The findings suggest that doctors should check for anxiety during the first and third trimesters.
According to a study published by the American Psychological Association, women who are anxious about their pregnancies give birth earlier on average than those who aren’t.
The research might assist doctors in determining when and how to most effectively screen for anxiety during pregnancy to help avoid preterm birth. It examined the link between pregnancy duration and several measures of anxiety.
“Anxiety about a current pregnancy is a potent psychosocial state that may affect birth outcomes,” said lead study author Christine Dunkel Schetter, Ph.D., of the University of California Los Angeles. “These days, depressive symptoms are assessed in many clinical settings around the world to prevent complications of postpartum depression for mothers and children. This and other studies suggest that we should also be assessing anxiety in pregnant women.”
The findings were recently published in the journal Health Psychology.
Previous studies have shown that clinically elevated anxiety symptoms may occur in up to one in four pregnant women and that anxiety can increase the chance of preterm birth, or birth before 37 weeks of pregnancy. However, those studies employed a variety of anxiety measures and included both general anxiety and anxiety specific to pregnancy, which includes concerns about childbirth, parenting, and the health of the unborn child. Researchers have also assessed anxiety at various stages of pregnancy, from early to late pregnancy, with the second trimester being the most common.
The researchers looked at data from a diverse sample of 196 pregnant women in Denver and Los Angeles who participated in the Healthy Babies Before Birth study to sort out the various effects of timing and anxiety type. 45% of the women identified as non-Hispanic white, 36% as Hispanic white, 10% as Asian, and 9% as Black or African American.
The researchers administered four different anxiety scales to the women, in both the first and the third trimesters of their pregnancies. One was a five-question screener for general anxiety and three were specific to pregnancy: a 10-question and a four-question scale of pregnancy-related anxiety, and a nine-question assessment of a broader range of pregnancy-related stressors, such as medical care and worries about taking care of a newborn.
The researchers found that participants’ scores on all three scales of pregnancy-related anxiety were interrelated, suggesting that the scales measure the same underlying thing.
They also found that pregnancy-related anxiety in the third trimester was most strongly associated with earlier births. However, general anxiety in the first trimester also contributed to the risk of early birth. One possibility, according to the researchers, is that general anxiety early in pregnancy could predispose women to be anxious later in pregnancy about such issues as medical risks, the baby, labor and delivery, and parenting. The results held even when adjusted for the actual medical risk of the women’s pregnancies.
“Although not all women who begin pregnancy with general anxiety symptoms will later experience pregnancy-specific anxiety, our results suggest that women who do follow this progression are likely to be especially at risk for earlier delivery,” Dunkel Schetter said.
The results suggest that doctors should screen women for general anxiety early in pregnancy, she added, just as they commonly screen for depression, and that women who score high could be monitored for increases in anxiety and possible intervention later in pregnancy.
Further research should continue to explore reasons that pregnancy anxiety is linked to birth timing, including stress-related neuroendocrine changes, inflammation, and health behaviors, according to Dunkel Schetter.
“Increasing precision in our understanding of both the risks and mechanisms of the effects of pregnancy anxiety on gestational length can improve our ability to develop, test, and implement interventions to address the pressing public health issue of preterm birth,” she said.
Reference: “Anxiety in pregnancy and length of gestation: Findings from the healthy babies before birth study” by Christine Dunkel Schetter, Ph.D., Danny Rahal, Ph.D., Carolyn Ponting, Ph.D., Melissa Julian, Isabel Ramos, Ph.D., Calvin Hobel, Ph.D. and Mary Coussons-Read, 26 September 2022, Health Psychology.
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