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology* / Q000523:psychology; D012307:Risk Factors; D013315:Stress, Psychological / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: chronic hypertension; combined effect; preeclampsia; psychosocial stress