Elevated Anxiety During Pregnancy Can Increase the Risk of Preterm Birth

Women who have a lot of anxiety during their pregnancies are more likely to give birth earlier on average than those who do not, according to a study of anxiety in pregnancy, which is also called antenatal anxiety. This information may lead to adding a routine screening for anxiety during pregnancy as part of a prenatal visit.

Having some anxiety during pregnancy is normal. Anxiety is when you feel nervous, worried, or concerned about something. There can be many causes for anxiety before a baby is born: anything from financial concerns or worries about your health or your baby’s health or trying to get everything done at work and get your home in order before the baby comes can cause you to worry or be nervous. All pregnant women have a lot going on in their lives during this time, and some anxiety is to be expected.

However, anxiety is a problem if you have nothing to be worried about or if your worries and fears are out of proportion to the problem. An example would be if you are pacing the floor worrying that you won’t be able to deal with childbirth, even after you have a birth plan in place, and your obstetrician or midwife has told you that everything is fine with your pregnancy. Of if you have an excessive fear that you will be a bad parent.

Anxiety disorders include such mental health issues as generalized anxiety disorder, where you are worried about your life most of the time and cannot stop having negative thoughts, or panic disorder, where you suddenly feel terrified for short periods of time.

There are several ways that healthcare providers measure anxiety. This new study looked at the relationship between different measures of anxiety and the length of a pregnancy. Researchers looked at data from 196 pregnant women who were taking part in a larger study called Healthy Babies Before Birth. The group of women were diverse and included non-Hispanic Whites, Hispanic Whites, Asians, and Blacks or African Americans.

Earlier studies had already shown that up to 25% of pregnant women have symptoms of clinically elevated anxiety. Other studies have also shown that anxiety can be a risk factor that can increase the chance of a birth that occurs before 37 weeks of pregnancy, which is a preterm birth. However, those earlier studies used several different measures of anxiety and looked at both general anxiety and pregnancy-specific anxiety. Those studies also evaluated anxiety at different points in pregnancy, from early to late pregnancy, but most often during the second trimester, the middle of the pregnancy.

The study chose four different tests for anxiety and measured the women’s anxiety in both the first and third trimesters of pregnancy. These anxiety tests included a five-question screening test for general anxiety, two questionnaires that were specific to anxiety during pregnancy, and a nine-question assessment of a wide range of stress factors related to pregnancy, such as medical issues and worries about dealing with a newborn baby.

The study found that participants’ scores on all three scales of pregnancy-related anxiety tests were interrelated, which suggests that all three were measuring the same underlying thing.

The study also found that pregnancy-related anxiety in the third trimester was most strongly associated with an earlier birth. But general anxiety—the worries and fears that are not connected directly to a pregnancy–in the first trimester also contributed to a higher risk for early birth.

The researchers believe that these findings mean that general anxiety early in pregnancy could predispose women to being anxious later in their pregnancy about issues directly related to the pregnancy, such as medical risks, the baby, labor and delivery, and parenting. Their results held even when adjusted for whether there were any actual medical risks in the women’s pregnancies.

Because this study shows that anxiety during pregnancy can be a predictor of preterm birth, the researchers suggest that healthcare providers should screen women for general anxiety early in their pregnancies in the same way they currently screen for depression. A woman who scores high on measures of general anxiety early in her pregnancy could be monitored for increases in her pregnancy-specific anxiety levels in her pregnancy.

Anxiety during pregnancy can be safely treated. Therapy with a mental health counselor is recommended to treat anxiety. If therapy is not helping on its own, or if anxiety is severe, there are anti-anxiety medications that can be safely used during pregnancy.

The study was published in the journal Health Psychology. The research was conducted at the University of California, Los Angeles; George Washington University; the University of California, Irvine; Cedars-Sinai Medical Center in Los Angeles; and the University of Colorado in Colorado Springs.

Valerie DeBenedette
Valerie DeBenedette is an experienced health and medical writer who lives about an hour north of New York City with a dog that is smaller than her cat. Her work has appeared in magazines, newspapers, newsletters, and on websites. She is a member of the National Association of Science Writers.

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