Screening for pregnancy anxiety in the first and third trimesters can help reduce early births

George Ruiz/Flickr

George Ruiz/Flickr

Key takeaways

  • Pregnancy anxiety is associated with shorter gestation times and earlier births.
  • Screening during the first and third trimesters could help reduce early births.
  • Latina women may experience higher levels of pregnancy anxiety than other groups.

A new UCLA study has found anxiety specific to pregnancy and childbirth is associated with shorter gestation times and earlier births. One screening tool administered in the first trimester could reliably predict early birth. Screening for depression in pregnancy and postpartum is now a common part of maternal care; the authors suggest that adding an evaluation for anxiety in early pregnancy and for a more specific form of anxiety called pregnancy anxiety during pregnancy could identify women who might need interventions for healthier pregnancies and babies. The is published in the journal, Health Psychology.

"The key finding in this new paper is that anxiety about a current pregnancy robustly predicted earlier birth measured in weeks of gestation," said UCLA psychology professor Christine Dunkel Schetter, who led the research. "Gestational length is one way of understanding the risk of preterm birth with attendant adversities for mother and child. This finding is consistent with our prior research and that of others."

In the five-year study, "Healthy Babies Before Birth," Dunkel Schetter and co-authors examined the relationships between maternal mood disorders before birth, pregnancy-specific anxiety and stress, and pregnancy outcomes and implications for infant immunologic and neurobehavioral development. The research tested the hypothesis that prenatal maternal mood disorders and symptoms increase the risk of poor pregnancy outcomes and compromise infant behavioral and immunological development in the first year of life. Dunkel Schetter’s ongoing work probes the biological pathways linking pregnancy anxiety with the timing of birth including stress biology, inflammation and health behavior.

Pregnancy anxiety, also referred to as pregnancy-specific anxiety and pregnancy-related anxiety, is a type of situation-specific anxiety and is defined as a particular emotional state tied to pregnancy concerns such as worries about the health of the baby and childbirth. Numerous studies have shown that anxiety can shorten gestation times and have other adverse effects. Less is known, however, about how the timing of anxiety over the course of a pregnancy affects the timing of labor and delivery.

Preterm birth — especially very preterm birth — can result in lower birthweight, lower survival rates, developmental delays and health problems for the baby. Determining when in pregnancy any test can predict early birth can lead to interventions to prevent it.

The study investigated four different published screening tools measuring anxiety or stress in pregnancy to learn if they assessed the same underlying problems and if any were better predictors of outcomes for the mother. The team followed 196 pregnant women from the first trimester through one-year postpartum with six study visits, one per trimester and three times in the year after birth. Structured interviews were conducted in clinical settings by trained research staff.

The data revealed that all four of these commonly used measures overlap in what they measure, and together, they predicted timing of delivery when measured in the third trimester. In addition, one measure of clinically significant anxiety, the OASIS, when measured in the first trimester predicted earlier delivery, suggesting that this clinical screener for anxiety may have some value in prenatal care. Not all study participants who began pregnancy with general anxiety went on to develop pregnancy anxiety, but those who did were at highest risk of early labor and delivery.

’Potent psychosocial state’

"We think it is important to know that anxiety about a current pregnancy is a potent psychosocial state that may affect birth outcomes," said Dunkel Schetter. "This and other studies suggest that we should be assessing anxiety in pregnant women. The brief clinical screener we used, the OASIS, can be administered easily in early in pregnancy with predictive validity."

A second brief measure of pregnancy anxiety the researchers used, called PSAS, can be repeated during pregnancy and captures changes over the course of pregnancy. It also reliably predicts length of pregnancy. Dunkel Schetter said that together, OASIS and PSAS seem valuable in prenatal research and care.

Co-author Isabel Ramos, who received her doctorate from UCLA in 2020 and interviewed participants during and after pregnancy, found evidence in the study and her master’s research that Latina women may experience higher levels of pregnancy anxiety than some other groups.

"I’m currently studying how Latina women’s cultural beliefs about pregnancy might elevate anxiety," said Ramos, now an assistant professor at UC Irvine. "I’m learning how cultural factors influence prenatal emotional health and the biological pathways that affect maternal and neonatal health."

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