| Objectives To understand the effect factors of pregnancy-related anxiety in the first trimester, determine the relationship between pregnancy-related anxiety and adverse birth outcomes.Methods By following up the pregnant women who had registered (before 16 weeks) in the maternal and child health(MCH) centers in the first trimester in 8 cities between Oct 2008 and Oct 2010, we collected the information related to the pregnant women and the baby's delivery records that including the mother's socio-demographic characteristics (age, education, family economic status, and so on), prior pregnancy history and medical history, environmental exposure during 6 months of pre-pregnancy and in the first trimester, mental health in the first trimester. The questionnaires measuring mental health status were pregnancy-related anxiety questionnaire (pregnancy-related anxiety), Self-Rating Anxiety Scale (SAS) and Epidemiological Studies-Depression scale (CES-D). We also collected the baby's delivery records including gender, gestational age and birth weight. A total of 20 308 pregnant women were completed questionnaires and 12 355 women delivered live babies. Descriptive statistics was applied to describe the pregnant women's demographic characteristics. Chi-square analysis and multiple stepwise regression analysis were used to compare difference about pregnancy-related anxiety between different groups to explore the possible risky factor. Variance analysis was performed to compare the baby's birth weight in different groups. The associations between pregnancy-related anxiety and adverse birth outcomes were investigated by logistics regression. Results The average scores of the pregnancy-related anxiety questionnaire was (20.57±5.04). The results of the stepwise multinomial regression analysis showed that following factors were significantly associated with pregnancy-related anxiety: smoking and alcohol 6 months before pregnancy, job stress in early pregnancy and unexpected pregnancy , the odds ratio (OR) were 1.89(95%CI: 1.35-2.65), 1.81(95%CI: 1.18-2.75), 2.26(95%CI: 1.94-2.65), 2.23(95%CI: 2.08-2.60), respectively. Multifactor logistics regression analysis also showed that the major factors of pregnancy-related anxiety were mothers'ages, the incomes of the family, smoking and drinking in 6 months before pregnancy, living environment and drug use 6 months pre-pregnancy and in the first trimester, the short interval between births, and abnormal gestation reaction in the first trimester.The rates of premature delivery, low birth weight, macrosomia, small for gestational age and large for gestational age were 3.5%, 1.9%, 10.1%, 3.6%, 24.3%, respectively. We found that pregnancy-related anxiety in the first trimester was no associated with adverse pregnancy outcomes(premature delivery, low birth weight, macrosomia, small for gestational age and large for gestational age). Furthermore, the birth weight of low, medium and high scores of pregnancy-related anxiety were 3344.01±419.64, 3302.36±414.91, 3312.74±400.87 in spontaneous delivery group, respectively, and there were significant difference in birth weight(F=3.98, P=0.019), however, there was no difference in cesarean section. Worried about the delivery(OR=1.33, 95%CI: 1.07-1.67) and depressive symptom(OR=1.53, 95%CI: 1.02-2.28)s were the risk factors to small for gestational age.Conclusions The multi-environmental factors in the pre-pregnancy and in the first trimester have the impact on the pregnant women's psychological health, and the factors also could lead to mothers'pregnant anxiety. Although there was no difference between pregnant-related anxiety and adverse pregnancy outcomes in the first trimester, we also should pay more attention to pregnancy-related anxiety during pregnancy because it is an important psychosocial stress.
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