Date of Award


Document Type

Campus Access Thesis


Epidemiology and Biostatistics



First Advisor

Jihong Liu


The objective of this study was to estimate the association between a diagnosis of anxiety and/or depression and the onset of hypertension in pregnancy (HIP). Second, this study aimed to investigate the association of anxiety and/or depression diagnosis and HIP by timing (before or in pregnancy) of first anxiety and/or depression diagnosis, and to identify confounders of these associations for the two stratums of timing. Data from the 2004-2006 South Carolina birth certificates and medical insurance claims data covered by Medicaid and/or the South Carolina state health plan for up to two years prior to the estimated conception date (ECD) were acquired from South Carolina's Office of Research Statistics (ORS). We further restricted to the first singleton births among women who were insured for at least twelve months prior to the child's date of birth and were free of chronic hypertension prior to pregnancy as indicated by ICD-9 codes. This leaves 45,653 observations available for analysis from the original 168,334. SAS Logistic Regression procedures were used to calculate odds ratios (OR) and 95% confidence intervals (CI) for the association between anxiety and/or depression and HIP. Confounders were identified as variables that, when added to the model, and resulted in a change of 10% or greater in the odds ratio between psychiatric diagnosis and HIP. We found that HIP occurred in five percent of women. A diagnosis of depression, anxiety, or both were all associated with increased odds of HIP, none of which were statistically significant at the 0.05 level. However, women who were diagnosed with anxiety or depression prior to pregnancy had a 34% increase in the odds of HIP (OR (95%CI): 1.34 (1.06, 1.68)). These data show that women diagnosed with anxiety or depression prior to pregnancy show no greater risk of HIP than unexposed women. However women diagnosed with anxiety or depression for the first time in pregnancy show a statistically significant increase in their odds of HIP compared to unexposed women. These results highlight the importance of the timing of psychiatric illness onset in perinatal research.