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Association Between Mental Stress and Gestational Hypertension/Preeclampsia: A Meta-Analysis

Zhang, Shanchun MD, PhD*; Ding, Zheyuan MD; Liu, Hui MD; Chen, Zexin MD; Wu, Jinhua MD; Zhang, Youding MD§; Yu, Yunxian MD, PhD*

Obstetrical & Gynecological Survey: December 2013 - Volume 68 - Issue 12 - p 825–834
doi: 10.1097/OGX.0000000000000009
CME Articles

Background: Hypertensive disorders of pregnant women are one of the important causes of maternal and perinatal morbidity and mortality. Evidence showed mental stress might be a risk factor of gestational hypertensive disorders.

Objective: The objective of this study was to evaluate the relationships between mental stress and gestational hypertension/preeclampsia in pregnant women.

Methods: Relevant studies were identified by PubMed, Cochrane, Chinese medical datasets (Wanfang, CNKI, and VIP Database). Only case-control or cohort studies evaluating an association of preeclampsia or gestational hypertension with mental stress were included in the present meta-analysis. Essential information was extracted from the qualified studies. Odds ratio (OR) was used as a pooled effect size. Potential heterogeneity and publication bias were detected as well.

Results: Thirteen studies were included in the final analyses, which totally recruited 668,005 pregnant women. The results indicated that mental stress was associated with an increased risk of gestational hypertension (OR, 1.26; 95% confidence interval [CI], 1.00–1.59; P = 0.047) and preeclampsia (OR, 1.49; 95% CI, 1.27–1.74; P < 0.001). Meanwhile, work stress (OR, 1.50; 95% CI, 1.15–1.97; P = 0.003) and anxiety or depression (OR, 1.88; 95% CI, 1.08–3.25; P = 0.02) were positively associated with risk of preeclampsia.

Conclusions: Mental stress during life or pregnancy may be a risk factor for gestational hypertension and preeclampsia among pregnant women.

Target Audience: Obstetricians and gynecologists, family physicians

Learning Objectives: After completing this CME activity, physicians should be better able to evaluate the mental stresses that put patients at risk for preeclampsia and gestational hypertension, identify risk factors for preeclampsia and gestational hypertension, and determine possible measures to prevent preeclampsia and related conditions.

*Associate Professor, †Medical Student, Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University; Chronic Disease Research Institute, School of Public Health, School of Medicine, Zhejiang University, Hangzhou; and ‡Associate Chief Physician, §Chief Physician, Zhoushan Maternal and Child Health Hospital, Zhoushan, Zhejiang, China

All authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.

S.Z. and Z.D. equally contributed to the manuscript.

This work was partly supported by the Natural Science Foundation of Zhejiang Province, China (grant Y2100505) and the National Key Technology R&D Program of China (grant 2009BAI80B01) and the Foundation of Department of Science & Technology of Zhejiang (grant 2009C33135).

Correspondence requests to: Yunxian Yu, MD, PhD, Associated professor, Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University; Chronic Disease Research Institute, School of Public Health, School of Medicine, Zhejiang University. 866 Yu-Hang-Tang Rd, Xihu District, Hangzhou 310058, Zhejiang, China. E-mail: yunxianyu@zju.edu.cn.

© 2013 by Lippincott Williams & Wilkins.