Pregnancy-specific anxiety associated with shorter gestation times and earlier births: Research

According to recent research, women who are anxious about their pregnancies give delivery earlier on average than those who are not.

The study, which looked at the association between pregnancy length and several anxiety indicators, might help doctors figure out when and how to screen for anxiety during pregnancy to help avoid premature delivery.

“Anxiety about a current pregnancy is a potent psychosocial state that may affect birth outcomes,” said lead study author Christine Dunkel Schetter, PhD, of the University of California Los Angeles. “These days, depressive symptoms are assessed in many clinic 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 reported in the journal Health Psychology.

Previous study has discovered that up to one in every four pregnant women had clinically heightened anxiety symptoms, and that anxiety can be a risk factor for preterm delivery, or birth before 37 weeks. Those studies, however, employed a range of anxiety measures and examined both general anxiety and pregnancy-specific worry, which includes concerns about birthing, parenting, and the baby’s health. 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 reviewed data from a broad sample of 196 pregnant women in Denver and Los Angeles who participated in the Healthy Babies Before Birth project to separate out these distinct impacts of timing and anxiety type. Women identified as non-Hispanic white 45% of the time, Hispanic white 36% of the time, Asian 10% of the time, and Black or African American 9% of the time.

The ladies were given four different anxiety scales by the researchers in both the first and third trimesters of their pregnancies. One was a five-question general anxiety screener, and the other three were pregnancy-specific: a 10-question and four-question scale of pregnancy-related anxiety, and a nine-question evaluation of a larger range of pregnancy-related stressors, such as medical care and anxieties 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 risk for 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.