Abstract
OBJECTIVE: This study aimed to elucidate the pathophysiological role of psychological distress in early-stage gestational hypertension (GH) through comprehensive assessment of its regulatory effects on disease progression and association with adverse pregnancy outcomes, thereby providing evidence-based support for early screening and intervention strategies. METHODS: We conducted a prospective case-control study involving 446 patients with early-stage GH (diagnostic criteria: new-onset hypertension after 20 weeks of gestation, blood pressure ≥140/90 mmHg without proteinuria) and 200 normotensive pregnant women as controls. Psychological distress was assessed using the Self-Rated Anxiety Scale (SAS). A multidimensional statistical approach, including univariate analysis and multivariate logistic regression, was employed to systematically explore the risk factors that influence psychological distress. Pregnancy and perinatal outcomes were compared using Chi-square tests and t-tests. RESULTS: The study revealed a markedly elevated prevalence of psychological distress in the early-stage GH group (20.9%) compared to controls (7.0%, P < 0.05). Multivariate analysis identified educational level (OR = 2.298, 95% CI [1.289-4.097]), history of adverse pregnancy (OR = 2.604, 95% CI [1.342-5.050]), and GH itself (OR = 1.859, 95% CI [1.213-2.850]) as independent risk factors for psychological distress. Follow-up data demonstrated that patients with psychological distress exhibited significantly higher rates of progression to preeclampsia (24.7% vs. 12.7%, P < 0.05), along with increased incidence of adverse pregnancy outcomes, including premature rupture of membranes, postpartum hemorrhage, neonatal infection, macrosomia, and low birth weight. CONCLUSIONS: This study provides a systematic characterization of psychological distress patterns in early stage GH patients and their potential impact on disease progression. Findings highlight the critical importance of integrating routine psychological screening and early intervention strategies into prenatal care for patients with GH to optimize maternal and neonatal outcomes.