Relationship between gestational body mass index, blood pressure variability, and postpartum depression in pregnant women with pre-eclampsia

Background: Pre-eclampsia has long been proven to be an independent risk factor for postpartum depression (PPD). Excessive increase in body mass index (BMI) during pregnancy is an important factor inducing pre-eclampsia. Increased blood pressure is the main symptom of patients with pre-eclampsia. However, whether there is a correlation between BMI and blood pressure variability during pregnancy and PPD occurrence in pregnant women with pre-eclampsia remains unclear.

Aim: To investigate the relationship between BMI, blood pressure variability, and PPD in pregnant women with pre-eclampsia.

Methods: Using a cross-sectional survey research, 201 pregnant women with pre-eclampsia who were treated and delivered in Suzhou Ninth People's Hospital from May 2016 to June 2024 were selected as this study's subjects. At 42 days after delivery, the subjects were re-examined in the hospital's outpatient department. The Edinburgh Postnatal Depression Scale (EPDS) was used to evaluate whether PPD symptoms, divided the subjects into two groups: The PPD and non-PPD groups. We analyzed clinical data, changes in BMI during pregnancy, and blood pressure variability in the two groups. The Pearson method was used to test the correlation between BMI increase, blood pressure variability during pregnancy, and EPDS score in patients with pre-eclampsia. Logistic regression analysis was performed to explore whether increased BMI and blood pressure variability during pregnancy are influencing factors for PPD occurrence in patients with pre-eclampsia.

Results: Of the 201 pre-eclamptic women who underwent an outpatient review 42 days after delivery, 37 had PPD symptoms based on the EPDS scale evaluation, resulting in an incidence rate of 18.41% (37/201). The differences between the PPD and non-PPD groups in terms of age, educational level, place of residence, reproductive history, gestational age, mode of delivery, newborn gender, and newborn birth weight were not statistically significant (P > 0.05). The gestational BMI increase, 24-hour systolic blood pressure (SBP) variability, and 24-hour diastolic blood pressure (DBP) variability in the PPD group were significantly higher than those in the non-PPD group; the differences were statistically significant (P < 0.001). Pearson correlation analysis showed that BMI increase, SBP variability, and DBP variability during pregnancy correlated positively with the EPDS score of pregnant women with pre-eclampsia (r = 0.349, 0.336, and 0.241; P < 0.001). Logistic regression analysis showed that a high increase in BMI during pregnancy [odds ratio (OR) = 4.614, 95% confidence interval (CI): 1.749-12.170, P = 0.002], large variability in 24-hour SBP (OR = 2.910, 95%CI: 1.322-6.404, P = 0.008), and large variability in 24-hour DBP (OR = 2.347, 95%CI: 1.138-4.831, P = 0.021) were factors affecting PPD occurrence in patients with pre-eclampsia.

Conclusion: Increased BMI and blood pressure variability during pregnancy can increase the risk of PPD in patients with pre-eclampsia. Strengthening pregnancy guidance and controlling fluctuations in BMI and blood pressure variability during pregnancy within a reasonable range can help reduce the risk of PPD in patients with pre-eclampsia.