(287) First Trimester Mean Arterial Pressure and Fetal Growth Restriction Among Subjects with Depression or Anxiety

Elevated 1^st trimester (Tri1) mean arterial pressure (MAP) is associated with hypertensive disorders (HDP) in pregnancy. While depression & anxiety are associated with hypertension, not all individuals with Tri1 depression or anxiety develop HDP or fetal growth restriction (FGR). Among subjects with depression or anxiety, we investigated if elevated Tri1 MAP identified those at risk for HDP or FGR.


Study Design:

We performed a retrospective cohort study of pregnant women who attended prenatal care in Tri1 & delivered at a diverse, urban county hospital from 2016-21.  Clinical & pregnancy data were abstracted from our perinatal database. MAP was calculated (Diastolic Blood Pressure + [Systolic Blood Pressure-Diastolic Blood Pressure]/3). HDP & FGR were defined using ACOG criteria. Tests for normality were performed; continuous variables were compared using Kruskal-Wallis tests; Chi-square tests were performed for categorical variables and multivariable logistic regression was performed with adjustment for confounders.


Results:

In our cohort (N= 3,917), 4.85% had depression or anxiety in Tri1. Individuals with depression or anxiety compared to those without had a higher MAP (87.5±8.9 vs 85.7± 9.2 p= 0.004).  Among those with depression or anxiety, subjects who developed FGR (N=28) had a higher Tri1 MAP compared to those without FGR (92.3 ± 12.4 vs 86.7±8.06, p= 0.015). This was not noted among those with Tri1 depression or anxiety who developed HDP vs those without HDP (Tri1 MAP 88.38 ± 6.91 vs 87.18± 9.7 p= 0.169). Controlling for subject age, race, and obesity, among those with depression or anxiety, higher Tri1 MAP maintained a significant association with FGR (β-coefficient 0.008, SE 0.002, 95% CI 0.002-0.14, p=0.003).


Conclusion:

Our data suggests that among pregnant persons with depression or anxiety, risk stratification by Tri1 MAP may identify those more likely to develop FGR, suggesting underlying vascular dysfunction. Future studies are necessary to investigate the pathophysiology driving this finding & consider if modified antenatal surveillance is necessary for this at-risk population.