Risk factors of transient and persistent anxiety during pregnancy

Abstract

Purpose: chronic poor mental health over the course of pregnancy contributes to greater adverse maternal and child outcomes. Identifying women with chronic depressive or anxiety symptoms can provide opportunities to reduce distress and improve pregnancy outcomes. The objective of this study was to determine risk factors of chronic antenatal depressive and anxiety symptoms using a longitudinal pregnancy cohort in Alberta, Canada.

Methods: women with singleton pregnancies were included (N=3021). Anxiety and depressive symptoms were measured in the second and third trimesters using the Spielberger State-Trait Anxiety Inventory and the Edinburgh Postnatal Depression Scale, respectively. On the basis of the timing and persistence of symptoms, the following three mutually exclusive subgroups for each anxiety and depressive symptoms were created: never symptomatic, symptomatic only in the second trimester, and symptomatic at both time points. Separate logistic regression models were used to derive risk factors for each subgroup.

Findings: women with chronic anxiety or depressive symptoms were distinguished from those with transient symptoms or no symptoms by their optimism scores, in which less optimistic pregnant women had a four-fold increased risk for developing chronic depressive or anxiety symptoms compared with more optimistic women (AOR varied from 4.30 to 4.93). Additionally, high perceived stress, low social support, history of mental health issues were common predictors of chronic anxiety and depressive symptoms in pregnancy. Partner tension was the exclusive predictor of anxiety symptoms (AOR varied from 1.94 to 2.31) and poor physical health (AOR 2.54; 95% CI 1.32-4.89), unplanned pregnancy (AOR 3.05; 95% CI 1.61-5.79), and infertility treatments (AOR 4.98; 95% CI 1.85-13.39) were unique predictors of chronic depressive symptoms.

Conclusions: knowledge of the risk factors of chronic poor mental health during pregnancy might inform the development of effective strategies within the limited resources of health-care systems to target populations with greater needs for interventions.

Keywords: Antenatal mental health; Chronic anxiety; Chronic depression; Risk factors.