The effect of anxiety and depression during pregnancy on obstetric complications

Department of Public Health Sciences, St. George's Hospital Medical School, London.
British Journal of Obstetrics and Gynaecology 08/1993; 100(7):629-34. DOI: 10.1016/0020-7292(94)90150-3
Source: PubMed


To investigate the effects of anxiety and depression during pregnancy on obstetric complications using the data collected from the St George's Birthweight Study.
Prospective population study.
District general hospital in inner London.
A consecutive series of 1860 white women booking for delivery were approached. Of these, 136 refused and 209 failed to complete the study for other reasons, leaving a sample of 1515.
Data were obtained by research interviewers at booking, 17, 28, and 36 weeks gestation and from the structured antenatal and obstetric record. The predictor variables were the anxiety and depression scores measured using the General Health Questionnaire. The outcome variables were five obstetric complications: preterm delivery; nonspontaneous onset of labour; major analgesia in the first and second stages of labour; and nonspontaneous vaginal deliveries. The possible confounding effects of 35 socio-economic, psychological and personal variables were investigated using logistic regression.
The factors that had the strongest relation with the outcomes were parity and maternal age. Depression during pregnancy was unrelated to the obstetric complications. Anxiety was weakly related to analgesia/anaesthesia in the second stage of labour (P = 0.04). However, anxiety accounted for only 0.1% of the variance in use of major analgesia/anaesthesia. The most effective model, that for analgesia/anaesthesia in the first stage of labour, accounted for only 7.3% of the variance.
In the general population of pregnant women, anxiety and depression during pregnancy, while undesirable in themselves, are of little importance in the evolution of obstetric complications.

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    • "All studies used general anxiety measures (e.g. STAI, General Health Questionnaire; GHQ, Hospital Anxiety Depression Scale; HADS) to assess anxiety in pregnancy and for all but one, no association with preterm birth/ low birth weight was evident (Berle et al., 2005; Copper et al., 1996; Dayan et al., 2002; Lobel et al., 1992; Perkin et al., 1993). In the remaining study (Ponirakis et al., 1998), anxiety was assessed as part of a wider construct encompassing both depression and anger, which may account for this divergent finding (see Davalos et al., 2012 for a review). "
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    ABSTRACT: Depression in pregnancy is a serious health issue; however, anxiety in pregnancy, with a reported higher prevalence, may also be a serious issue. Anxiety symptoms in pregnancy can relate to several anxiety types, such as general anxiety, anxiety disorders, and pregnancy-related anxiety (PrA), anxiety characterised by pregnancy specific fears and worries. Awareness of these distinctions however, is not always widespread. Both general anxiety and PrA are associated with maternal negative outcomes (e.g. increased nausea) however; PrA is more often associated with negative outcomes for the child (e.g. preterm birth). Furthermore, PrA is potentially a risk factor for postnatal depression with assessment of PrA potentially affording important intervention opportunities. Currently several different instruments are used for PrA however their psychometric properties are unclear. To our knowledge a review of current instruments and their psychometric properties is lacking, this paper aims to fill that gap. Studies, which assessed PrA, published between 1983 and 2013 in peer-reviewed journals, were identified. Sixty studies were identified after applying inclusion/exclusion criteria, and classified as: pregnancy-related anxiety specific, scales for other constructs, sub scales of another instrument and general anxiety scales. Each scale׳s strengths and limitations were discussed. Our findings may be limited by restricting our review to peer-reviewed journals. This was done however as we sought to identify scales with good psychometric properties. Currently no scales are available for pregnancy-related anxiety with sound theoretical and psychometric properties. Clinically the need for such a scale is highlighted by the potential intervention opportunities this may afford. Future research should be directed towards the development of such a scale. Copyright © 2015 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 05/2015; 176. DOI:10.1016/j.jad.2015.01.039 · 3.38 Impact Factor
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    • "Several studies have evaluated the relationship between anxiety and obstetric outcomes, such as mode of delivery (normal, caesarean, and forceps), prematurity, length of delivery, etc. Some studies have shown that high anxiety levels in pregnant women are associated with spontaneous preterm delivery (Dayan et al., 2002; Glynn et al., 2008; Orr et al., 2007) and caesarean section delivery (Anderson et al., 2004), while other studies have found no association between mothers' anxiety levels and mode of delivery (Perkin et al., 1993; Wu et al., 2002), spontaneous preterm delivery (Berle et al., 2005; Perkin et al., 1993) or length of delivery (Sjötröm et al., 1997). Finally, some studies have found associations between anxiety levels and low birth weight (Field et al., 2003; Mulder et al., 2002) and lower cranial perimeter (Lobel, Dunkel–Schetter, & Scrimshaw, 1992), while others have found no relation (Berle et al., 2005). "
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    ABSTRACT: The objective of this research was to study whether positive and negative maternal emotional states were related to obstetrical outcomes in 205 women who participated in a study conducted between 2004 and 2007 in the Sant Joan University Hospital of Reus, Spain. Maternal anxiety and positive emotional states were assessed using the State Trait Anxiety Inventory. The obstetrical outcomes of interest were gestational age at birth, birth weight, and mode of delivery. More women with lower anxiety levels and a more positive state of mind had normal deliveries. Anxiety was related to lower birth weight and to difficult delivery. A positive state of mind and emotional stability were associated with having a normal delivery. Therefore, moderate levels of anxiety were associated with complications during delivery and poorer fetal outcomes, whereas a positive state of mind was associated with better childbirth experiences.
    Women & Health 03/2011; 51(2):124-35. DOI:10.1080/03630242.2010.550991 · 1.05 Impact Factor
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    • "Studies also show associations between antenatal depression and poor infant outcomes (low birth weight, preterm delivery or both) in low (Rahman et al., 2004; Patel, 2006; Rahman et al., 2007) and middle‐income countries (Rondo et al., 2003). In high‐ income countries, findings of associations between antenatal depression and infant outcomes are limited (Perkin et al., 1993; Hoffman & Hatch, 2000; Andersson et al., 2004), except in economically disadvantaged women (Hickey et al., 1995; Rini et al., 1999; Hoffman & Hatch, 2000). Lack of recognition or treatment of depression during pregnancy may increase the risk of poor nutrition and ability to follow through health care recommendations including limiting alcohol, smoking and substance abuse, all of which can potentially result in adverse perinatal outcomes (Hoffman & Hatch, 2000; Chung et al., 2001; Larsson et al., 2004). "
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    ABSTRACT: Depression during pregnancy may negatively influence social functioning, birth outcomes and postnatal mental health. A cross-sectional analysis of the baseline survey of a prospective study was undertaken with an objective of determining the prevalence and socio-demographic factors associated with depressive morbidity during pregnancy in a Tanzanian peri-urban setting. Seven hundred and eighty seven second to third trimester pregnant women were recruited at booking for antenatal care at two primary health care clinics. Prenatal structured interviews assessed socio-economic, quality of partner relationships and selected physical health measures. Depressive symptoms were measured at recruitment and three and eight months postpartum using the Kiswahili version of the Hopkins Symptom Checklist. Completed antenatal measures available for 76.2% participants, showed a 39.5% prevalence of depression. Having a previous depressive episode (OR 4.35, P<0.01), low (OR 2.18, P<0.01) or moderate (OR 1.86, P=0.04) satisfaction with ability to access basic needs, conflicts with the current partner (OR 1.89, P<0.01), or booking earlier for antenatal care (OR 1.87, P=0.02) were independent predictors of antenatal depression in the logistic regression model; together explaining 21% of variance in depression scores. Attenuation of strength of multivariate associations suggests confounding between the independent risk factors and socio-demographic and economic measures. In conclusion, clinically significant depressive symptoms are common in mid and late trimester antenatal clinic attendees. Interventions for early recognition of depression should target women with a history of previous depressive episodes or low satisfaction with ability to access basic needs, conflict in partner relationships and relatively earlier booking for antenatal care. Findings support a recommendation that antenatal services consider integrating screening for depression in routine antenatal care.
    Tanzania journal of health research 07/2010; 12(1):23-35. DOI:10.4314/thrb.v12i1.56276
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