Association between hypertensive disorders of pregnancy and postpartum depression: a study on low- and middle-income countries with insights from Ghanaian healthcare professionals.

Abstract

Hypertensive disorders of pregnancy (HDP) and postpartum depression (PPD) are significant global health challenges affecting maternal and child well-being. HDP, including pre-eclampsia, gestational hypertension, and chronic hypertension, complicate up to 10% of pregnancies worldwide, with profound implications for maternal mortality, particularly in low- to middle-income countries (LMICs) like Ghana. The incidence of HDP is rising globally, contributing substantially to maternal deaths and severe perinatal outcomes such as stillbirth and low birth weight. Concurrently, perinatal mental health issues, including PPD, affect a significant proportion of women globally, with higher prevalence rates observed in LMICs. Despite the known physiological impacts of HDP, their association with maternal mental health remains underexplored, especially in LMIC contexts. A systematic review and meta-analysis were conducted to explore the association between HDP and PPD in LMICs, focusing on available literature and studies from diverse global settings. Additionally, semi-structured qualitative interviews were conducted with healthcare professionals in Ghana to gather insights into local perspectives and experiences regarding this association. The systematic review revealed a consistent association between HDP and increased risk of PPD across various LMIC settings. Meta-analysis findings indicated a significant pooled odds ratio, highlighting a robust statistical linkage between HDP severity and subsequent PPD risk. Qualitative data underscored healthcare professionals' observations of heightened psychological distress among women with HDP, emphasizing the complex interplay between physiological complications and maternal mental health outcomes in the Ghanaian context. The study findings underscore the critical need for integrated maternal health strategies that address both physical and psychological aspects of pregnancy complications like HDP. By elucidating these connections, the study contributes to advancing evidence-based interventions and support systems tailored to LMIC settings, aiming to mitigate adverse maternal mental health outcomes and improve overall perinatal care in Ghana and similar contexts worldwide. These insights are pivotal for informing policy decisions, guiding healthcare practices, and fostering targeted interventions that enhance maternal well-being during the vulnerable perinatal period.