A longitudinal study of maternal anxiety from the antenatal to the postpartum period: risk factors and adverseoutcomes on infant temperament and development

Abstract

Anxiety is common among pregnant and postpartum women. The research attention in the area of reproductive mental health has mainly focused on postpartum depression in past decades. Given the health implications of maternal anxiety on the physical and psychological well being of both mothers and their offspring, there is an urgent need to fill the current research gaps. The objectives of the present study were to determine the prevalence of antenatal and postpartum anxiety symptoms; investigate the nature and development of antenatal and postpartum anxiety; clarify the constructs of antenatal anxiety; identify demographic and psychosocial risk factors; and examine the effects of antenatal anxiety on postpartum anxiety and infant development and temperament.

A prospective longitudinal design with quantitative approach was adopted in the present study. Pregnant women from two regional hospitals in Hong Kong were invited to participate in the study. They were assessed using standardized and validated psychological instruments on 5 time points including the first, second and third trimesters of pregnancy, 6-weeks and 6-months postpartum. A total sample of 1470 pregnant women was assessed on antenatal general anxiety and postpartum anxiety and hypothesized risk factors. A subset of 186 pregnant women was assessed on pregnancy-specific anxiety and infant temperament and development.

The results showed that an appreciable proportion of pregnant women manifested general anxiety symptoms and pregnancy-specific anxiety symptoms during pregnancy. A mixed-effects model analysis for repeated measures showed that both forms of anxiety followed a U-pattern across pregnancy (p<.05 for both), with both being less prevalent in the second trimester. Findings supported that pregnancy-specific anxiety symptoms and general anxiety symptoms are two distinct but inter-related forms of anxiety. Different demographic risk factors for anxiety symptoms vary across different trimesters. Self esteem and marital satisfaction were consistently associated with both general anxiety symptoms and pregnancy-specific anxiety symptoms over the course of pregnancy. Regarding the impact of antenatal anxiety, general anxiety symptoms in the third trimester had the strongest association with postpartum anxiety at 6-weeks postpartum (p<.05). In general, general anxiety symptoms were more strongly associated with postpartum anxiety than pregnancy-specific anxiety symptoms. After adjusting for the effects of postpartum anxiety and depression and other covariates, pregnancy-specific anxiety symptoms were independent predictors for fewer infant’s falling reactivity response (p<.05), greater infant’s fear response (p<.05) and greater distress to limitations (p<.05), whereas general anxiety symptoms were independent predictors for poorer social (p<.05) and speech (p<.05) development.

The present study points to the need for greater research and clinical attention to antenatal anxiety given that antenatal anxiety is a prevalent problem with changing course and has serious impacts on maternal well-being and infant development. General anxiety symptoms and pregnancy-specific anxiety symptoms reflect different pathologies with potentially different pathogeneses and different pathways to postpartum well-being and infant outcomes which deserved further investigation. The present findings contributed to the understanding of maternal anxiety and have implications for the design of effective identification, prevention and treatment of these significant clinical problems.