A systematic review of the influence of hypertensive disorders of pregnancy on the mental health of expectant mothers in Nigeria

Hypertensive disorders of pregnancy (HDP) are a major contributor to maternal morbidity and mortality in Nigeria, yet their relationship with maternal mental health remains insufficiently synthesized. This systematic review maps and synthesizes evidence on depression, anxiety, and psychological distress among pregnant women with HDP in Nigeria. The review aimed to identify, describe, and thematically synthesize empirical studies examining mental health outcomes among Nigerian women with HDP, and to highlight key gaps in research and practice. A systematic review was conducted following the PRISMA guideline. Six electronic databases (PubMed, Scopus, AJOL, ScienceDirect, CINAHL, and PsycINFO) and grey literature sources were searched for studies published between 2015 and 2025. Findings were synthesized using thematic analysis. Eighteen studies met the inclusion criteria. Across studies, HDP was consistently associated with poorer mental health outcomes, particularly depression, anxiety, pregnancy-related anxiety, and psychological distress. Women with HDP were more likely to report adverse psychological outcomes compared with normotensive pregnant women. Key determinants of mental health outcomes included low socioeconomic status, intimate partner violence, marital dissatisfaction, poor social support, and low educational attainment. Evidence indicates a consistent association between HDP and adverse mental health outcomes among pregnant women in Nigeria, although the evidence base remains methodologically limited. Integration of routine mental health screening and scalable psychosocial support into antenatal care, particularly through task-sharing approaches, is urgently required.

World Health Organization. Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. 2023. Available from: https://www.who.int/publications/i/item/9789240068759

Say L, Chou D, Gemmill A, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2014;2:e323-33. DOI: https://doi.org/10.1016/S2214-109X(14)70227-X

UNICEF. Maternal mortality. 2023. Available from: https://data.unicef.org/topic/maternal-health/maternal-mortality/

National Population Commission, ICF. Nigeria demographic and health survey 2018. 2019. Available from: https://dhsprogram.com/pubs/pdf/FR359/FR359.pdf

World Health Organization. Maternal mortality. 2025. Available from: https://www.who.int/news-room/fact-sheets/detail/maternal-mortality

Adamu AN, Okusanya BO, Tukur J, et al. Maternal near-miss and death among women with hypertensive disorders in pregnancy: a secondary analysis of the Nigeria Near-miss and Maternal Death Survey. BJOG 2019;126:12-8. DOI: https://doi.org/10.1111/1471-0528.15427

Abdurrahman A, Adamu AN, Ashimi A, et al. Predictors, prevalence and outcome of hypertensive disorders in pregnancy in Nigerian tertiary health facilities. BJOG 2024;131:42-54. DOI: https://doi.org/10.1111/1471-0528.17902

Kokori E, Aderinto N, Olatunji G, et al. Prevalence and materno-fetal outcomes of preeclampsia/eclampsia among pregnant women in Nigeria: a systematic review and meta-analysis. Eur J Med Res 2024;29:482. DOI: https://doi.org/10.1186/s40001-024-02086-x

Biaggi A, Conroy S, Pawlby S, Pariante CM. Identifying the women at risk of antenatal anxiety and depression: a systematic review. J Affect Disord 2016;191:62-77. DOI: https://doi.org/10.1016/j.jad.2015.11.014

Howard LM, Ryan EG, Trevillion K, et al. Accuracy of the Whooley questions and the Edinburgh Postnatal Depression Scale in identifying depression and other mental disorders in early pregnancy. Br J Psychiatry 2018;212:50-6. DOI: https://doi.org/10.1192/bjp.2017.9

Fisher J, Cabral de Mello M, Patel V, et al. Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review. Bull World Health Organ 2012;90:139G-49G. DOI: https://doi.org/10.2471/BLT.11.091850

Gelaye B, Rondon MB, Araya R, Williams MA. Epidemiology of maternal depression, risk factors, and child outcomes in low- and middle-income countries. Lancet Psychiatry 2016;3:973-82. DOI: https://doi.org/10.1016/S2215-0366(16)30284-X

Wegbom AI, Edet CK, Ogba AA, et al. Determinants of depression, anxiety, and stress among pregnant women attending tertiary hospitals in urban centers, Nigeria. Women 2023;3:41-52. DOI: https://doi.org/10.3390/women3010003

Izuka EO, Iyidobu TO, Obiora-Izuka CE, et al. Evaluation of anxiety and depression among pregnant women in Enugu, Nigeria. Niger J Clin Pract 2023;26:1368-76. DOI: https://doi.org/10.4103/njcp.njcp_196_23

Bello OO, Bella-Awusah TT, Adebayo AM, et al. Psychiatric morbidity among pregnant and non pregnant women in Ibadan, Nigeria. J Obstet Gynaecol 2023;43:2205503. DOI: https://doi.org/10.1080/01443615.2023.2205503

Oboro OF, Ebulue V, Oboro VO, et al. The magnitude and determinants of depressive symptoms amongst women in early pregnancy in Southern Nigeria: a cross-sectional study. S Afr J Psychiatry 2022;28:1691. DOI: https://doi.org/10.4102/sajpsychiatry.v28i0.1691

Akinsulore A, Temidayo AM, Oloniniyi IO, et al. Pregnancy-related anxiety symptoms and associated factors amongst pregnant women attending a tertiary hospital in south-west Nigeria. S Afr J Psychiatry 2021;27:1616. DOI: https://doi.org/10.4102/sajpsychiatry.v27i0.1616

Oladeji BD, Ayinde OO, Bello T, et al. Addressing the challenges of integrating care for perinatal depression in primary care in Nigeria. Soc Psychiatry Psychiatr Epidemiol 2024;59:1671-84. DOI: https://doi.org/10.1007/s00127-024-02611-7

Liu CH, Zhang HY, Wang F, et al. Anxiety and hypertensive disorders of pregnancy: epidemiology, mechanisms, and management strategies. World J Psychiatry 2025;15:105944. DOI: https://doi.org/10.5498/wjp.v15.i6.105944

Ncube CN, Choi M, Barnard-Mayers R, et al. Association of pre-pregnancy mental health disorders with hypertensive disorders of pregnancy. medRxiv 2025. doi:10.1101/2025.02.03.25321596 DOI: https://doi.org/10.1101/2025.02.03.25321596

Loveland Cook CA, Flick LH, Homan SM, et al. Posttraumatic stress disorder in pregnancy: prevalence, risk factors, and treatment. Obstet Gynecol 2004;103:710-7. DOI: https://doi.org/10.1097/01.AOG.0000119222.40241.fb

Furuta M, Sandall J, Bick D. A systematic review of the relationship between severe maternal morbidity and post-traumatic stress disorder. BMC Pregnancy Childbirth 2012;12:125. DOI: https://doi.org/10.1186/1471-2393-12-125

Mari Addo K, Khan HTA, Ohl M. Association between hypertensive disorders of pregnancy and postpartum depression: a study on low- and middle-income countries with insights from Ghanaian healthcare professionals. J Biosoc Sci 2025;57:429-48. DOI: https://doi.org/10.1017/S0021932025000264

Federal Ministry of Health Nigeria. National Mental Health Policy. 2021. Available from: https://share.google/nMBBkRzakL6fBD1Fp

Adewuya AO, Adewumi T, Ola B, et al. Primary health care workers’ knowledge and attitudes towards depression and its management in the MeHPric-P project, Lagos, Nigeria. Gen Hosp Psychiatry 2017;47:1-6. DOI: https://doi.org/10.1016/j.genhosppsych.2017.04.002

Akeju DO, Vidler M, Oladapo OT, et al. Community perceptions of pre-eclampsia and eclampsia in Ogun State, Nigeria: a qualitative study. Reprod Health 2016;13:57. DOI: https://doi.org/10.1186/s12978-016-0134-z

Sripad P, Kirk K, Adoyi G, et al. Exploring survivor perceptions of pre-eclampsia and eclampsia in Nigeria through the health belief model. BMC Pregnancy Childbirth 2019;19:431. DOI: https://doi.org/10.1186/s12884-019-2582-2

Nigeria Health Watch. Breaking the silence: integrating mental health support into maternal health care. 2023. Available from: https://articles.nigeriahealthwatch.com/breaking-the-silence-integrating-mental-health-support-into-maternal-health-care/

Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. DOI: https://doi.org/10.1136/bmj.n71

Hilton M. JBI critical appraisal checklist for systematic reviews and research syntheses. J Can Health Libr Assoc 2024;45:180-3. DOI: https://doi.org/10.29173/jchla29801

PRISMA 2020 flow diagram for systematic reviews and meta-analyses. Available from: https://www.prisma-statement.org/prisma-2020-flow-diagram

Hong QN, Fàbregues S, Bartlett G, et al. The Mixed Methods Appraisal Tool (MMAT) version 2018. Educ Inf 2018;34:285-91. DOI: https://doi.org/10.3233/EFI-180221

Fadipe OO, Sotunsa JO, Owopetu CA, et al. Pregnancy outcomes of women with hypertensive disease in Lagos State, Nigeria. Int J Public Health Pharm Pharmacol 2024;9:56-63. DOI: https://doi.org/10.37745/ijphpp.15/vol9n25663

Adekanle D, Adebayo K, Fasanu A, Abidoye O. Psychiatric morbidity among pregnant women with hypertensive disorders: a comparative study. Trop J Obstet Gynaecol 2015;32:90-5.

Bello O, Oni O, Ajekola D, Ogunkuade M. Quality of life of pregnant women with medical disorders in Ibadan, Nigeria. Cureus 2024;16:e72133. DOI: https://doi.org/10.7759/cureus.72133

Eleje GU, Oguejiofor CB, Oriji SO, et al. Depression, anxiety, and stress and adverse pregnancy outcomes in pregnant women with history of recurrent pregnancy loss in Nigeria. Int J Psychiatry Med 2024;59:303-24. DOI: https://doi.org/10.1177/00912174231199215

Olaluwoye O, Onofa L, Sowunmi O. Psychometric properties of the GAD-7 in Nigerian pregnant women attending primary health care. BJPsych Open 2023;9:S65-6. DOI: https://doi.org/10.1192/bjo.2023.224

Mahmoud Z, Orji IA, Shedul GL, et al. Clinical characteristics and treatment patterns of pregnant women with hypertension in primary care in Nigeria. BMC Pregnancy Childbirth 2023;23:416. DOI: https://doi.org/10.1186/s12884-023-05723-1

Afolabi-Obe EA, Agboola SM, Ibrahim OA, et al. Health-related quality of life and its determinants among hypertensive patients in rural southwest Nigeria. West Afr J Med 2023;40:1155-63.

Olabisi OI, Ogunmodede E, Ojo S, et al. Body image perception and social support as predictors of psychological distress among third trimester pregnant women in Nigeria. BMC Pregnancy Childbirth 2024;24:298. DOI: https://doi.org/10.1186/s12884-024-06463-6

Anyebe EE, Olisah VO, Garba SN, Murtala HH. Assessing levels of anxiety and psychological distress among pregnant women in south-west Nigeria. Adv Appl Sci Res 2023;14:1-10.

Soyemi AO, Sowunmi OA, Amosu SM, Babalola EO. Depression and quality of life among pregnant women in first and third trimesters in Abeokuta: a comparative study. S Afr J Psychiatry 2022;28:1779. DOI: https://doi.org/10.4102/sajpsychiatry.v28i0.1779

Sunday EM, Okoli PC, Dinwoke VO. Level of awareness and treatment of anxiety and depression during pregnancy in southeast Nigeria. S Afr J Psychiatry 2018;24:1192. DOI: https://doi.org/10.4102/sajpsychiatry.v24i0.1192

Lawan A, Apeyemi C, Chutiyami M, et al. Impact of physical activity and traumatic exposure on occurrence of gestational hypertension in Nigeria. Hypertens Pregnancy 2020;39:295-301. DOI: https://doi.org/10.1080/10641955.2020.1765173

Federal Republic of Nigeria. National Mental Health Act. 2021. Available from: https://static1.squarespace.com/static/63438980e505485cb3299aad/t/63f39b465a87b9639c5ff2f5/1676909382894/National+Mental+Health+Act+2021.pdf

World Health Organization. mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings, version 2.0. 2016. Available from: https://www.who.int/publications/i/item/9789241549790

Omoge Adeyemi O, Abraham FU, Adekale TA, et al. Assessment of social determinants of health among residents of Buari Ishola Isibo in Ede North Local Government Area, Osun State, Nigeria. 2nd International Azerbaijan Congress on Life, Social, Health and Art Sciences, Baku, Azerbaijan; 2022. pp. 490-6. Available from: https://drive.google.com/file/d/1cm4uq7ODR4N7RLfWDCnxB6GsD2p9zpZu/view?usp=sharing

Omoge Adeyemi O, Abraham FU, Adekale TA, et al. Assessment of social determinants of health among residents of Buari Ishola Isibo in Ede North Local Government Area, Osun State, Nigeria. 7th International Congress on Life, Social, Health and Sports Sciences in a Changing World; 2022. pp. 441-6. Available from: https://drive.google.com/file/d/1J14ILkAw3rFMsYP8vJ_spE1JJycetiiG/view

Omoge AO, Adesegun MM, Coursin OO, et al. Assessment of social determinants of health among residents of Buari Ishola Isibo in Ede North Local Government Area, Osun State, Nigeria. Preprints 2023;2023100603. DOI: https://doi.org/10.20944/preprints202310.0603.v1

Omoge AO. Prevalence of hypertension among residents of Ebudu community in Edo State, Nigeria. J Hypertens 2021;10:298.

Omoge O, Adeyemi MO, Erinsakin BO. Prevalence of hypertension among residents of Ebudu community in Edo State, Nigeria. 7th International Congress on Life, Social, Health and Sports Sciences in a Changing World; 2022. pp. 455-9. Available from: https://drive.google.com/file/d/1J14ILkAw3rFMsYP8vJ_spE1JJycetiiG/view

Omoge O, Adeyemi MO, Erinsakin BO. Prevalence of hypertension among residents of Ebudu community in Edo State, Nigeria. 2nd International Azerbaijan Congress on Life, Social, Health, and Art Sciences; 2022. pp. 458-62. Available from: https://drive.google.com/file/d/1cm4uq7ODR4N7RLfWDCnxB6GsD2p9zpZu/view?usp=sharing