Skip to main content

Advertisement

Log in

Anxiety and Optimism Associated with Gestational Age at Birth and Fetal Growth

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

Abstract

Psychosocial factors such as anxiety or optimism may be related to the risk of adverse pregnancy outcomes, but the evidence is conflicting. We investigated the relation between maternal anxiety, optimism, gestational age and infant birth weight in a cohort of 667 nulliparous women from the Prenatal Exposures and Preeclampsia Prevention study, Pittsburgh PA. Women completed the Spielberger Trait Anxiety Inventory and the Life Orientation Test at 18 weeks gestation. Linear and logistic regression models assessed the relation of anxiety and optimism to gestational age, birth weight centile, preterm delivery (<37 weeks) or small for gestational age (<10th percentile) births. After adjustment for age, race, preeclampsia, and smoking, higher anxiety was associated with decreasing gestational age (−1.6 days per SD increase in anxiety score, P = 0.06). This relationship was modified by maternal race (P < 0.01 for interaction). Among African American women, each SD increase in anxiety was associated with gestations that were, on average, 3.7 days shorter (P = 0.03). African American women with anxiety in the highest quartile had gestations that were 8.2 days shorter, and they had increased risk for preterm birth after excluding cases of preeclampsia (OR 1.69, 95% CI 1.08, 2.64). There was no association between anxiety and gestational age among White women. There was also no relation between anxiety, optimism and birth weight centile. Trait anxiety was associated with a reduction in gestational age and increased risk for preterm birth among African American women. Interventions that reduce anxiety among African American pregnant women may improve pregnancy outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Steer, P. (2005). The epidemiology of preterm labour. BJOG: An International Journal of Obstetrics & Gynaecology, 1, 1–3.

    Article  Google Scholar 

  2. Institute of Medicine. (2006). Preterm birth: Causes, consequences, and prevention. Washington, DC.

  3. Zeitlin, J., Ancel, P., Saurel-Cubizolles, M., & Papiernik, E. (2001). Are risk factors the same for small for gestational age versus other preterm births. American Journal of Obstetrics and Gynecology, 185, 208–215.

    Article  CAS  PubMed  Google Scholar 

  4. Fox, S., Koepsell, T., & Daling, J. (1994). Birth weight and smoking during pregnancy-effect modification by maternal age. American Journal of Epidemiology, 139, 1008–1015.

    CAS  PubMed  Google Scholar 

  5. Shiono, P., & Klebanoff, M. (1986). Ethnic differences in preterm and very preterm delivery. American Journal of Public Health, 76, 1317–1321.

    Article  CAS  PubMed  Google Scholar 

  6. Unis, K., Beydoun, H., Tamim, H., Nassif, Y., & Khogali, M. (2004). Risk factors for term or near-term fetal growth restriction in the absence of maternal complications. American Journal of Perinatology, 21, 227–234.

    Article  Google Scholar 

  7. Spencer, N. (2003). Social, economic, and political determinants of child health. Pediatrics, 112, 704–706.

    Google Scholar 

  8. Savitz, D. A., Kaufman, J., Dole, N., Siega-Riz, A. M., Thorp, J., & Kaczor, D. (2004). Poverty, education, race, and pregnancy outcome. Ethnicity and Disease, 14, 322–329.

    PubMed  Google Scholar 

  9. Simhan, H. N., & Bodnar, L. M. (2006). Prepregnancy body mass index, vaginal inflammation, and the racial disparity in preterm birth. American Journal of Epidemiology, 163, 459–466.

    Article  PubMed  Google Scholar 

  10. David, R., & Collins, J. (1997). Differing birth weight among infants of U.S.-born Blacks, African-born Blacks and U.S.-born Whites. NEJM, 337, 1209–1214.

    Article  CAS  PubMed  Google Scholar 

  11. Abrams, B., & Newman, V. (1991). Small-for-gestational age birth: Maternal predictors and comparison with risk factors of spontaneous delivery in the same cohort. American Journal of Obstetrics and Gynecology, 164, 785–790.

    CAS  PubMed  Google Scholar 

  12. Borders, A., Grobman, W., Amsden, L., & Holl, J. (2007). Chronic stress and low birth weight neonates in a low-income population of women. Obstetrics and Gynecology, 109, 331–338.

    PubMed  Google Scholar 

  13. Copper, R. L., Goldenberg, R. L., Das, A., Elder, N., Swain, M., Norman, G., et al. (1996). The preterm prediction study: Maternal stress is associated with spontaneous preterm birth at less than thirty-five weeks’ gestation. American Journal of Obstetrics and Gynecology, 175, 1286–1292.

    Article  CAS  PubMed  Google Scholar 

  14. Cousson-Read, M., Okun, M., & Nettles, C. (2006). Psychosocial stress increases inflammatory markers and alters cytokine production across pregnancy. Brain, Behavior, and Immunity, 21, 343–350.

    Article  Google Scholar 

  15. Coussons-Read, M. E. P., Okun, M. L. M. A., Schmitt, M. P. B. S., & Giese, S. B. S. (2005). Prenatal stress alters cytokine levels in a manner that may endanger human pregnancy. SO––Psychosomatic Medicine, 67, 625–631.

    Article  CAS  Google Scholar 

  16. Dayan, J., Creveuil, C., Herlicoviez, M., Herbel, C., Baranger, E., Savoye, C., et al. (2002). Role of anxiety and depression in the onset of spontaneous preterm labor. American Journal of Epidemiology, 155, 293–301.

    Article  CAS  PubMed  Google Scholar 

  17. Dole, N., Savitz, D. A., Hertz-Picciotto, I., Siega-Riz, A. M., McMahon, M. J., & Buekens, P. (2003). Maternal stress and preterm birth. American Journal of Epidemiology, 157, 14–24.

    Article  CAS  PubMed  Google Scholar 

  18. Glynn, L., Schetter, C., Hobel, C., & Sandman, C. (2008). Pattern of perceived stress and anxiety in pregnancy predicts preterm birth. Health Psychology, 27, 43–51.

    Article  PubMed  Google Scholar 

  19. Nordentoft, M., Lou, H. C., Hansen, D., Nim, J., Pryds, O., Rubin, P., et al. (1996). Intrauterine growth retardation and premature delivery: The influence of maternal smoking and psychosocial factors. American Journal of Public Health, 86, 347–354.

    Google Scholar 

  20. Orr, S., PReiter, J., Blazer, D., & James, S. (2007). Maternal prenatal pregnancy-related anxiety and spontaneous preterm birth in Baltimore, Maryland. Psychosomatic Medicine, 69, 566–570.

    Article  PubMed  Google Scholar 

  21. Lobel, M., DeVincent, C. J., Kaminer, A., & Meyer, B. A. (2000). The impact of prenatal maternal stress and optimistic disposition on birth outcomes in medically high-risk women. Health Psychology, 19, 544–553.

    Article  CAS  PubMed  Google Scholar 

  22. Littleton, H. L., Breitkopf, C. R., & Berenson, A. B. (2007). Correlates of anxiety symptoms during pregnancy and association with perinatal outcomes: A meta-analysis. American Journal of Obstetrics and Gynecology, 196, 424–432.

    Article  PubMed  Google Scholar 

  23. Lobel, M., & Dunkel-Schetter, C. (1990). Conceptualizing stress to study effects on health. Anxiety Research, 3, 213–230.

    Google Scholar 

  24. Speilberger, C. (1983). Manual for the state-trait anxiety inventory. Palo Alto, CA: Consulting Psychologist Press.

    Google Scholar 

  25. Rini, C., Dunkel-Schetter, C., Wadhwa, P., & Sandman, P. (1999). Psychological adaptation and birth outcomes: The role of personal resources, stress, and sociocultural context in pregnancy. Psychology, 18, 333–345.

    CAS  Google Scholar 

  26. WHO Consultation on Obesity. (2000). Obesity: Preventing and managing the global epidemic. WHO Technical Report Series 894.

  27. Roberts, J. M., Bodnar, L. M., Lain, K. Y., Hubel, C. A., Markovic, N., Ness, et al. (2005). Uric acid is as important as proteinuria in identifying fetal risk in women with gestational. Hypertension, 46, 1263–1269.

  28. SAS. (2002–2003). 9.1. ed. Cary, NC: SAS Institute, Inc.

  29. Kessler, R., McGonagle, K., Ahao, S., Nelson, C., Hughes, M., Eshleman, S., et al. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Archives of General Psychiatry, 51, 8–19.

    CAS  PubMed  Google Scholar 

  30. Holllins, K. (2007). Consequences of antenatal mental health problems for child health and development. Current Opinion in Obstetrics and Gynecology, 19, 568–572.

    Article  Google Scholar 

  31. Neggers, Y., Goldenberg, R., Cliver, S., & Hauth, J. (2006). The relationship between psychosocial profile, health practices, and pregnancy outcomes. Acta obstetricia et gynecologica Scandinavica, 85, 277–285.

    Google Scholar 

  32. Beydoun, H., & Saftlas, A. (2008). Physical and mental health outcomes of prenatal maternal stress in human and animal studies: A review of recent evidence. Paediatric and Perinatal Epidemiology, 22, 438–466.

    Article  PubMed  Google Scholar 

  33. Paarlberg, K. M., Vingerhoets, A. J. J. M., Passchier, J., Dekker, G. A., & Van Geijn, H. P. (1995). Psychosocial factors and pregnancy outcome: A review with emphasis on methodological issues. Journal of Psychosomatic Research, 39, 563–595.

    Article  CAS  PubMed  Google Scholar 

  34. Lobel, M., Cannella, D., Graham, J., DeVincent, C., Schneider, J., & Meyer, B. (2008). Pregnancy-specific stress, prenatal health behaviors, and birth outcomes. Health Psychology, 27, 604–615.

    Article  PubMed  Google Scholar 

  35. Andersson, L., Sundstrom-Poromaa, I., Wulff, M., Astrom, M., & Bixo, M. (2004). Neonatal outcome following maternal antenatal depression and anxiety: A population-based study. American Journal of Epidemiology, 159, 872–881.

    Article  PubMed  Google Scholar 

  36. Dayan, J. M. D. P., Creveuil, C. P., Marks, M. N. P., Conroy, S. M., Herlicoviez, M. M. D. P., Dreyfus, M. M. D. P., et al. (2006). Prenatal depression, prenatal anxiety, and spontaneous preterm birth: A prospective cohort study among women with early and regular care. Psychosomatic Medicine, 68, 938–946.

    Article  PubMed  Google Scholar 

  37. Hedegaard, M., Henriksen, T. B., Sabroe, S., & Secher, N. J. (1996). The relationship between psychological distress during pregnancy and birth weight for gestational age. Acta obstetricia et gynecologica Scandinavica, 75, 32–39.

    Google Scholar 

  38. Mancuso, R. A., Schetter, C. D., Rini, C. M., Roesch, S. C., & Hobel, C. J. (2004). Maternal prenatal anxiety and corticotropin-releasing hormone associated with timing of delivery. Psychosomatic Medicine, 66, 762–769.

    Google Scholar 

  39. Matthews, K., & Rodin, J. (1992). Pregnancy alters blood pressure responses to psychological and physical challenge. Psychophysiology, 29, 232–240.

    Article  CAS  PubMed  Google Scholar 

  40. Alexander, G., Kogan, M., Bader, D., Carlo, W., Allen, M., & Mor, J. (2003). US Birth weight/gestational ag-specific neonatal mortality: 1995–1997 rates for Whites, Hispanics, and Blacks. Pediatrics, 111, e61–e66.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Funding was provided by NIH-2P01-HD30367 (Preeclampsia Program Project), NIH-5M01-RR00056 (Magee-Womens Clinical Research Center), and the BIRCWH-K12HD043441-06.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Janet M. Catov.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Catov, J.M., Abatemarco, D.J., Markovic, N. et al. Anxiety and Optimism Associated with Gestational Age at Birth and Fetal Growth. Matern Child Health J 14, 758–764 (2010). https://doi.org/10.1007/s10995-009-0513-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-009-0513-y

Keywords

Navigation