title: PP105. Mental health problems following preeclampsia or HELLP syndrome: Do we have a case? A systematic review.
abstract: BACKGROUND
  Women who suffered from pregnancy complications seem at higher risk for mental health problems. A common pregnancy complication is preeclampsia (PE) and the HELLP syndrome.
  
  
  OBJECTIVE
  To review the literature and to investigate whether former PE/HELLP patients are more likely to have mental health problems or more severe mental health problems, as compared to women without a history of PE/HELLP, and to investigate whether PE/HELLP is an independent risk factor for developing mental health problems.
  
  
  METHODS
  We performed a systematic search on PubMed and PsycInfo in July 2011. Studies had to present original data, consider postpartum depression, anxiety, or posttraumatic stress as outcomes, include both women with a history of PE/HELLP syndrome and at least one comparison group of women who had not experienced PE/HELLP, present the results for each group separately, or present the results of a multivariate regression analysis in which the diagnosis of PE/HELLP was considered as a factor, or both. Information on study design, participants and outcomes of interest for the current review were extracted using a prespecified form. Furthermore, a short critical appraisal checklist was used in order to evaluate the appropriateness of the studies in light of our specific review questions. For the purpose of the second review question, confounder control and handling of intermediate variables were specifically considered important.
  
  
  RESULTS
  The search resulted in 227 articles, of which six were included. Four studies were historical cohort studies, two prospective. With respect to depression, the evidence is mixed. Out of the six studies addressing depression, all studies showed positive associations between PE/HELLP and the prevalence of depression or severity of depressive symptoms. However, the results of three of them were not statistically significant. The two studies addressing anxiety did not show a statistically significant association between PE and anxiety scores, although differences were in the expected direction (i.e. higher scores among women with PE). In the four studies addressing posttraumatic stress, associations were generally in the expected direction (i.e. higher prevalence and severity among women with PE/HELLP), but only a minority of them was statistically significant or partly significant. In most studies, confounder control was poor.
  
  
  CONCLUSIONS
  Current evidence supporting a higher prevalence and an increased severity of mental health problems after PE/HELLP than after an uneventful pregnancy is inconclusive. Future studies should be prospective in design and should control for more possible confounders.
authors.affiliation: Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht, the Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Delahaije
authors.affiliation: Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht, the Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Dirksen
authors.affiliation: Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Peeters
authors.affiliation: Department of Epidemiology, Maastricht University, Maastricht, the Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Smits