Whether Hypertensive Diseases in Pregnancy are Associated with Emotional Stress

Objective : Stress plays important role in effecting the cardiovascular disease and most of the risk factors with hypertensive disease in pregnancy [HDP] is caused by stress. Main objective of the study is to find connection between stress and risks for HDP during pregnancy. Place and duration of study : Obstetrics and Gynaecology Department Rajab Tayyep Erdogan Indus Hospital, Muzaffargerh. From August 2018 to August 2019.   Material and method: A controlled examination contrasting obstetrical and psychosocial  was conducted by 724 patient and 879 matched control for ages, equality, and educational level. Results: Emotional stress during pregnancy was linked with 1.6 times increase risk for hypertension during pregnancy. Conlusion : Psychosocial involvement to decrease emotional stress during the period of pregnancy can aid to reduce the risk to emerge HDP. Keywords: Hypertensive, Pregnancy, Emotional Stress DOI : 10.7176/JMPB/60-04 Publication date :October 31 st 2019

pregnancy complex by hypertension and evaluated on 24 week of pregnancy. Patients were contrasted to control females for risk factors of HDP like age of mother, nationality, level of education. Written consent were signed from the patients. The study was completed according the ethical committee of hospital.

Statistical analysis
The dissamilatities between the proportion were examined by the use of chi-square test. Oginizational regression model evaluated the link between HDP and emotional stress during pregnancy. Forward regression model including variable that was p<0.05 effected risk of HDP in the different analysis. Data analysis was done by using SPSS computer software.

RESULTS
After contrasting the data of 724 patient and 870 control female were accessible for inspection. From 724 patient , 99 (13.1%) suffered from gestational hypertension, 300 (41.4%) suffered from preclampsia, and 325 (44.8%) had HELLP-syndrome . 123/17.0 <0.0001 The assessment of strain during pregnancy was same in females after HDP having healthy baby or those with baby suffering from a kind of abnormality contrasted to control females. For both categories of females with HDP small level of strain was described significantly less often, on the other hand, stress which is severe or very severe was described significantly much more than that of control females. Main reason of stress were same in patients and controls. In both categories three main significant reason for stress during the period of pregnancy were the mother's injury or death of the friend or relative, or illness or family or friend. Females having HDP explained significantly marital confls, financial issues, also alteration in the habitate. This study explained that 1.6 times increased threat of HDP happened during period of pregnancy in stress's case. Threat of preclampsia during the pregnancy increases by 2.1 folds due to stress and risk of HELLP syndrome by 1.6 folds.

DISCUSSION
In this study, in following to another survey on aggravation during pregnancies [25] patients declared remarkably much severe emotional strain during the time of their pregnancies when contrasted to controls[ table no.2]. the impact of aggravation on the initiation of HDP may be elaborated by a lot of processes. Important symptoms that is related to stress is hypertonia [12,[31][32][33] . preclampsia in human is linked with sympathetic activity, and elevation of sympthattic activity causes symptoms , also alteration in the lab standards usuall for HDP [11,14,34] . For instance, It causes the actuation and aggregation of thrombocyte, alteration of coagulation, endothelial dysfunction, which may remains from week till month after taking event. [33,35,36] Main role of emotional stress as threat factor for HDP is also aided by the fact that HDP and heart diseases represent common threat factor. In cardiac diseases the impact of severe stress has been observed to be equivalent to the impact of conventional threat factors like overweight or nicotine addiction [32,33] .
Apparently, identification of HDP is also reason for more strain and anxiety. Also, in initial phase oof placentation, stress causes decreased trophoblast invasion. [36] initial involment of stress has also represented in the related studies, in which catecholamines elevated prior the expansion of HDP. [37] thus the activation of SNS by stress appears to be definite reason of disease and not the outcome of the identification of HDP. Additionally to the stress experienced during pregnancy , the patient had suffered from abortions before to the index-pregnancy , in few cases above 5 times. Mostly, recurrent abortion is most common to carry the threat for stress in the Journal of Medicine, Physiology and Biophysics www.iiste.org ISSN 2422-8427 An International Peer-reviewed Journal Vol.60, 2019 subsequent pregnancy. [38] When the life of patients and controls contrasted, they suffered from same stress during the pregnancy period. Therefore, during the pregnancy period not only straning events of life but according to SPSS stress was much in patient presenting HDP when contrasted to controls. Those outcomes represented were in line with those of Rippman and colleague [25] , expresses that stress related to job is stressor for HDP. But it was not confirmed by them, that in the duration of pregnancy financial buden is linked with elevating threat of HDP.
Difference between the pateunt and controls was remarkable for females having preclampsia , but not significant for patients with gestational hypertension. Gestational hypertension is less harmful hypertensive problem during pregnancy as it is not much harmful for new born and mother. Threat of preclampsia during the pregnancy increases by 2.1 folds due to stress and risk of HELLP syndrome by 1.6 folds. Psychological stress is much more linked with hypertension [21,[31][32][33] , that is the symptom of preclampsia bit not the symptom of HELLP syndrome, this may explain that why the impact of preclampsia is strong than on HEELP syndrome. Difference in risk factors of both categories of HDP have shown other risk factors like addiction of nicotine. [22,39] . However, development of stress may be useful approach to reduce the threat of preclampsia and HELLP syndrome. These therapy option have proved to be successful in the cardiac diseases. [32,33,40] psychotherapy during the period of pregnancy can decrease the symptoms of HDP. [28] in additton, eexcercise is helpful in decreasing the effect of stress. [31,32] . also, decrease in the stress in the pragnancy may decrease other complication like premature birth of baby. [42] Main drawback of the study is that the assessment of the effects of stress is much hard to measure. Stress has different sides and includes severe experience and assessmbled effect of lifetime exposure to crises. [43] Addition to this, explained stressors are knowledgeable differently by all female. [44] assessment of stress has been used in combinations with stress test to command for separate difference of stress perception. [45] In the survey , we didn't differentiate in stressors that occurs in distinct period of gestational age. As HDP occurs in two phases, it looks like there are important endangered phases, where stress has more noticeable impact than during different time of pregnancy. Thus, writer can not exclude that in some females the stress normally appears after the initiation of the diseases, that leads to high estimation of connection between stress and the threat of HDP. Thus , future investigators will have to study , whether the impact of stressful incidents have effect on gestational age oe whether a high strain levels prior to pregnancy shows a susceptibility for HDP.
Outcomes and categories of recent outcomes directing on the pathophysiology of HDP carry the hypothesis that stress in the duration of pregnancy causes the threat for spreading HDP. Well-organized psychological involvement supplies low-cost prophylaxis that can ameliorate prenatal care for females at that for HDP. As a result, assessment of stress and connected coping procedures must be part of prenatal care.