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Hypertensive Disorders of Pregnancy and Symptoms of Depression and Anxiety as Related to Gestational Age at Birth

Findings From the All Our Families Study

Horsley, Kristin J., BA; Tomfohr-Madsen, Lianne M., PhD; Ditto, Blaine, PhD; Tough, Suzanne C., PhD

doi: 10.1097/PSY.0000000000000695

Objective The aim of the study was to investigate whether symptoms of depression or state anxiety changed the strength or nature of the association between hypertensive disorders of pregnancy (HDP) and gestational age at birth.

Methods We conducted a secondary analysis of data from the All Our Families Cohort, a prospective pregnancy cohort study based in Calgary, Alberta, Canada. Self-reported depressive symptoms and state anxiety were assessed between 3 and 5 months of gestation, and obstetrical information, including diagnosis of HDP, parity, type of delivery, and gestational age at birth, was retrieved from the maternal discharge abstract. All models were adjusted for sociodemographic and obstetric confounders.

Results Of 2763 women who had a singleton pregnancy and live birth, 247 (9%) were diagnosed with HDP. Women with HDP had significantly shorter gestational length relative to those without the diagnosis (M = 37.87 versus M = 38.99 weeks of gestation), t(2761) = 9.43, p < .001. Moderation analyses showed significant HDP by depressive symptoms and HDP by state anxiety interactions, such that the strength of the association between HDP and gestational age at birth increased alongside greater depressive symptom and state anxiety severity.

Conclusions Results suggest that depressive symptoms and state anxiety may add to the increased risk for shortened gestation associated with HDP. Women at high risk of cardiovascular complications during pregnancy may benefit from additional resources to manage symptoms of depression or anxiety.

From the Department of Psychology (Horsley and Ditto), Faculty of Science, McGill University, Montreal, Quebec; Department of Psychology (Tomfohr-Madsen), Faculty of Arts, University of Calgary, Alberta; and Department of Pediatrics and Community Health Sciences (Tough), Cumming School of Medicine, University of Calgary, Alberta, Canada.

Address correspondence to Kristin J. Horsley, BA, Department of Psychology, McGill University, 2001 Avenue, McGill College, Montreal, Quebec H3A 1G1. E-mail:

Received for publication July 27, 2018; revision received January 31, 2019.

Online date: April 15, 2019

Copyright © 2019 by American Psychosomatic Society
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