Constructing a predictive model for postpartum anxiety in patients with preeclampsia based on multidimensional indicators and its application

Abstract

BACKGROUND

Preeclampsia (PE) substantially increases the risk of postpartum anxiety, yet limited research has examined how disease onset and clinical features, such as blood pressure control and body mass index (BMI) changes during pregnancy, affect this risk.

AIM

To develop and apply a predictive model for postpartum anxiety disorder in patients with PE based on multidimensional indicators.

METHODS

A cross-sectional study was conducted among 196 patients with PE admitted to the Department of Obstetrics, Ninth People’s Hospital of Suzhou (Affiliated with Soochow University), from June 2019 to June 2024. According to the self-rating anxiety scale at six weeks postpartum, participants were divided into anxiety and no-anxiety groups. Two data sets were analyzed, and multivariate logistic regression was performed to identify risk and protective factors. Regression coefficients and constants were used to construct the predictive model. Model performance was evaluated using the receiver operating characteristic curve and area under the curve, along with a goodness-of-fit test. The model was then validated with clinical data.

RESULTS

Of the 196 patients with PE evaluated using the self-rating anxiety scale at six weeks postpartum, 51 (26.02%) patients showed anxiety symptoms. Significant group differences (P < 0.05) were observed for blood pressure control, BMI increase, hematocrit (Hct), family relationships, and psychological resilience. Logistic regression indicated that, poor blood pressure control, greater BMI increase, elevated Hct levels, and strained family relationships during pregnancy were risk factors for postpartum anxiety in patients with PE (P < 0.05), whereas higher psychological resilience was a protective factor (P < 0.05). The prediction model was defined as: Logit (P) = 0.684 × pregnancy blood pressure control + 0.805 × pregnancy BMI increase + 0.756 × Hct + 1.063 × family relationship - 1.105 × psychological resilience score - 5.487. The model’s area under the curve (0.908) exceeded that of individual indicators: Blood pressure control (0.794), BMI increase (0.814), Hct (0.808), family relationships (0.840), and psychological resilience (0.833). The goodness-of-fit test showed no overfitting (χ² = 1.904, P = 0.725). Clinical validation demonstrated sensitivity of 85.71%, specificity of 87.72%, and accuracy of 87.18%.

CONCLUSION

Postpartum anxiety risk in patients with PE is associated with poor blood pressure control, excessive BMI gain, elevated Hct index, and poor family relationships, while strong psychological resilience serve as a protective factor. The developed prediction model effectively supports clinical assessment and targeted management of postpartum anxiety in patients with PE.

Keywords: Preeclampsia; Postpartum; Anxiety disorder; Influencing factors; Prediction model

Core Tip: Preeclampsia, as an idiopathic disease during pregnancy, is not conducive to the physical and mental health of pregnant women and the growth and development of the fetus, and will increase the risk of postpartum anxiety in pregnant women. This study identified the influencing factors of postpartum anxiety in patients with preeclampsia and constructed a predictive model, offering guidance for clinical risk assessment and preventive management.