"Our goal is to better understand maternal depression, anxiety and related medications in relation to risk of maternal hypertension (HTN) disorders, i.e. chronic hypertension (CH), Gestational hypertension (GH), and preeclampsia (PE). We first systematically reviewed relevant literature by searching electronic databases PubMed and EMBASE from inception to May 2017. Observational studies were included if they were published in the English language and assessed the association of pre-pregnancy and/or pregnancy depression, anxiety, or antidepressant medication use with maternal HTN disorders. A total of 29 studies meeting these criteria were critiqued and findings summarized. Reports of pre-pregnancy depression/anxiety and chronic hypertension (CH) were few and results were inconsistent. Most failed to find a compelling link between pre-pregnancy depression/anxiety and GH or PE. Pregnancy depression /anxiety was associated with PE in some studies but not others. A majority of studies reported higher rates of PE and GH among women taking antidepressants.. It is unresolved whether the increased risk for PE and GH represents a direct effect of medication or the severity of the disorder marked by pregnancy medication use. We next conducted our own study to further explore maternal mental health in relation to HTN disorders of pregnancy. Working with Blue Cross Blue Shield of Michigan (BCBSM) we examined medical and pharmacy claims data of women who met our study eligibility criteria, i.e. singleton pregnancy ending in live birth between October-1-2010 and September-30-2014,15-44 years of age at delivery, and 75% continuous enrollment in medical and pharmacy claims for 2 years prior to last menstrual period (LMP). These data were then linked with birth certificate data to obtain an analytic sample of 12,647 women. We used International Classification of diseases ninth revision Clinical modification (ICD-9CM) to assess depression, anxiety, and HTN disorders of pregnancy from medical claims, and National Drug Codes (NDC) to get antidepressant and anxiolytic medication prescription data from pharmacy claims. In our analytic sample the majority of HTN disorders were pregnancy hypertension (PH) which includes PE and GH. Approximately 10.6% of all women had a depression or anxiety diagnosis (defined as 2265 1 inpatient or 2265 2 outpatient visits) in the study period; only 0.9% first met the diagnostic criteria for depression during pregnancy CH was positively associated with antidepressant and anxiolytic medication use prior to and during pregnancy. PH was associated with: 1) antidepressant use prior to pregnancy only; 2) antidepressant use prior to and during pregnancy; and 3) initiation of anxiolytic medication during pregnancy. CH and PH were not associated with depression or anxiety among non-users of medications. Our observations reinforce the importance of pre-pregnancy mental health and related medication assessment; this information may help in risk stratification for HTN disorders of pregnancy, plans for greater surveillance during prenatal care and development of prevention strategies. Clearly, the benefits of controlling maternal depression symptoms must be weighed against any excess risk posed by medication."--Pages ii-iii.
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