Background
The leading cause of maternal morbidity and mortality worldwide, hypertensive disorders of pregnancy affect between 5% and 10% of pregnancies in Canada. (1,2) New clinical guidance for management of pregnancy hypertension recommends considering women’s preferences before making treatment decisions. (3) While new work has investigated women’s preferences and decisional needs for pregnancy hypertension, (4) research has yet to explore emotional responses to diagnosis and treatment, despite evidence that anxiety is heightened during pregnancy (5) and emotional responding is important for decision-making. (6) 

Methods
A qualitative approach was used. Working with two patient partners, we developed an interview approach and topic guides for focus groups and individual interviews. Semi-structured focus groups and individual interviews were conducted in an iterative fashion, with memoing and debriefing after each group meeting or interview. All interactions will be transcribed for constant comparison grounded in a critical realist perspective. Codes will be developed inductively and collected into themes that will reviewed with the patient partners, and then the research team for face validity. 

Results
28 women participated in two focus groups and 20 individual interviews. Preliminary analysis identified three broad themes relating to emotional responses in the context of pregnancy hypertension: 
1)	Information seeking/avoidance
2)	Importance of self-care
3)	Taking cues about anxiety and stress from others
4)	Anxiety caused by treatment requirements

Discussion
Preliminary analysis indicates that emotion plays a large role in how women experience and navigate healthcare decision-making in pregnancy hypertension. Next steps will be exploring if ability to manage emotions impacts aspects of healthcare decision-making in pregnancy (i.e., ability to understand and remember new information).

Dissemination Plan
Results from this work will be shared at conferences directed at patient and professional audiences and will be incorporated into the design of a publicly available patient decision aid.

Acknowledgements
This work was funded by the BC SUPPORT Unit and the Canadian Institutes of Health Research

References
1. Ghulmiyyah L, Sibai B. Maternal mortality from preeclampsia/eclampsia. Semin Perinatol. 2012 Feb;36(1):56–9.
2. Lo JO, Mission JF, Caughey AB. Hypertensive disease of pregnancy and maternal mortality: Curr Opin Obstet Gynecol. 2013 Apr;25(2):124–32. 
3. Butalia S, Audibert F, Côté A-M, Firoz T, Logan AG, Magee LA, et al. Hypertension Canada’s 2018 Guidelines for the Management of Hypertension in Pregnancy. Can J Cardiol. 2018 May 1;34(5):526–31
4. Metcalfe RK, Harrison M, Hutfield A, Lewish M, Singer J, Magee LA, et al., Patient Preferences and Decisional Needs When Choosing a Treatment Approach for Pregnancy Hypertension: A Stated Preference Study (Under Review).
5. Ross LE, McLean LM. Anxiety disorders during pregnancy and the postpartum period: A systematic review. The Journal of clinical psychiatry. 2006 Aug.
6. Schwarz N. Emotion, cognition, and decision making. Cognition & Emotion. 2000 Jul 1;14(4):433-40.

The role of emotion in healthcare decision making in pregnancy: findings from a qualitative investigation