Meta-Analysis of Depression and Anxiety in Early Pregnancy and Its Risk for Preeclampsia

Abstract

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Handling depression is one of the greatest challenges facing pregnant women across the globe. The level of antenatal depression and anxiety has a prevalence rate of above five percent but less than twelve. Escalated depression has been associated with increasing maternal and infant mortality because of the development of secondary disorders such as preeclampsia and other obstetric-related conditions. The objective of this meta-analysis is to determine the relationship that exists between depression and anxiety and preeclampsia in early pregnancy. The paper considered seven major studies that discussed anxiety, depression, and preeclampsia from the PubMed database. The paper has presented the main conclusions of the studies consulted as well as the methodologies used to gather the results. The meta-analysis focused on antenatal depression and anxiety by looking at the risk factors and prevalence. A comparison is made for preeclampsia to draw the interrelation. Based on the seven publication as well as other supportive literature, the paper has outlined the etiology relating to preeclampsia as well as the scholarly analysis. The consolidation of the results from the research papers consulted formed the baseline for the assessment of the pathogenesis and future direction. The paper concludes that there is a need for further scholarly analysis; nevertheless, the existing literature has ascertained the existence of a correlation between antenatal anxiety and depression and preeclampsia.

Table of Contents

Introduction

Depression and anxiety among pregnant women is a common condition that has been reviewed and examined over the years. Worth pointing out is that frequent exposure to hypertensive disorders has been associated with different health complications that contribute to increasing maternal as well as fetal mortality. One of the common disorder is preeclampsia, which is a hypertensive condition among pregnant women that is exhibited after the first 20 weeks (3). The disorder has been investigated in different studies with limited finding regarding the etiology. Such outcomes have contributed to the need for extensive analysis of the risk factors, implication, and prevention measures to ascertain the rate of diagnosis among pregnant women. An estimation of about 2-7% of pregnancies across the globe is at risk of being associated with preeclampsia (1). The percentage of diagnosis is high as compared to the general hypertensive tendency in early pregnancy, which stands at about 8%. Currently, several risk factors have been identified as contributing factors such as lifestyle, sleep disorder, high hemoglobin, and psychological factors (1).

On the other hand, different studies have been carried out to determine the effects emanating to exposure to depression and anxiety during the early pregnancy among women. The studies have examined various risk factors and correlation to other condition and psychometrics elements. However, the key concern regarding depressive tendencies and anxiety among pregnant women is in line with the prevalence of preeclampsia. Most studies have been centered on the correlation between stress-based diagnosis and the onset of preeclampsia (1). The condition has been noted to have a high prevalence and risk factors, which contributes to increasing maternal and infant mortality. Nevertheless, the large number of scholarly evaluations have been associated with limited etiological validity that reveals the reasons why preeclampsia is common during early pregnancy (1). The meta-analysis approach that has been undertaken in this review has considered multiple results from the various key studies carried out to determine the extent to which the existing gaps in research have been filled. On the other hand, the focus on etiology presented in the studies included in this paper is meant to expound on the risk factors and prevalence rates associated with the relationship between depression and anxiety and preeclampsia during early pregnancy.

MethodsThe existing studies have focused on different approaches to achieve the intended objectives in line with the nature of factors being investigated. A study that focused on the assessment of the level of anxiety among pregnant women in line with the prevalence of preeclampsia considered a case-control approach (1). In the research, the methodology allowed for assessment of 150 pregnant women diagnosed with preeclampsia while a control experiment involved other 150 women without the condition (1). Case-control approaches have been used extensively whenever a comparative approach is required to evaluate the implication of the disorder based on existing health status of those under investigation. In such a case, other control factors necessary for reliable and valid analysis are incorporated. Moreover, a cross-sectional approach is also common when examining the effect of depression and anxiety among women during early pregnancy. Research that evaluated the level of prevalence and risk factors among pregnant women at a Rio de Janeiro, Brazil health facility considered a cross-sectional analysis of over 330 women (2). The evaluation of the risk factors was carried out over a period of one year, which focused on demographic factors, social orientations, violence during pregnancy, and medical conditions such as obstetrical tendencies.

Other studies have been based on a mixed approach where the qualitative and quantitative measures have been included to ascertain the implication of depression and anxiety associated with early pregnancy. The assessment of pregnant women screened in obstetrics environment and depicted depressive symptoms included the evaluation of the 3472 women (3). The variables that were examined included the specific risk factors that lead to mood symptoms during the early stages of the pregnancy. Therefore, having a segregated analysis based on factors such as age cluster, the number of visits, and use of tobacco and alcohol was necessary to ascertain the level of contributing elements based on metric and non-metric assessments (3). On the other hand, a prospective population-based evaluation has been essential in measuring the degree of risk for preeclampsia among women diagnosed with depressive symptoms and anxiety. Research that examined 623 nulliparous women with singleton pregnancies involved the examination of the main symptoms among women whose blood pressure was above 140/100 mmHg (4). Therefore, the methodology was necessary to distinguish preeclampsia-specific risk factors from the Beck Depression vulnerability. However, the level of depression and anxiety remained the baseline variable to the assessment of preeclampsia diagnosis as well as the magnitude of prevalence.

FindingsThis meta-analysis focused on seven key studies that examined the risk factors associated with the onset of preeclampsia among women during early pregnancy. The studies examined the behaviors linked to depression and anxiety and the relation to the condition. Most studies have reviewed the rate at which pregnant women developed the disorder; however, the approach to the variables being examined has been different. A study seeking to examine the relationship between escalated anxiety among pregnant persons and the beginning of preeclampsia symptoms found out that the correlation was weak (1). In fact, both the sampled group as well as the control population all depicted anxiety tendencies; however, among those diagnosed with preeclampsia, only 26.7% showed depressive symptoms while 10.7% of the control group were also diagnosed with anxiety (1). Therefore, based on the values that characterized the evaluation process, anxiety presents preeclampsia risk of about 2.9 fold when compared with those not diagnosed with depression (1). Nevertheless, the results relating to this research was different from the other four studies based on the nature of the variables, population samples, and control factors examined in assessments.

Moreover, other studies examining the effect of depression and anxiety in line with the diagnosis of preeclampsia among women considered the use of Composite International Interview. Based on the analysis of over 331 women during early pregnancy, the rate of prevalence of depression was estimated to be 14.2%, with a significant rate of preeclampsia development of less 3.7% (2). Most of the factors that were dominant when examining the risk elements included the previous history of psychiatry-related conditions, nature of casual labor, unplanned pregnancy, and several serious illnesses diagnosed during the pregnancy period (2). On the other hand, the results depicted the need for the screening of the contributing factors within a setting where the pregnant women involved in the study are receiving care. Moreover, a mixed approach study that evaluated 3472 pregnant women above 18 years old using screening questionnaire revealed a 20% showed the risk of developing depression while 13.8% were diagnosed with depressive disorder and anxiety (3). The report linked several factors as the contributors of the prevalence, which included health factors, use of constituents such as alcohol and tobacco, and social factors such as unemployment and lower education attainment. Although the need for higher validity was clear, the study evaluated various risk elements, and the sampled population was significant (3).

Furthermore, other scholarly findings have associated depression with 4.5% preeclampsia diagnostic rate among pregnant women at an early stage (4). The findings emanated from the prospective population-based analysis of 623 women where high blood pressure was the metric used to determine the level of depression and anxiety. One of the major findings of the study was the correlation between the Beck Depression and preeclampsia disorder. Moreover, over 30% of women involved in the survey showed depressive symptoms; however, only 28 of them, which forms 4.5%, were diagnosed with preeclampsia (4). The results, therefore, showed a correlation between the level of anxiety as a risk factor for the development of the condition. On the other hand, the results regarding the risk of developing depression were also estimated at 30% among pregnant women (5). The main contributing factors have remained to be associated with heath status, the nature of environmental factors, and social-based elements that affect the life of pregnant women. Based on the findings from the main studies included in this meta-analysis, it is clear that depression and present anxiety pathways for developing preeclampsia; however, little evaluation has been done regarding the etiology of the correlation.

DiscussionDepression and Risk Factors During PregnancyPereira and the colleagues (2) showed that the prevalence rate of antenatal depression in their analysis was 14.2% when a sample of pregnant women was assessed. The scholars went ahead to examine the factors that contributed to the r...