Maternal anxiety across pregnancy: prevalence, pattern and relations to postpartum anxiety

Abstract

OBJECTIVE: Accumulating evidence suggests that pregnancy does not protect women from mental illness. Over the past decades, however, much less research attention in the area of reproductive mental health has been given to anxiety symptoms among pregnant women. The aims of the present study were to determine the prevalence of antenatal anxiety symptoms across different trimesters of pregnancy and examine the effects of antenatal anxiety symptoms on anxiety symptoms in 6-week postpartum. METHODOLOGY: A prospective longitudinal design was adopted. A consecutive sample of 1470 Chinese pregnant women from three regional hospitals in Hong Kong was invited to participate in the study. They were assessed using standardized instruments on 4 time points: first trimester, second trimester and third trimester of pregnancy and 6-week postpartum. RESULTS: The prevalence of antenatal anxiety was characterized by a U-shaped curve. The prevalence of anxiety was 17.7% in the first trimester. The rate significantly dropped to 15.5 % in the second trimester but increased significantly again to 16.2% in the third trimester. ANCOVA was used to examine the differences among the groups according to the numbers of trimesters in which pregnant women reported elevated levels of antenatal anxiety symptoms with respect to prevalence of postpartum anxiety symptoms, after adjusting for the effects of potential confounders. The difference was significant (F = 3.74, p<.05). Post hoc LSD analysis indicated that pregnant women who had elevated levels of anxiety symptoms in all three trimesters reported significantly higher levels of postpartum anxiety symptoms than those who had elevated levels of anxiety in one or two trimesters, and those who did not have elevated anxiety in any trimesters. DISCUSSIONS: Antenatal anxiety shows a changing course across pregnancy. However, women who had higher levels of anxiety symptoms persistently during the entire antenatal period reported significantly higher levels of postpartum anxiety. These results provide clinical direction suggesting that screening for antenatal anxiety is recommended to be done at antenatal clinic throughout the pregnancy.