# Exploring Maternal Mental Health Conditions and Urban-Rural Disparities in Hypertensive Disorders of Pregnancy in South Carolina: A Fairlie Decomposition Approach

## TL;DR

This study explores how maternal mental health affects the urban-rural differences in hypertensive disorders of pregnancy in South Carolina.

## Contribution

This is the first study to quantify the role of maternal mental health in rural-urban disparities in hypertensive disorders of pregnancy.

## Key findings

- Maternal factors like education and chronic hypertension explained 90% of urban-rural HDP disparities.
- Mental health conditions reduced the urban-rural gap in HDP prevalence.
- Community support for mental health can improve maternal health outcomes.

## Abstract

Reproductive complications vary across rural and urban areas in the Southeastern U.S., yet maternal mental health–an important precursor to such complications–remains understudied. This study is the first to examine how mental disorders may contribute to disparities in hypertensive disorders of pregnancy (HDP) between urban and rural settings.

We used South Carolina (SC) data on delivery hospitalizations for more than 270,000 mothers presenting with HDP who have given birth only once between 1999 and 2017. A Fairlie decomposition method was performed to examine the contribution of diagnosed maternal mental health conditions, and social inequalities account for the urban-rural differences in HDP prevalence.

The prevalence of HDP was 5.75% among urban mothers and 6.16% among rural mothers. Fairlie decomposition results indicated that maternal factors such as education attainment, chronic hypertension, and gestation age explained 90% of the geographic disparities in the HDP prevalence. Interestingly, differences in maternal mental health conditions, such as mental disorders of pregnancy and perinatal mood and anxiety disorders, reduced the urban-rural gap in the HDP prevalence.

Our results highlight the importance of individual and community drivers required to improve maternal mental health conditions. More community support systems for the mental health along with reproductive health will greatly improve maternal health outcomes.

What is Already Known on this Subject?

What this Study Adds?

HDP diagnoses tend to be more common among rural individuals, the potential mental health effects of HDP, and the well-documented birth complications and subsequent hypertension complications following HDP.

The link between mental health conditions and HDP have yet to be analyzed. To the best of our knowledge, this study is the first to quantify the role of diagnosed maternal mental health experiences in analyzing the rural-urban differences in the probability of an HDP diagnosis.