- Depressive symptoms (EPDS ≥10 or positive item 10) were independently associated with obstetric ICU admission and prolonged hospitalisation in women with HDP.
- Anxiety (GAD-7 ≥10) showed an inverse association with ICU admission, an exploratory and counterintuitive finding requiring further investigation.
- Most assessments occurred after ICU transfer, precluding causal inference. Integration of mental health screening into HDP management is recommended.
J Acad Consult Liaison Psychiatry. 2026 Oct 27:S2667-2960(26)00469-6. doi: 10.1016/j.jaclp.2026.10.343. Online ahead of print.
ABSTRACT
BACKGROUND: Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal morbidity and mortality, particularly in Latin America. Depression and anxiety are frequent during pregnancy and may influence HDP severity, yet their impact on clinical outcomes remains unclear.
OBJECTIVE: To determine whether depressive and anxiety symptoms are associated with obstetric intensive care unit (ICU) admission and hospital length of stay among women with HDP.
METHODS: A prospective cohort study was conducted at a Colombian tertiary-care referral hospital (July 2024-January 2025). Women aged ≥16 years in their third trimester hospitalized for HDP completed the Edinburgh Postnatal Depression Scale (EPDS) and Generalized Anxiety Disorder-7 (GAD-7). Multivariable Firth penalized logistic regression and Cox regression models assessed associations with ICU admission and length of stay RESULTS: Among 234 participants (median age 25 years), 61.1% required ICU care; only 14 of the 143 ICU patients (9.8%) were assessed before ICU transfer. An EPDS score ≥10 or a positive response to item 10 was independently associated with ICU admission (OR 4.83 , 95% CI 1.56 -14.94, p=0.006) and longer hospitalization (HR 0.69 , 95% CI 0.48 -1.00, p=0.048). In an exploratory finding, a GAD-7 score ≥10 showed an inverse association with ICU admission (OR 0.29, 95% CI 0.09-0.88, p=0.029). Hemoglobin <11 g/dL and a post hoc mean arterial pressure threshold ≥102.5 mmHg were also significantly associated with ICU admission.
CONCLUSIONS: Depressive symptoms were associated with obstetric ICU admission and prolonged hospitalization in patients admitted for HDP, whereas anxiety appeared protective, which seems counterintuitive and requires future research to confirm its association; however, because most assessments took place after ICU transfer, causality could not be established. Integrating mental health screening into HDP management may improve maternal outcomes.
PMID:42946258 | DOI:10.1016/j.jaclp.2026.10.343
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