Determining psychological distress during pregnancy and its association with the development of a hypertensive disorder.

OBJECTIVE: To explore the association of psychological distress, including stress, depression, and anxiety, with the development of a hypertensive disorder during pregnancy. DESIGN: A secondary data analysis using a 1:3 case control study; cases (n = 29 with a hypertensive disorder) and controls (n = 87 without hypertension) frequency matched on age and parity. PARTICIPANTS: Women in the study were older than 14 years of age, Medicaid eligible, with at least one risk factor for preterm birth, and without a current diagnosis of mental illness. METHODS: Hypertensive disorder status was verified through medical record report. Components of psychological distress were measured with valid instruments. Measures of psychological distress level, including CESD-R-10, PSS-4, and GAD-7, were compared between women with a hypertensive disorder and normotensive women were made in both early and late pregnancy. Components of psychological distress were tested as independent risk factors with the development of a hypertensive disorder as the outcome. RESULTS: There were no differences in psychological distress between hypertensive and normotensive women. Furthermore, no changes in psychological distress by time between groups were identified. However, this population did not present with significant symptoms of psychological distress. BMI was the only independent risk factor associated with an increased risk of developing a hypertensive disorder during pregnancy (OR = 1.13; 95% CI: 1.04-1.23, p = .003). CONCLUSIONS: These findings indicate psychological distress was not associated with the development of a hypertensive disorder during pregnancy in women with few symptoms of psychological distress. Women with higher BMI were at an increased risk of developing a hypertensive disorder.

Determining Whether Hypertensive Status and Stress Level Are Associated With Inflammatory Markers.

BACKGROUND: Hypertensive disorders are common pregnancy complications in the United States. Although the exact mechanism underlying hypertensive disorders in pregnancy is unknown, there is evidence of involvement of a maladaptive maternal inflammatory response. Psychological maternal stress experienced during pregnancy can increase the risk of a hypertensive disorder by altering the maternal inflammatory response. OBJECTIVES: The purpose of this analysis was to evaluate the relationships of hypertensive status and stress with inflammatory biomarkers throughout pregnancy. METHOD: A 1:2 case-control design was used to analyze secondary data longitudinally with repeated measures of a multicenter, culturally and ethnically diverse pregnant population. Demographic data, psychological stress, and serum inflammatory data were analyzed. The sample consisted of 30 pregnant women with hypertension and 61 normotensive women. Measurements were taken once in each trimester of pregnancy. RESULTS: Trimester-specific levels of inflammatory biomarkers varied based on stress and hypertensive status. IL-6 was elevated in the hypertensive, high-stress group, while IL-8 was greater among those with high stress, regardless of hypertensive status or trimester. For IL-1α and IL-1ß, there was a significant stress-by-trimester interaction, while IL-10 was associated with a significant three-way interaction among stress level, hypertension status, and trimester. CONCLUSIONS: The associations of stress and hypertensive status with inflammatory biomarkers are complex. Stress and hypertension were associated with changes in inflammatory response. Hypertensive women with high stress experienced a heightened anti-inflammatory response, potentially a compensatory mechanism. To better understand this relationship, further longitudinal studies are warranted.

A Policy Analysis of Smoke-Free Legislation in Kentucky.

This article presents a policy analysis of proposed smoke-free legislation in Kentucky during the 2015 General Assembly. Kingdon's three streams model of agenda setting is used to analyze the failure to pass HB145. Secondhand smoke exposure and related deaths are a significant public health problem in Kentucky, a state with one of the highest smoking rates in the U.S. HB145, a comprehensive smoke-free bill, was designed to protect workers and the general public from secondhand smoke and e-cigarette aerosol in enclosed workplaces and public places, with few exemptions. The bill faced intense criticism from opponents who were concerned about violation of personal and business rights and the belief that the decision should be addressed on a local level. HB145 passed the House with amendments but failed to receive a hearing in the Senate. Failure of the smoke-free legislation was due to partisanship, fragmentation of advocacy groups, lack of political bargaining, and conflict of values. As in past years, the policy window did not open for state smoke-free legislation in 2015.

Experience of Preeclampsia and Bed Rest: Mental Health Implications.

Preeclampsia is a major cause of maternal and fetal morbidity and mortality affecting 5-10% of pregnancies. Mental health issues are often exhibited in this vulnerable population partly due to the rigid management of this condition including prolonged bed rest. The purpose of this qualitative study is to describe women's experience with preeclampsia and being placed on bed rest. Six themes emerged including: negative feelings and thoughts, lack of guidelines about their diagnosis, family stressors, lack of social support, not being heard, loss of normal pregnancy, and physical symptoms. The identified categories provide insight into improving care for these women.