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Anxiety has been known to occur in up to 27 per cent of pregnant women. Prenatal anxiety can have a negative effect on the emotional, mental, and physical health of mothers and babies. Prenatal anxiety can also increase a mother’s chances of developing postpartum depression and anxiety, further exacerbating the negative health outcome of her children.

Some of the anxieties pregnant women may experience include worries about parenting, the health of the baby and an intense fear of labor.

A new study on pregnancy-related anxiety in women during all three trimesters and its association with symptoms of social and generalized anxiety, was recently published in the Journal of Affective Disorders.

“We investigated the course and associated factors of pregnancy-related anxiety, a distinct form of anxiety,” study author, Dr. Susanne Mudra explained to us, “that can be differentiated from general stress or anxiety focusing on the current pregnancy, the unborn baby and/or labor and childbirth.”

Dr. Mudra’s research focuses on prenatal anxiety as well as other factors in the transition to parenthood that seem to be relevant for the developing parent-infant-relationship. In her current study, Dr. Mudra and colleagues wanted to find out more about the physiologic course of pregnancy-related anxiety across pregnancy in their population-based sample. They also aimed to identify the associated risk factors of pregnancy-related anxiety, and investigate the role of symptoms of anxiety disorders such as social phobia or generalized anxiety disorder which have rarely been examined. Lastly, they hoped to explore the worrisome levels of pregnancy-related anxiety to identify women at a higher risk for it.

“Based on previous research, we expected total levels of pregnancy-related anxiety to be rather stable in contrast to the different dimensions of pregnancy-related anxiety such as child-related worries, birth-related anxiety or concerns about the woman herself.” Dr. Mudra told us. “We also expected symptoms of anxiety disorders to be associated with pregnancy-related anxiety, particularly prenatal child-related worries.”

There is little knowledge about pregnancy-related anxiety and its dimensions such as child-related worries in clinical practice and no standardized screening exists. Also, research in pregnancy-related anxiety and different forms of anxiety have not been differentiated sufficiently from stress until recently.

To test out their theory, Dr. Mudra and fellow researchers assessed and analyzed the data of 180 women prospectively across three trimesters of pregnancy regarding pregnancy-related anxiety, symptoms of anxiety disorders and several associated sociodemographic, obstetric and psychosocial factors across pregnancy as part of a longitudinal study. The data was analyzed by linear mixed model analyses and the classes were explored by latent class growth analyses.

“While pregnancy-related anxiety total scores remained stable across all three trimesters, the pregnancy-related anxiety dimensions showed differing courses,” Dr. Mudra told us. “Fear of childbirth increased, child-related worries decreased significantly across pregnancy and concerns about one’s own appearance showed a decreasing trend.”

Dr. Mudra explained that after controlling for other relevant factors, symptoms of social phobia predicted all dimensions of pregnancy-related anxiety, and symptoms of generalized anxiety disorder predicted child-related worries.

“Moreover, parity, education self-efficacy, and social support showed associations to child-related worries and fear of childbirth,” Dr. Mudra told us. “The explorative analysis of trajectory classes revealed two classes of women, one showing constant high levels of pregnancy-related anxiety, and one showing constant low levels across pregnancy.”

Some of the results were surprising to researchers.

“We did expect symptoms of social phobia as being relevant but that they would predict all dimensions of pregnancy-related anxiety and the total after controlling for other factors was surprising,” Dr. Mudra told us. “We were able to identify significant changes of pregnancy-related anxiety dimensions across pregnancy and two separate classes of women showing higher and lower symptoms across all three trimesters.”

Dr. Mudra believes that the study demonstrates that pregnancy-related anxiety is a relevant construct that should be perceived and assessed in prenatal care by clinicians working with pregnant women.

“The course of pregnancy-related anxiety shows that it is important to differentiate between dimensions of pregnancy-related anxiety instead of focusing on a total score only,” Dr. Mudra told us. “Furthermore, women suffering from social phobia and generalized anxiety should be screened also for pregnancy-related anxiety (and vice versa), since child-related worries or fear of childbirth may cause negative consequences for mother-infant development. These are not addressed in standard treatment for anxiety disorders due to their specific content. The other significant factors such as parity, self-efficacy or social support should be considered also, when working with expecting parents.”