title: Association between pre-pregnancy depression/anxiety symptoms and hypertensive disorders of pregnancy.
abstract: BACKGROUND
  Depression and anxiety symptoms have been linked with hypertensive disorders during pregnancy, but these associations have not been fully elucidated. Our objective was to consider hypertension in pregnancy and its subtypes (chronic hypertension, gestational hypertension, preeclampsia) and evaluate whether the proximity of psychological symptoms to pregnancy informs any associations observed.
  
  
  METHODS
  Pregnancy Outcomes and Community Health Study participants who provided interview data at enrollment (16-27 weeks' gestation) and whose hypertensive disorder status was abstracted from medical records were eligible for inclusion (n=1371). Maternal history of depression/anxiety symptoms at four time points in the life course were ascertained via self-report at enrollment (i.e., lifetime history, 1 year prior to pregnancy, since last menstrual period, and past week). Weighted logistic regression models were used to examine depression/anxiety symptom measures in relation to hypertensive disorders (overall) and subtype.
  
  
  RESULTS
  Following adjustment for maternal sociodemographic factors, smoking, and prepregnancy body mass index, prepregnancy depression or anxiety symptoms (i.e., lifetime history and 1 year prior to pregnancy) were associated with hypertensive disorders during pregnancy. Subtype analyses revealed that these associations were driven primarily by chronic hypertension (adjusted odds ratios=2.7-3.5). Preeclampsia accompanied by preterm delivery was also linked to women's lifetime history of depression symptoms (odds ratio=2.3, 95% confidence interval 1.0-5.2).
  
  
  CONCLUSIONS
  Our results suggest that the link between maternal chronic hypertension and depression/anxiety symptoms precedes pregnancy. In addition, prepregnancy history of depression/anxiety symptoms may be considered part of a risk profile for preterm preeclampsia.
authors.affiliation: Department of Epidemiology & Biostatistics, Michigan State University , East Lansing, Michigan.
authors.forename: Madhavi K
authors.initials: MK
authors.lastname: Thombre
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Talge
authors.forename: Claudia
authors.initials: C
authors.lastname: Holzman
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000503:physiopathology* / Q000523:psychology; D015992:Body Mass Index; D003863:Depression / Q000503:physiopathology* / Q000523:psychology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000503:physiopathology*; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology / Q000523:psychology; D007231:Infant, Newborn; D016017:Odds Ratio; D011225:Pre-Eclampsia / Q000453:epidemiology / Q000523:psychology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000523:psychology; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000150:complications / Q000453:epidemiology