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Depressed mood and anxiety as risk factors for hypertensive disorders of pregnancy: a systematic review and meta-analysis

Published online by Cambridge University Press:  11 September 2020

Matthew Shay*
Department of Psychology, University of Calgary, Calgary, Alberta, Canada
Anna L. MacKinnon
Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
Amy Metcalfe
Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada Department of Obstetrics and Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
Gerald Giesbrecht
Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
Tavis Campbell
Department of Psychology, University of Calgary, Calgary, Alberta, Canada
Kara Nerenberg
Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada Department of Obstetrics and Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
Suzanne Tough
Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
Lianne Tomfohr-Madsen
Department of Psychology, University of Calgary, Calgary, Alberta, Canada Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
Author for correspondence: Matthew Shay, E-mail:



Psychosocial factors have been implicated as both a cause and consequence of hypertension in the general population but are less understood in relation to hypertensive disorders of pregnancy (HDP). The aims of this review were to (1) synthesize the existing literature examining associations between depression and/or anxiety in pregnancy and HDP and (2) assess if depression and/or anxiety in early pregnancy was a risk factor for HDP.


A comprehensive search of Medline, Embase, CINAHL, and PsycINFO was conducted from inception to March 2020 using terms related to ‘pregnancy’, ‘anxiety’, ‘depression’, and ‘hypertensive disorders’. English-language cohort and case-control studies were included if they reported: (a) the presence or absence of clinically significant symptoms of depression/anxiety, or a medical record diagnosis of depression or an anxiety disorder in pregnancy; (b) diagnosis of HDP; and/or (c) data comparing the depressed/anxious group to the non-depressed/anxious group on HDP. Data related to depression/anxiety, HDP, study characteristics, and aspects related to study quality were extracted independently by two reviewers. Random-effects meta-analyses of estimated pooled relative risks (RRs) were conducted for depression/anxiety in pregnancy and HDP.


In total, 6291 citations were retrieved, and 44 studies were included across 61.2 million pregnancies. Depression and/or anxiety were associated with HDP [RR = 1.39; 95% confidence interval (CI) 1.25–1.54].


When measurement of anxiety or depression preceded diagnosis of hypertension, the association remained (RR = 1.27; 95% CI 1.07–1.50). Women experiencing depression or anxiety in pregnancy have an increased prevalence of HDP compared to their non-depressed or non-anxious counterparts.

Review Article
Copyright © The Author(s) 2020. Published by Cambridge University Press

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