A Cohort Study On Effects Of Maternal Emotional Symptoms On Adverse Pregnancy Outcomes Among Chinese Women

Objectives To describe the relation between maternal anxiety, depression,pregnancy-specific anxiety and evaluate the impact of antenatal anxiety, depressionand pregnancy-specific anxiety as predictors of adverse birth outcomes, includingpreterm delivery, low birth weight and small for gestational age. Furtherly, to describethe epidemic status of mental development index (MDI) and psychomotordevelopment index (PDI), and to explore the association between maternal anxiety,depression, pregnancy-specific anxiety and MDI, PDI.Methods A total of4694women were surveyed between Oct2008and Oct2010.Self-reported anxiety and depression were assessed at their first visit to maternalhealth center in a prospective longitudinal study of a community sample of women inChina. The questionnaire also included sociodemographic characters, prior pregnancyoutcome, pregnancy-induced diseases and the other variables. The data concerningpregnancy outcome were recorded by the women and complemented with informationcollected from the hospital records. Binary logistic regression was used to estimaterisk ratios (RR) and95%confidence intervals (95%CI) between the association formaternal psychological state and preterm birth, low birth weight and small forgestational age. Bayley scales of Infant Development of China Revison (BSID-CR)was used to evaluate children MDI and PDI. The association between maternalanxiety, depression, pregnancy-specific anxiety and children MDI and PDI wereanalyzed by t test analysis. After controlling for confoundings including maternal age,education, children sex, low birth weight, small for gestational age, prior spontaneous abortion, prior drug abortion, prior induced abortion, Covariance analysis were usedto explore the association for maternal anxiety, depression, pregnancy-specific anxietywith children MDI and PDI.Results Anxiety occurred among125pregnant women, the incidence of anxiety was2.7%.224(4.8%) women had depression symptoms during pregnancy. Correlationbetween anxiety score and depression score was significant (r=0.692, P＜0.001).Anxiety was significantly related to depression by univariate analysis (t=-16.90, P<0.001). Binary logistic regression demonstrated that second-trimester depression wasstronger associated with an increased of small for gestational age (RR=4.59,95%CI:2.17-9.71) than any depression (RR=2.27,95%CI:1.23-4.21). No statisticallysignificant associations were found between maternal anxiety and adverse pregnancyoutcomes from our study. T test demonstrated that maternal anxiety, maternalfirst-trimester anxiety, maternal second-trimester anxiety were not significantlyassociated with children MDI and PDI. Maternal depression, maternal first-trimesterdepression, maternal second-trimester depression were not related to children MDIand PDI. Maternal pregnancy-specific anxiety, maternal first-trimester anxiety,maternal second-trimester pregnancy-specific anxiety, maternal third-trimesterpregnancy-specific anxiety were not linked to children MDI and PDI. After wecontrolled the confoundings such as maternal education, children sex, maternal ageand so on, Analysis of Covariance was used to demonstrate the predictors of childrenMDI and PDI, maternal anxiety, depression and pregnancy-specific anxiety in alltrimesters were not associated with MDI and PDI, but the factor associated withchildren MDI with a p value of0.05or less was “self Care” included in maternalpregnancy-specific anxiety in the third trimester.Conclusions These results suggest maternal depression; above all, second-trimesterdepression was an increased risk of small for gestational age. Policies aimed at thedetection and effective management of depressive symptoms during pregnancy may be helpful to reduce the incidence of small for gestational age and act as an importantmeasure in the prevention of SGA. Although some study showed that maternalanxiety, depression predicted delayed development of MDI and PDI, our study didn’tfind this association. However, third-trimester “self care” of pregnancy-relatedanxiety was associated with MDI of children between23-month-old and26-month-old.