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

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.