Lived experience of hypertensive disorders of pregnancy: a systematic review and meta-synthesis

BACKGROUND: Hypertensive disorders are major causes of maternal and neonatal morbidity and mortality, affecting >> 10% pregnancies worldwide. OBJECTIVE: Understanding the lived experience of women with hypertensive disorders during pregnancy is important to inform best practice and provide holistic care. STUDY DESIGN: This is a systematic review and meta-synthesis of studies containing qualitative components relating to direct lived experience of hypertensive disorders of pregnancy. Medline via Ovid, Embase via Ovid, CINAHL via Ebsco, PsycINFO via Ebsco, Scopus, Web Science Core Collection, and ASSIA via ProQuest were searched between database inception and June 2024. Quality assessment was performed using the Critical Appraisal Skills Programme checklist for qualitative research. Themes were labeled and organized into a framework using NVivo software. RESULTS: Eighteen studies were included in the meta-synthesis. Anxiety, stress, fear panic emerged as the most common emotional experiences during hypertensive disorders pregnancy. Loss of control was also mentioned frequently and consistently across studies (frequency effect size 38.9% and intensity effect size 15.3%). Emotional responses to physical symptoms or lack thereof, and feelings about the impact of the complicated pregnancy family and community also emerged as central themes associated with hypertensive disorders of pregnancy. CONCLUSION: A range of emotional experiences was captured across the studies included our meta-synthesis, some of which were observed across global settings whereas others were context-dependent. Interventions and care pathways for pregnancies affected by hypertensive disorders should aim to support women through complex emotional experiences as well reducing morbidity and mortality.