Possible relationship between general and pregnancy-related anxiety during the first half of pregnancy and the birth process: a prospective cohort study

Abstract

ObjectivesThe rate of interventions during childbirth has increased dramatically during the last decades. Maternal anxiety might play a role in the progress of the labour process and interventions during labour. This study aimed to identify associations between anxiety in the first half of pregnancy and the birth process, including any interventions required during labour. In addition, differences in the associations by parity and ethnicity were explored.DesignProspective cohort study.SettingPrimary care midwifery practices and secondary/tertiary care obstetric practices in Amsterdam, participating in the multiethnic ABCD (Amsterdam Born Children and their Development) study (participation rate 96%; response 8266/12 373 (67%)).ParticipantsIncluded were women with singletons, alive at labour start, with a gestational age ≥24 weeks (n=6443).Independent variableGeneral anxiety (State-Trait Anxiety Inventory state) and pregnancy-related anxiety (Pregnancy-Related Anxieties Questionnaire (PRAQ)) were self-reported in the first half of pregnancy.OutcomesAssociations between both forms of anxiety and several indicators of the birth process were analysed. Subgroup analyses were performed for parity and ethnicity.ResultsThe prevalence of high general anxiety (State-Trait Anxiety Inventory score ≥43) and pregnancy-related anxiety (PRAQ score ≥P90) were 30.9% and 11.0%, respectively. After adjustment, in nulliparae, both general anxiety and pregnancy-related anxiety were associated with pain relief and/or sedation (OR for general anxiety 1.23; 95% CI 1.02 to 1.48; OR for pregnancy-related anxiety 1.45; 95% CI 1.14 to 1.85). In multiparae, general anxiety was associated with induction of labour (OR 1.53; 95% CI 1.16 to 2.03) and pregnancy-related anxiety was associated with primary caesarean section (OR 1.66; 95% CI 1.02 to 2.70). Associations were largely similar for all ethnicities.ConclusionsHigh levels of general and pregnancy-related anxiety in early pregnancy contribute modestly to more interventions during the birth process with similar associations between ethnic groups, but with some differences between nulliparae and multiparae.

Does Mindful Parenting Mediate the Association between Maternal Anxiety during Pregnancy and Child Behavioral/Emotional Problems?

“…In our study, it had good internal consistency at 21 weeks' gestation and at age 4 years (α = .89 and α = .94, respectively). In our study, rates of high prenatal state anxiety (i.e., state subscale scores > 43 as defined at 21 weeks' gestation) were low (i.e., 7.6%), as compared to the rates of high state anxiety (30.9%) during the first half of pregnancy in a Dutch population-based study (n = 6443) (Koelewijn et al 2017).…”

Associations between maternal psychological distress and salivary cortisol during pregnancy: A mixed-models approach

“…The PRAQ-R consists of 5 subscales: concern for self (3 items), fear of integrity (4 items), fear of delivery (3 items), fear of changes (3 items) and concern for future relationships (4 items), with item scores ranging from 1 to 7. According to a Dutch population-based study (N = 6443), the cutoff for high state anxiety on the STAI is 43 (Koelewijn et al, 2017). Additionally, the cutoff for the SCL-90 anxiety subscale for "above average/high" for anxiety is 15 (Arrindell and Ettema, 2003).…”

Comparison of Postoperative Opioid Consumption and Pain Scores in Primary Versus Repeat Cesarean Delivery in Opioid Naïve Patients

“…This group demonstrated a lower rate of pregnancy-related anxiety in the multipara vs. nullipara groups [20]. This group also demonstrated a relationship between pregnancy-related anxiety to a higher likelihood to receive pain relief or sedation [20]. These findings support the plausibility that patients undergoing repeat CD may require less postoperative opioids secondary to a reduced state of anxiety associated with the procedure.…”

“…Koelewijn et al recently performed a prospective cohort study evaluating factors associated with pregnancy-related anxiety. This group demonstrated a lower rate of pregnancy-related anxiety in the multipara vs. nullipara groups [20]. This group also demonstrated a relationship between pregnancy-related anxiety to a higher likelihood to receive pain relief or sedation [20].…”