The Course O F Maternal Pregnancy-Related Anxiety Across Pregnancy And Effects On Neonatal Outcomes: A Longitudinal Cohort Study

Objective The current study aims to investigate the prevalence, trends and related influencing factors of pregnancy-related anxiety symptoms throughout pregnancy and examine the associations between pregnancy-related anxiety symptoms and adverse neonatal outcomes. Methods Pregnant women registered in the maternal and child health centers of Ma’anshan in the first trimester(before 16 weeks) were recruited to participate in the birth cohort study. Women filled out questionnaires three times during pregnancy(before 16, 24-28 and 32-36 weeks). Data on demographic characteristic(age, residence, education, and so on), unplanned pregnancy, prior pregnancy history, vaginal bleeding, vomiting of pregnancy, fever, use of nutritional supplementation during pregnancy and neonatal birth records were collected. The Pregnancy-Related Anxiety Questionnaire(PRAQ) was used to assess the anxiety symptoms. A total of 1662 women participated in all three surveys and 1554 women delivered singletons live births. Repeated measures ANOVA, χ2 test and generalized estimating equations(GEE) was used to evaluate the related influencing factors of pregnancy-related anxiety symptoms. The relationships between pregnancy-related anxiety symptoms and adverse neonatal outcomes were investigated by use of logistics regression. Results The mean score of the pregnancy-related anxiety was 20.2±4.8, 19.7±4.7, 18.8±4.3 for the first, second and third trimester, respectively. Pregnancy-related anxiety showed a significant difference among the three trimesters(F=186.62, P<0.001). Prevalence of pregnancy-related anxiety symptoms was 20.6%, 17.7% and 13.1%, respectively, at the first, second and third trimester. 29.4%(488/1662) of pregnant women had pregnancy-related anxiety symptoms and among these pregnant women 6.6%(110/1662) experienced continuous anxiety symptoms from the first to third trimester. Results from GEE analysis indicated that lower maternal education of junior and senior high school(OR=1.53, 95%CI 1.03–2.28; OR=1.67, 95%CI 1.16–2.40), primigravida(OR=1.69, 95%CI 1.03–2.78), unplanned pregnancy(OR=2.24, 95%CI 1.74–2.88), history of miscarriage(OR=2.02, 95%CI 1.24–3.30), vomiting of pregnancy(OR=1.31, 95%CI 1.13–1.51), and use of nutritional supplementation during pregnancy(OR=1.38, 95%CI 1.13–1.68) significantly increased the risk of pregnancy-related anxiety symptoms. Results of the logistics regression indicated that there was no association between pregnancy-related anxiety symptoms and adverse neonatal outcomes such as preterm birth, small for gestational age and low birth weight. Conclusion Pregnancy-related anxiety appeared a decrease from the first to third trimester. Maternal lower education, primigravida, unplanned pregnancy, history of miscarriage, and vomiting of pregnancy were associated with the risk of pregnancy-related anxiety symptoms. Clinicians should focus on these adverse factors on pregnancy-related anxiety symptoms and fundamentally to prevent it. Furthermore, associations between pregnancy-related anxiety symptoms and adverse neonatal outcomes were not detected. Future well designed studies of large sample are warranted to examine the findings.