IL‐17 and TNFalpha are increased in a rural population of women experiencing anxiety and depression during pregnancy

Background Studies have indicated that there is an association between hypertension and inflammation during pregnancy and maternal mood. To date these studies have not evaluated if this was primarily due to hypertension or other factors such as race and/or socioeconomic factors, especially as both maternal black race and lower socioeconomics are independently associated with hypertension and inflammation. In our initial pilot studies to address this question, we set out to evaluate whether anxiety/depression during pregnancy is associated with increased hypertension at delivery in a predominantly black study population. Study design A prospective Intuitional Review Board approved single-institution pilot study of women without a history of infant death, preeclampsia or mood disorders. Patients were consented and enrolled in this study between 20-26 weeks. Sociodemographic information along with perceived anxiety, depression and stress were collected with validated questionnaires. After childbirth pregnancy history was abstracted from medical records. Primary outcome was the incidence of hypertensive pregnancies among women with anxiety/depression at enrollment. Secondary outcome was to determine if our primary outcome was impacted by race. We also assessed circulating IL-17 and TNFα in blood samples that were collected at each study visit. Statistical analysis were used to evaluate the correlation between anxiety/depression in pregnancy and hypertensive disorders (preeclampsia or chronic or gestational hypertension) at delivery. Results Of the 54 women who met inclusion criteria, 20 (37%) screened positive for anxiety/depression and 24 (45.2 %) had a delivery complicated by a hypertensive disease. Our analysis showed that neither a hypertensive disease at the time of delivery nor a term delivery were associated with anxiety/depression in pregnancy. When adjusted for race our results showed that Black women with anxiety/depression were more likely to have a hypertensive delivery at term (aOdds ratio, 3.7, confidence interval, 0.94-15.78). The number of deliveries complicated by hypertensive disease was higher in Black women (odds ratio, 6.1, confidence interval, 1.5-24.8) and obese women (odds ratio, 1.1, confidence interval, 1.01-1.18). There was a significant increase in circulating IL-17 (p=0.02) and TNFα (p=0.003) among women who were comorbid for both anxiety and depression that was independent of gestational or postpartum age. Conclusion Our findings suggest clinically that black race is associated with anxiety/depression in pregnancy. We did not find an association between hypertension and maternal mood, but both the inflammatory cytokines IL-17 and TNFα were increased. We are currently conducting additional analysis to determine if this association is dependent upon hypertensive status. More research is needed to evaluate the impact of maternal education and socioeconomic factors on anxiety/depression.