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Anxiety in early pregnancy: prevalence and contributing factors

Abstract

Antenatal anxiety symptoms are not only a health problem for the expectant mother. Research has found that maternal anxiety may also have an impact on the developing baby. Therefore, it is important to estimate the prevalence of maternal anxiety and associated factors. The current study aims to estimate the prevalence of anxiety symptoms during the first trimester of pregnancy and to identify associated risk factors. Secondly, to investigate other factors associated with anxiety during early pregnancy including fear of childbirth and a preference for cesarean section. In a population-based community sample of 1,175 pregnant women, 916 women (78 %) were investigated in the first trimester (gestation week 8–12). The Hospital Anxiety Depression Scale (HADS-A) was used to measure anxiety symptoms. The prevalence of anxiety symptoms (HADS-A scores ≥8 during pregnancy) was 15.6 % in early pregnancy. Women under 25 years of age were at an increased risk of anxiety symptoms during early pregnancy (OR 2.6, CI 1.7–4.0). Women who reported a language other than Swedish as their native language (OR 4.2, CI 2.7–7.0), reported high school as their highest level of education (OR 1.6, CI 1.1–2.3), were unemployed (OR 3.5, CI 2.1–5.8), used nicotine before pregnancy (OR 1.7, CI 1.1–2.5), and had a self-reported psychiatric history of either depression (OR 3.8, CI 2.6–5.6) or anxiety (OR 5.2, CI 3.5–7.9) before their current pregnancy were all at an increased risk of anxiety symptoms during early pregnancy. Anxiety symptoms during pregnancy increased the rate of fear of birth (OR 3.0, CI 1.9–4.7) and a preference for cesarean section (OR 1.7, CI 1.0–2.8). Caregivers should pay careful attention to history of mental illness to be able to identify women with symptoms of anxiety during early pregnancy. When presenting with symptoms of anxiety, the women might need counseling and or treatment in order to decrease her anxiety.

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References

  1. Alder J, Fink N, Bitzer J, Hözli I, Holzgreve W (2007) Depression and anxiety during pregnancy: a risk factor for obstetric, fetal, and neonatal outcome. A critical review of the literature. J Matern Fetal and Neonatal Med 20(3):89–209

    Google Scholar 

  2. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington, DC

    Google Scholar 

  3. Andersson L, Sundström-Poromaa I, Bixo M, Wulff M, Bondestam K, Åström M (2003a) Point prevalence of psychiatric disorders during the second trimester of pregnancy: a population-based study. Am J Epidemiol 189:148–154

    Google Scholar 

  4. Andersson L, Sundström-Poromaa I, Wulf M, Åström M, Bixo M (2003b) Neonatal outcome following maternal antenatal depression and anxiety: a population-based study. Am J Epidemiol 159:872–881

    Article  Google Scholar 

  5. Andersson L, Sundström-Poromaa I, Wulf M, Åström M, Bixo M (2004) Implications of antenatal depression and anxiety for obstetric outcome. Obstet Gynecol 104:467–476

    PubMed  Article  Google Scholar 

  6. Andersson L, Sundström-Poromaa I, Wulf M, Åström M, Bixo M (2006) Depression and anxiety during pregnancy and 6 month postpartum: a follow-up study. Acta Obstet Gynecol 85:937–944

    Article  Google Scholar 

  7. Austin MP, Tully L, Parker G (2007) Examing the relationship between antenatal anxiety and postnatal depression. J Affect Disord 101:169–174

    PubMed  Article  Google Scholar 

  8. Berle JØ, Mykletun A, Daltveit AK, Rasmussen S, Holsten F, Dahl AA (2005) Neonatal outcomes in offspring of women with anxiety and depression during pregnancy: a Linkage Study from The TrØndelag Health Study (HUNT) and Medical Birth Registry of Norway. Arch Wom Mental Health 8:181–189

    CAS  Article  Google Scholar 

  9. Bjelland I, Dahl AA, Haug TT, Neckelmann D (2002) The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res 52(2):69–77

    PubMed  Article  Google Scholar 

  10. Coleman V, Carter M, Morgan M, Schulkin J (2008) Obstetrician-gynecologists’ screening patterns for anxiety during pregnancy. Depress Anxiety 25:114–123

    PubMed  Article  Google Scholar 

  11. Conde A, Figueiredo B, Tendais I, Teixeira C, Costa R, Pacheco A, Ceu Rodrigues M, Nogueira R (2010) Mother’s anxiety and depression and associated risk factors during early pregnancy: effects on fetal growth and activity at 20–22 weeks of gestation. J Psychosom Obstet Gynecol 31(2):70–82

    Article  Google Scholar 

  12. Copper LR, Goldenberg R, Das A, Elder N, Swain M, Norman G, Ramsey R, Cotroneo P (1996) The preterm prediction study: maternal stress is associated with spontaneous preterm birth at less than 35 weeks’ gestation. Am J Obstet Gynecol 175:1286–1292

    CAS  PubMed  Article  Google Scholar 

  13. Goedart G, Snijders AC, Gavin AR et al (2010) Maternal depressive symptoms in relation to perinatal mortality and morbidity: results from a large multiethnic cohort study. Psychosom Med 72:769–776

    Article  Google Scholar 

  14. Goodman J, Tyer-Viola L (2010) Detection, treatment, and referral of perinatal depression and anxiety by obstetrical providers. J Wom Health 19:477–490

    Article  Google Scholar 

  15. Heron J, O’connor GT, Evens J, Golding J, Glover V (2004) The course of anxiety and depression through pregnancy and the postpartum in a community sample. J Affect Disord 80:65–73

    PubMed  Article  Google Scholar 

  16. Hildingsson I, Rådestad I, Rubertsson C, Waldenström U (2002) Few women wish to be delivered by cesarean section. Int J Obstet Gynael 109(6):618–623

    Article  Google Scholar 

  17. Josefsson A, Berg G, Nordin C, Sydsjo G (2001) Prevalence of depressive symptoms in late pregnancy and postpartum. Acta Obstet Gynecol Scand 80(3):251–255

    CAS  PubMed  Article  Google Scholar 

  18. Kringeland T, Dalveit AK, Möller A (2009) What characterize women in Norway who wish to have a cesarean section? Scand J Publ Health 37:364–371

    Article  Google Scholar 

  19. Kurki T, Hiilesmaa V, Raitasalo R, Mattila H, Ylikorkala O (2000) Depression and anxiety in early pregnancy and risk for preeclampsia. Obstet Gynecol 95(4):487–490

    CAS  PubMed  Article  Google Scholar 

  20. Larsson C, Sydsjo G, Josefsson A (2004) Health, sociodemographic data, and pregnancy outcome in women with antepartum depressive symptoms. Obstet Gynecol 104(3):459–466

    PubMed  Article  Google Scholar 

  21. Leight KL, Fitelson EM, Weston CA, Wisner KL (2010) Childbirth and mental disorders. Int Rev Psychiatry 22:453–471

    PubMed  Article  Google Scholar 

  22. Li D, Liu L, Odouli R (2009) Presence of depressive symptoms during early pregnancy and the risk of preterm delivery: a prospective cohort study. Hum Reprod 24(1):146–153

    CAS  PubMed  Google Scholar 

  23. Lisspers J, Nygren A, Söderman E (1997) Hospital Anxiety and Depression Scale (HAD): some psychometric data for a Swedish sample. Acta Psychiatr Scand 96:281–286

    CAS  PubMed  Article  Google Scholar 

  24. Martini J, Knappe S, Beesdo-Baum K, Lieb R, Wittchen H-U (2010) Anxiety disorders before birth and self-perceived distress during pregnancy: associations with maternal depression and obstetric, neonatal, and early childhood outcomes. Early Hum Dev 86:305–310

    PubMed  Article  Google Scholar 

  25. Matthey S, Ross-Hamid C (2012) Repeat testing on the Edinburgh Depression Scale and the HADS-A in pregnancy: differentiating between transient and enduring distress. J Affect Disord 141:213–221

    PubMed  Article  Google Scholar 

  26. Matthey S, Barnett B, Howie P, Kavanagh KJ (2003) Diagnosing post-partum depression in mothers and fathers: Whatever happened to anxiety? J Affect Disord 74:139–147

    Google Scholar 

  27. Molarius A, Berglund K, Eriksson C, Eriksson HG, Lindén-Boström M, Nordström E, Persson C, Sahlqvist L, Starrin B, Ydreborg B (2009) Mental health symptoms in relation to socio-economic conditions and lifestyle factors—a population-based study in Sweden. BMC Public Health 9

  28. O’Connor GT, Heron J, Glover V, The Alspac Study Team (2002) Antenatal anxiety predicts child behavioral/emotional problems independently of postnatal depression. Am Acad Child Adolesc Psychiatry 41(12):1470–1477

    Article  Google Scholar 

  29. Qiu C, Williams MA, Calderon-Margalit R, Cripe SM, Sorensen TK (2009) Preeclampsia risk in relation to maternal mood and anxiety disorders diagnosed before or during early pregnancy. Am J Hypertens 22(4):397–402

    PubMed  Article  Google Scholar 

  30. Ross LE, McLean LM (2006) Anxiety disorders during pregnancy and the postpartum period: a systematic review. J Clin Psychiatry 67:1285–1298

    PubMed  Article  Google Scholar 

  31. Rubertsson C, Wickberg B, Gustavsson P, Radestad I (2005) Depressive symptoms in early pregnancy, 2 months and 1 year postpartum-prevalence and psychosocial risk factors in a national Swedish sample. Arch Wom Ment Health 8(2):97–104

    CAS  Article  Google Scholar 

  32. Sjögren B, Thomassen P (1997) Obstetric outcome in 100 women with severe anxiety of childbirth. Acta Gynecol Scand 76(10):948–952

    Article  Google Scholar 

  33. van Bussel CHJ, Spiz B, Demyttenaere K (2009) Anxiety in pregnant and postpartum women. An exploratory study of the role of maternal orientations. J Affect Disord 11:232–242

    Article  Google Scholar 

  34. van den Bergh BRH, Marcoen A (2004) High antenatal maternal anxiety is related to ADHD symptoms, externalizing problems, and anxiety in 8 and 9 year olds. Child Dev 75:1085–1097

    PubMed  Article  Google Scholar 

  35. van den Bergh BRH, Mennes M, Oosterlaan J, Stevens V, Stiers P, Marcoen A, Lagae L (2004) High antenatal maternal anxiety is related to impulsivity during performance on cognitive tasks in 14 and 15 year olds. Neurosci Biobehav Rev 29:259–269

    PubMed  Article  Google Scholar 

  36. Vesga-Lopéz O, Blanco C, Keyes C, Olfson M, Grant FB, Hasin SD (2008) Psychiatric disorders in pregnant and postpartum women in the United States. Arch Gend Psychiatry 65(7):805–815

    Article  Google Scholar 

  37. Wisner KL, Sit DK, Hanusa BH, Moses-Kolko EL, Bogen DL, Hunker DF et al (2009) Major depression and antidepressant treatment: impact on pregnancy and neonatal outcomes. Am J Psychiatry 166(5):557–566

    PubMed  Article  Google Scholar 

  38. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67(6):361–370

    CAS  PubMed  Article  Google Scholar 

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Acknowledgments

Thanks to Karin Monsen Börjesson and all the midwives who participated in the recruitment process to the Betti-study.

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There are no conflicts of interest to report.

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Correspondence to M. Cross.

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Rubertsson, C., Hellström, J., Cross, M. et al. Anxiety in early pregnancy: prevalence and contributing factors. Arch Womens Ment Health 17, 221–228 (2014). https://doi.org/10.1007/s00737-013-0409-0

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Keywords

  • Pregnancy
  • Anxiety
  • Anxiety disorder
  • Hospital anxiety and depression scale