199030 Does depression increase the risk of poor outcomes associated with cHTN in African American women

Wednesday, November 11, 2009: 9:15 AM

Renaisa S. Anthony, MD, MPH , Center for Reducing Health Disparities, University of Nebraska Medical Center, Omaha, NE
Marie Gantz, PhD , Statistics and Epidemiology Unit, RTI International, Rockville, MD
Ayman El Mohandes, MBBCh, MD, MPH , Department of Prevention and Community Health, George Washington University School of Public Health and Health Services, Washington, DC
Growing literature indicates that depression is an important risk associated with chronic illness. African American (AA) women suffer disproportionately from chronic illness during pregnancy including chronic hypertension (cHTN). This study examines the impact of associated depression with cHTN in a population of pregnant AA women in the District of Columbia. Women seeking prenatal care at 6 DC clinics were eligible if they were AA, >18, English speaking, and < 28 weeks estimated gestational age. 1,044 participants who screened positive for smoking, environmental tobacco smoke exposure, depression or intimate partner violence were randomized to either a cognitive behavioral intervention or usual care. Behavioral risk factors were evaluated at baseline (BL) and at follow up interviews in the second and third trimester of pregnancy. Pregnancy outcomes were collected by medical record review. Sixty participants were diagnosed with cHTN prior to pregnancy, 22 of whom were depressed at BL as measured by the Hopkins scale. Maternal and infant outcomes were compared in women with cHTN classified by depression. An increased risk for Cesarean Section (C/S) was noted in cHTN women who also suffered from depression during pregnancy (61% vs 27%, unadjusted p-value=0.01). In a logistic model to predict C/S delivery among women with cHTN, controlling for other medical risks, BL depression was the only significant predictor (OR 4.9, 95 % CI 1.1 20.9, p-value=0.03). This indicates that women with cHTN should be screened for depression. Mechanisms suggested for worsened outcomes may include failure to optimize prenatal care, or compliance to hypertension treatment.

Learning Objectives:
1) Discuss the association between baseline depression and chronic illness and the impact of these two factors on pregnancy outcomes. 2) Discuss disparities between African American and Caucasian women with chronic illness namely cHTN suffering from depression during pregnancy. 3) Discuss Project HOPE (Health Outcomes of Pregnancy Education) Study methodology and results pertaining to depression and Cesarean Section. 4) Discuss potential depression screening and management recommendations based on results of study.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: The Project HOPE (Healthy Outcomes of Pregnancy Education) study was conducted by the George Washington University School of Public Health and Health Services in the Department of Prevention and Community Health. I am qualified to be an abstract author on this content for the study subjects discussed in the abstract are a part of the Project Hope Study. I am an Assistant Research Professor at the George Washington University School of Public Health and Health Services with expertise in pregnancy outcomes and continue to work on Project HOPE.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.