Pregnancy-related anxiety

Pregnancy-related anxiety is a distinct anxiety contextualized by pregnancy specific fears, worries, and concerns.[1][2] Pregnancy-related anxiety is characterized by increased concerns or excessive fears and worries about their unborn baby, childbirth, body image, and impending motherhood.[3][4] This anxiety is also known as pregnancy-specific anxiety, pregnancy anxiety, pregnancy distress, or pregnancy concerns [5] and was first identified in 1956 when women were observed to be anxious about different aspects of their pregnancy.[6] However, it was not until conventional measures of anxiety and depression were shown to not adequately capture this anxiety that the first empirical evidence was provided.[7] Subsequent studies have provided further support for the distinctiveness of pregnancy-related anxiety from state and trait anxiety, depression and anxiety disorder symptomology. [8][2][9]

Pregnancy-related anxiety
SpecialtyPsychiatry

Presentation

Complications

Several adverse outcomes are regularly associated with pregnancy-related anxiety. This anxiety is a risk factor for negative fetal/child outcomes, including preterm birth, low birth weight, developmental delays, and behavioral problems.[10][11][12] Pregnancy-related anxiety is also linked to negative affectivity and poorer child and infant cognitive development.[13] Health risk behaviors such as alcohol consumption and continued smoking during pregnancy have also been associated with pregnancy-related anxiety.[14][15][16] This is particularly concerning given that these behaviors introduce harmful teratogens into the baby's environment during critical developmental periods.[17]

Diagnosis

Several instruments assess pregnancy-related anxiety. These include unidimensional scales such as Levin's Pregnancy Anxiety Scale,[18] Cote-Arsenault's Pregnancy Anxiety Scale,[19] the Pregnancy Related Thoughts Scale,[20] and the Pregnancy Specific Anxiety Scale.[21] In addition, the Pregnancy Related Anxiety Questionnaire (PRAQ-R) is a multidimensional scale that assesses core concerns of pregnant women (i.e., childbirth, appearance, and the unborn baby).[2] The PRAQ-R2 is the revised version applicable for women of any parity.[22]

Prevalence

The reported prevalence of pregnancy-related anxiety varies depending on the country and timing of the assessment. For example, in high-income countries, the prevalence is around 10%,[23][24] whereas, in low-income or less developed countries, it is as high as 56%.[25] Also, the prevalence of this anxiety type can fluctuate across the duration of pregnancy, with higher prevalence noted in the earlier and later stages of pregnancy consistent with a u-shaped course.[26] This u-shaped curve is consistent with worries and concerns in early pregnancy for the unborn child being more salient in the first trimester and fears about childbirth more salient in late pregnancy.[27][28]

References
  1. Brunton, RJ; Dryer, R; Saliba, A; Kohlhoff, J (2015). "Pregnancy anxiety: A systematic review of current scales". Journal of Affective Disorders. 176: 24–34. doi:10.1016/j.jad.2015.01.039. PMID 25687280.
  2. Huizink, AC; Mulder, EJ; Robles de Medina, PG; Visser, GH; Buitelaar, JK (2004). "Is pregnancy anxiety a distinctive syndrome?". Early Human Development. 79 (2): 81–91. doi:10.1016/j.earlhumdev.2004.04.014. PMID 15324989.
  3. Dunkel Schetter, C (January 2011). "Psychological Science on Pregnancy: Stress Processes, Biopsychosocial Models, and Emerging Research Issues". Annual Review of Psychology. 62 (1): 531–58. doi:10.1146/annurev.psych.031809.130727. ISSN 0066-4308. PMID 21126184.
  4. Brunton, RJ; Dryer, R; Saliba, A; Kohlhoff, J (2019-02-01). "The initial development of the Pregnancy-related Anxiety Scale". Women and Birth. 32 (1): e118–e130. doi:10.1016/j.wombi.2018.05.004. ISSN 1871-5192. PMID 29859678. S2CID 44164114.
  5. Dryer, Rachel; Brunton, Robyn, eds. (2021). Pregnancy-Related Anxiety: Theory, Research, and Practice. Routledge. doi:10.4324/9781003014003. ISBN 9781003014003. S2CID 244225796.
  6. Pleshette, Norman; Asch, S; Chase, J (1956). "A study of anxieties during pregnancy, labor, the early and late puerperium". Bulletin of New York Academic Medicine. 32 (6): 436–455.
  7. Theut, Susan K.; Pedersen, Frank A.; Zaslow, Martha J.; Rabinovich, Beth A. (1988). "Pregnancy Subsequent to Perinatal Loss: Parental Anxiety and Depression". Journal of the American Academy of Child & Adolescent Psychiatry. 27 (3): 289–292. doi:10.1097/00004583-198805000-00004. ISSN 0890-8567. PMID 3379012.
  8. Anderson, Carla M.; Brunton, Robyn J.; Dryer, Rachel (2019-04-01). "Pregnancy‐related anxiety: Re‐examining its distinctiveness†". Australian Psychologist. 54 (2): 132–142. doi:10.1111/ap.12365. ISSN 0005-0067. S2CID 150295282.
  9. Brunton, Robyn; Dryer, Rachel; Saliba, Anthony; Kohlhoff, Jane (2019). "Re-examining pregnancy-related anxiety: A replication study". Women and Birth. 32 (1): e131–e137. doi:10.1016/j.wombi.2018.04.013. PMID 29747955. S2CID 13685699.
  10. Reck, C.; Zimmer, K.; Dubber, S.; Zipser, B.; Schlehe, B.; Gawlik, S. (2013). "The influence of general anxiety and childbirth-specific anxiety on birth outcome". Archives of Women's Mental Health. 16 (5): 363–369. doi:10.1007/s00737-013-0344-0. ISSN 1434-1816. PMID 23558948. S2CID 8774010.
  11. Huizink, Anja C.; Robles De Medina, Pascale G.; Mulder, Eduard J.H.; Visser, Gerard H.A.; Buitelaar, Jan K. (2002). "Psychological Measures of Prenatal Stress as Predictors of Infant Temperament". Journal of the American Academy of Child & Adolescent Psychiatry. 41 (9): 1078–1085. doi:10.1097/00004583-200209000-00008. ISSN 0890-8567. PMID 12218429.
  12. Dunkel Schetter, Christine; Tanner, Lynlee (2012). "Anxiety, depression and stress in pregnancy: implications for mothers, children, research, and practice". Current Opinion in Psychiatry. 25 (2): 141–148. doi:10.1097/YCO.0b013e3283503680. ISSN 0951-7367. PMC 4447112. PMID 22262028.
  13. Garcia, Sarah E.; Perzow, Sarah E. D.; Hennessey, Ella-Marie P.; Glynn, Laura M.; Davis, Elysia Poggi (2021), "Examining the relation between maternal pregnancy-related anxiety and child development", Pregnancy-Related Anxiety, pp. 74–96, doi:10.4324/9781003014003-8, ISBN 9781003014003, S2CID 244176091, retrieved 2022-08-23
  14. Brunton, R., & Dryer, R. (2022). Alcohol consumption after pregnancy awareness and the additive effect of pregnancy-related anxiety and child abuse. Current Psychology, under review.
  15. Arch, Joanna J. (2013-04-01). "Pregnancy-specific anxiety: which women are highest and what are the alcohol-related risks?". Comprehensive Psychiatry. 54 (3): 217–228. doi:10.1016/j.comppsych.2012.07.010. ISSN 0010-440X. PMID 22943960.
  16. Goedhart, Geertje; van der Wal, Marcel F.; Cuijpers, Pim; Bonsel, Gouke J. (2009-04-01). "Psychosocial problems and continued smoking during pregnancy". Addictive Behaviors. 34 (4): 403–406. doi:10.1016/j.addbeh.2008.11.006. ISSN 0306-4603. PMID 19070436.
  17. Keegan, Joan; Parva, Mehdi; Finnegan, Mark; Gerson, Andrew; Belden, Michael (2010-04-16). "Addiction in Pregnancy". Journal of Addictive Diseases. 29 (2): 175–191. doi:10.1080/10550881003684723. ISSN 1055-0887. PMID 20407975. S2CID 21010797.
  18. Levin, Jeffrey S (1991). "The factor structure of the Pregnancy Anxiety Scale". Journal of Health & Social Behavior. 32 (4): 368–381. doi:10.2307/2137104. JSTOR 2137104. PMID 1765627.
  19. Côté-Arsenault, Denise; Dombeck, Mary-T. B. (2001-10-01). "Maternal Assignment of Fetal Personhood to a Previous Pregnancy Loss: Relationship to Anxiety in the Current Pregnancy". Health Care for Women International. 22 (7): 649–665. doi:10.1080/07399330127171. ISSN 0739-9332. PMID 12141842. S2CID 45388763.
  20. Rini, Christine Killingsworth; Dunkel-Schetter, Christine; Wadhwa, PD; Sandman, CA (1999). "Psychological adaptation and birth outcomes: The role of personal resources, stress, and sociocultural context in pregnancy". Health Psychology. 18 (4): 333–345. doi:10.1037/0278-6133.18.4.333. ISSN 1930-7810. PMID 10431934. S2CID 3479575.
  21. Mancuso, Roberta A.; Schetter, Christine Dunkel; Rini, Christine M.; Roesch, Scott C.; Hobel, Calvin J. (2004). "Maternal Prenatal Anxiety and Corticotropin-Releasing Hormone Associated With Timing of Delivery". Psychosomatic Medicine. 66 (5): 762–769. doi:10.1097/01.psy.0000138284.70670.d5. ISSN 0033-3174. PMID 15385704. S2CID 18957226.
  22. Huizink, A. C.; Delforterie, M. J.; Scheinin, N. M.; Tolvanen, M.; Karlsson, L.; Karlsson, H. (2016). "Adaption of pregnancy anxiety questionnaire–revised for all pregnant women regardless of parity: PRAQ-R2". Archives of Women's Mental Health. 19 (1): 125–132. doi:10.1007/s00737-015-0531-2. ISSN 1434-1816. PMC 4728175. PMID 25971851.
  23. Fairlie, Tarayn G.; Gillman, Matthew W.; Rich-Edwards, Janet (2009-07-01). "High Pregnancy-Related Anxiety and Prenatal Depressive Symptoms as Predictors of Intention to Breastfeed and Breastfeeding Initiation". Journal of Women's Health. 18 (7): 945–953. doi:10.1089/jwh.2008.0998. ISSN 1540-9996. PMC 2851128. PMID 19563244.
  24. Koelewijn, Johanna Maria; Sluijs, Anne Marie; Vrijkotte, Tanja G. M. (2017-05-01). "Possible relationship between general and pregnancy-related anxiety during the first half of pregnancy and the birth process: a prospective cohort study". BMJ Open. 7 (5): e013413. doi:10.1136/bmjopen-2016-013413. ISSN 2044-6055. PMC 5623367. PMID 28490549.
  25. Nath, Anita; Venkatesh, Shubhashree; Balan, Sheeba; Metgud, Chandra S.; Krishna, Murali; Murthy, Gudlavalleti Venkata Satyanarayana (2019-04-10). "The prevalence and determinants of pregnancy-related anxiety amongst pregnant women at less than 24 weeks of pregnancy in Bangalore, Southern India". International Journal of Women's Health. 11: 241–248. doi:10.2147/IJWH.S193306. PMC 6489575. PMID 31114392.
  26. Madhavanprabhakaran, Girija Kalayil; D’Souza, Melba Sheila; Nairy, Karkada Subrahmanya (2015-01-01). "Prevalence of pregnancy anxiety and associated factors". International Journal of Africa Nursing Sciences. 3: 1–7. doi:10.1016/j.ijans.2015.06.002. ISSN 2214-1391.
  27. Blackmore, ER; Gustafsson, H; Gilchrist, M; Wyman, C; G O’Connor, T (2016-06-01). "Pregnancy-related anxiety: Evidence of distinct clinical significance from a prospective longitudinal study". Journal of Affective Disorders. 197: 251–258. doi:10.1016/j.jad.2016.03.008. ISSN 0165-0327. PMC 4837058. PMID 26999549.
  28. Rouhe, H; Salmela-Aro, K; Halmesmäki, E; Saisto, T (2009). "Fear of childbirth according to parity, gestational age, and obstetric history". BJOG: An International Journal of Obstetrics & Gynaecology. 116 (1): 67–73. doi:10.1111/j.1471-0528.2008.02002.x. PMID 19055652. S2CID 40951634.
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