Pregnancy-related anxiety explained

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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] [9]

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. Health risk behaviors such as alcohol consumption and continued smoking during pregnancy have also been associated with pregnancy-related anxiety.[13] [14] [15] This is particularly concerning given that these behaviors introduce harmful teratogens into the baby's environment during critical developmental periods.[16]

Diagnosis

Several instruments assess pregnancy-related anxiety. These include unidimensional scales such as Levin's Pregnancy Anxiety Scale,[17] Cote-Arsenault's Pregnancy Anxiety Scale,[18] the Pregnancy Related Thoughts Scale,[19] and the Pregnancy Specific Anxiety Scale.[20] 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). The PRAQ-R2 is the revised version applicable for women of any parity.[21]

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%,[22] [23] whereas, in low-income or less developed countries, it is as high as 56%.[24] 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.[25] 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.[26] [27]

Notes and References

  1. Brunton . RJ . Dryer . R . Saliba . A . Kohlhoff . J . 2015 . Pregnancy anxiety: A systematic review of current scales . Journal of Affective Disorders . en . 176 . 24–34 . 10.1016/j.jad.2015.01.039 . 25687280.
  2. Huizink . AC . Mulder . EJ . Robles de Medina . PG . Visser . GH . Buitelaar . JK . 2004 . Is pregnancy anxiety a distinctive syndrome? . Early Human Development . en . 79 . 2 . 81–91 . 10.1016/j.earlhumdev.2004.04.014 . 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 . 10.1146/annurev.psych.031809.130727 . 0066-4308 . 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 . en . 32 . 1 . e118–e130 . 10.1016/j.wombi.2018.05.004 . 29859678 . 44164114 . 1871-5192.
  5. Book: Pregnancy-Related Anxiety: Theory, Research, and Practice . 2021 . Routledge . Dryer . Rachel . 10.4324/9781003014003 . 9781003014003 . 244225796 . Brunton . Robyn.
  6. Pleshette . Norman . Asch . S . Chase . J . A study of anxieties during pregnancy, labor, the early and late puerperium . Bulletin of the New York Academy of Medicine . 1956 . 32 . 6 . 436–455. 13316338 . 1805940 .
  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 . 10.1097/00004583-198805000-00004 . 3379012 . 0890-8567.
  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 . 10.1111/ap.12365 . 150295282 . 0005-0067.
  9. Brunton . Robyn . Dryer . Rachel . Saliba . Anthony . Kohlhoff . Jane . 2019 . Re-examining pregnancy-related anxiety: A replication study . Women and Birth . en . 32 . 1 . e131–e137 . 10.1016/j.wombi.2018.04.013 . 29747955 . 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 . en . 16 . 5 . 363–369 . 10.1007/s00737-013-0344-0 . 1434-1816 . 23558948 . 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 . 10.1097/00004583-200209000-00008 . 0890-8567 . 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 . en . 25 . 2 . 141–148 . 10.1097/YCO.0b013e3283503680 . 0951-7367 . 4447112 . 22262028.
  13. 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.
  14. Arch . Joanna J. . 2013-04-01 . Pregnancy-specific anxiety: which women are highest and what are the alcohol-related risks? . Comprehensive Psychiatry . en . 54 . 3 . 217–228 . 10.1016/j.comppsych.2012.07.010 . 0010-440X . 22943960.
  15. Goedhart . Geertje . van der Wal . Marcel F. . Cuijpers . Pim . Bonsel . Gouke J. . 2009-04-01 . Psychosocial problems and continued smoking during pregnancy . Addictive Behaviors . en . 34 . 4 . 403–406 . 10.1016/j.addbeh.2008.11.006 . 0306-4603 . 19070436.
  16. Keegan . Joan . Parva . Mehdi . Finnegan . Mark . Gerson . Andrew . Belden . Michael . 2010-04-16 . Addiction in Pregnancy . Journal of Addictive Diseases . 29 . 2 . 175–191 . 10.1080/10550881003684723 . 1055-0887 . 20407975. 21010797 . free .
  17. Levin . Jeffrey S . 1991 . The factor structure of the Pregnancy Anxiety Scale . Journal of Health & Social Behavior . 32 . 4 . 368–381. 10.2307/2137104 . 2137104 . 1765627 .
  18. 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 . 10.1080/07399330127171 . 0739-9332 . 12141842. 45388763 .
  19. 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 . en . 18 . 4 . 333–345 . 10.1037/0278-6133.18.4.333 . 10431934 . 3479575 . 1930-7810.
  20. 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 . en . 66 . 5 . 762–769 . 10.1097/01.psy.0000138284.70670.d5 . 15385704 . 18957226 . 0033-3174.
  21. 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 . en . 19 . 1 . 125–132 . 10.1007/s00737-015-0531-2 . 1434-1816 . 4728175 . 25971851.
  22. 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 . 10.1089/jwh.2008.0998 . 1540-9996 . 2851128 . 19563244.
  23. 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 . en . 7 . 5 . e013413 . 10.1136/bmjopen-2016-013413 . 2044-6055 . 5623367 . 28490549.
  24. 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. English. 11. 241–248. 10.2147/IJWH.S193306. 6489575. 31114392 . free .
  25. 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 . en . 3 . 1–7 . 10.1016/j.ijans.2015.06.002 . 2214-1391. free .
  26. 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 . en . 197 . 251–258 . 10.1016/j.jad.2016.03.008 . 0165-0327 . 4837058 . 26999549.
  27. 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 . en . 116 . 1 . 67–73 . 10.1111/j.1471-0528.2008.02002.x. 19055652 . 40951634 .

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