Poor marital support associate with anxiety and worries during pregnancy in Greek pregnant women

Anxiety during the pregnancy and affecting factors: a cross-sectional study

PURPOSE

Studies have shown that anxiety in the perinatal period leads to preterm birth and negatively affects mother and fetus. Understanding prenatal anxiety and associated factors may help develop screening strategies to identify high-risk women needing intervention during pregnancy. The aim of this study is to determine the pregnancy-related, state, and trait anxiety in the prenatal period and affecting factors.

METHODS

This descriptive study was conducted with 203 pregnant women between May 20 and November 30, 2019. Data were collected using socio-demographic and obstetrics characteristics data collection form, Pregnancy-Related Anxiety Questionnaire-Revised-2 (PRAQ-R2), and State-Trait Anxiety Inventory-I and II (STAI-I and STAI-II).

RESULTS

We found statistically significant correlations between age, employment, and parity with fear of giving birth subscale of PRAQ-R2. Pregnant women's mean scale scores were 35.42 ± 9.11 for STAI-I, 42.21 ± 8.21 for STAI-II, and 25.63 ± 8.58 for PRAQ-R2. We found a positive correlation between PRAQ-R2 scale scores and STAI-I, STAI-II scale scores of pregnant women.

CONCLUSIONS

Age, parity, income, planning status of the pregnancy, and employment status affected the anxiety levels of pregnant women. Assessing the anxiety with multiple validated tools helps clarify the cause of the anxiety and allows to plan appropriate interventions.

An examination of the association between marital status and prenatal mental disorders using linked health administrative data

Background

International research shows marital status impacts the mental health of pregnant women, with prenatal depression and anxiety being higher among non-partnered women. However, there have been few studies examining the relationship between marital status and prenatal mental disorders among Australian women.

Methods

This is a population-based retrospective cohort study using linked data from the New South Wales (NSW) Perinatal Data Collection (PDC) and Admitted Patients Data Collection (APDC). The cohort consists of a total of 598,599 pregnant women with 865,349 admissions. Identification of pregnant women for mental disorders was conducted using the 10^th version International Classification of Diseases and Related Health Problems, Australian Modification (ICD-10-AM). A binary logistic regression model was used to estimate the relationship between marital status and prenatal mental disorder after adjusting for confounders.

Results

Of the included pregnant women, 241 (0.04%), 107 (0.02%) and 4359 (0.5%) were diagnosed with depressive disorder, anxiety disorder, and self-harm, respectively. Non-partnered pregnant women had a higher likelihood of depressive disorder (Adjusted Odds Ratio (AOR) = 2.75; 95% CI: 2.04, 3.70) and anxiety disorder (AOR = 3.16, 95% CI: 2.03, 4.91), compared with partnered women. Furthermore, the likelihood of experiencing self-harm was two times higher among non-partnered pregnant women (AOR = 2.00; 95% CI: 1.82, 2.20) than partnered pregnant women.

Conclusions

Non-partnered marital status has a significant positive association with prenatal depressive disorder, anxiety disorder and self-harm. This suggests it would be highly beneficial for maternal health care professionals to screen non-partnered pregnant women for prenatal mental health problems such as depression, anxiety and self-harm.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-05045-8.

Relationships between anxiety induced by COVID-19 and perceived social support among Iranian pregnant women

BACKGROUND

The rapid spread of COVID-19 and the time needed to develop a vaccine or definitive treatment for the disease have caused great anxiety in communities, especially in pregnant women whose high levels of distress may have short and/or long-term maternal and fetal consequence. This study was conducted to investigate the relationship between anxiety induced by COVID-19 and perceived social support in Iranian pregnant women.

METHODS

This online cross-sectional study was conducted on 801 pregnant women from all over Iran in 2020. The data were collected using a demographic questionnaire, the multidimensional scale of perceived social support, and the coronavirus disease anxiety scale. A standard multiple linear regression model was used to identify the association between perceived social support and anxiety, controlling for possible confounding variables. Partial r was used as an estimate of effect size.

RESULTS

The mean anxiety score was 10.7 ± 8.0, in which its level was moderate in 122 (15.2%; 95% confidence interval (CI): 12.8-17.9%)) of the participants, and severe in 28 (3.4%; 95% CI: 2.3-5.0%) of them. The mean score of perceived social support was 48.2 ± 7.6. 6.9% (95% CI: 5.2-8.8%) and 93.1% (95% CI: 91.2-94.8%) of the participants reported mild and moderate levels of perceived social support, respectively. The results of the multiple linear model showed a significant negative correlation between perceived social support and anxiety levels in a way that for every 10 units increase in the perceived social support score, the anxiety level of pregnant women was decreased by 0.8 units (B= -0.08, t= -2.08, p = 0.037), which was a small effect size (partial r = -0.07).

CONCLUSION

There was a small significant relationship between the perceived social support and COVID-19 anxiety. Further studies are required to identify associated factors of anxiety level during COVID-19 in pregnant women.

Repetitive negative thinking in the perinatal period and its relationship with anxiety and depression

BACKGROUND

Rumination and worry represent two types of repetitive negative thinking (RNT), and their predictive and maintaining roles are well-established in depression and anxiety, respectively. Furthermore, there is an emerging literature on the link between RNT and psychological wellbeing in the perinatal period.

METHODS

We conducted a scoping review of studies that have investigated the relationship between RNT and perinatal depression and anxiety. We identified 87 papers eligible for inclusion in the review; they included cross-sectional and longitudinal studies, as well as treatment evaluations (pilot trials and randomised controlled trials).

RESULTS

Cross-sectional studies provided evidence of an association between RNT (i.e., rumination and worry) and depression and anxiety, in both pregnancy and postpartum. Longitudinal findings were mixed. Whilst antenatal worry consistently predicted subsequent depression and anxiety (both later in pregnancy and postpartum), rumination did not consistently predict depression. However, there was some evidence that rumination interacted with other processes to predict later psychopathology. Three randomised controlled trials evaluated whether psychological treatments reduce RNT in the perinatal period, only one of which included a clinical sample.

LIMITATIONS

No experimental investigations were eligible for inclusion in the review.

CONCLUSIONS

Further studies are needed to further our understanding of the nature and role of RNT in pregnancy and postpartum, and its consequences for maternal mental health. These include (but are not limited to) experimental investigations, studies with large clinical samples, and RCTs evaluating the effectiveness of psychological interventions targeting RNT to prevent and treat perinatal depression and anxiety.

Psychoeducation for psychological issues and birth preparedness in low- and middle-income countries: a systematic review

BACKGROUND

Psychological issues usually accompany the pregnancy of first-time mothers, and psychoeducational interventions might be effective in addressing these concerns and preparing first-time mothers for childbirth and the postnatal period.

OBJECTIVE

This study aimed to identify, analyze, and synthesize the components and determine the effectiveness of psychoeducational interventions that are used for managing psychological issues and enhancing birth preparedness among primigravid women or couples in low- and middle-income countries.

STUDY DESIGN

A systematic search of 12 databases (APA PsycINFO, EmCare, Embase, MEDLINE(R), Ovid Nursing, British Nursing Index, Health & Medical Collection, ProQuest, CINAHL, Cochrane, Hinari, and PubMed) was conducted to identify relevant studies published between 1946 and October 2021. The quality of the included studies was appraised by the Joanna and Briggs Institute critical appraisal tool, and a narrative synthesis was performed to analyze data extracted from included articles. The systematic review protocol is registered with the International Prospective Register of Systematic Reviews (registration number: CRD42021237896).

RESULTS

The initial search yielded 8658 articles. Of note, 16 articles, including 7 randomized controlled trials and 9 nonrandomized trials, met the inclusion criteria and were selected and reviewed for quality. In addition, 31 outcomes were measured in the studies, including psychological outcomes, birth preparedness outcomes, and other outcomes. The design of the interventions included antenatal education that was delivered through lectures, role plays, trainings, and antenatal counseling. All the psychoeducational interventions had a significant effect (P<.05; Cohen's d or Hedges’ g=0.2–1.9) on certain psychological outcomes, including childbirth attitude, fear of childbirth, depression, fear, and anxiety, and birth preparedness outcomes.

CONCLUSION

Although first-time mothers experience a range of psychological issues during pregnancy, psychoeducational interventions were beneficial in addressing their psychological concerns. It would seem that these interventions are less expensive and could be easily implemented in low- and middle-income countries. However, rigorous research, such as randomized controlled trials, is hereby warranted to standardize the interventions and outcome assessment tools.

Pregnancy-related anxiety symptoms and associated factors amongst pregnant women attending a tertiary hospital in south-west Nigeria

Background

Pregnancy can be associated with anxiety symptoms because of anticipated uncertainty.

Aim

This study investigated pregnancy-related anxiety symptoms (PRASs) and their associated factors amongst pregnant women.

Setting

Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.

Methods

This cross-sectional survey involved 230 pregnant women attending antenatal clinic at a tertiary teaching hospital in Nigeria. Pregnancy-related anxiety symptoms, maternal worries, personality traits and social support were measured by using Perinatal Anxiety Screening Scale (PASS), Cambridge Worry Scale (CWS), Big Five Personality Inventory (BFI-10) and Maternal Social Support Scale (MSSS) respectively. Socio-demographic and obstetric details were also obtained. The Chi-square, t-test and logistic regression were used.

Results

Respondents’ mean age was 28.2 ± 5.4 years, whilst 192 (83.5%) were of Yoruba ethnicity. Twenty-four respondents (10.4%) were in the first trimester, 85 (37.0%) in the second and 121 (52.6%) in the third trimester. Some 154 (67.0%) were parous. The prevalence of PRAS and major maternal worries were 43.5% and 55.7% respectively. The socio-demographic factors significantly associated with PRAS were age (p = 0.004), ethnicity (p = 0.001), educational level (p = 0.011) and living arrangement (p = 0.029). Associated obstetric factors include trimester (p = 0.01), hypertension (p = 0.006), past miscarriage(s) (p = 0.013) and past pregnancy complication (p = 0.030). Significant psychosocial factors were partner social support (p = 0.038), maternal worries (p < 0.001) and extraversion (p = 0.016). Factors that contributed significantly to regression models were older maternal age and socio-medical worries.

Conclusion

High level of PRAS and major maternal worries were common amongst antenatal clinic attendees of a tertiary teaching hospital in Nigeria. Older maternal age and socio-medical maternal worries are important predictors of PRAS.

Living With Parents-In-Law Increased the Risk of Postpartum Depression in Chinese Women

Background: A variety of psychological and socioeconomic factors contribute to the development of postpartum depression (PPD). However, the relationship between maternal living arrangements and PPD is unclear. Objective: To assess the relationship between maternal living arrangements and PPD in Chinese population. Methods: A cross-sectional survey was conducted among puerperal women delivered in Baoan Maternal and Child Health Hospital in Shenzhen, China. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess PPD. A score of ≥10 was used as the threshold for postpartum depression. Results: A total of 4,813 women were recruited, of whom 2,535 (52.7%) lived only with their husbands, 664 (13.8%) lived with their parents, and 1,614 (33.5%) lived with their parents-in-law. Compared with women who lived with husbands, puerperal women who lived with their parents-in-law were more likely to be positive for PPD screening (14.1 vs. 10.5%, P < 0.001). After adjusting for other influencing factors, living with parents-in-law was significantly associated with the risk of PPD (OR = 1.38, 95% CI, 1.12-1.70). Additionally, stratification analyses showed that the association between living with parents-in-law and the presence of PPD was more significant in women with anxiety during pregnancy (P for interaction <0.05). Conclusions and Relevance: Our data confirms that the maternal living arrangements affect the risk of PPD, especially among women with anxiety during pregnancy. Therefore, more targeted preventive measures should be taken for postpartum depression in women who live with their parents-in-law.

The relationship between dyadic adjustment and psychiatric symptomatology in expectant couples: An actor-partner interdependency model approach

BACKGROUND

Many researchers who evaluated psychological distress during the transition to parenthood agree in identifying pregnancy as the most sensitive period for the onset of psychiatric symptomatology for both parents. Furthermore, research highlights a correlation between symptoms experienced by fathers in relation to those experienced by mothers.

OBJECTIVE

The aim of this study was to investigate whether dyadic functioning influences the level of psychiatric symptomatology in couples expecting their first child. Participants were 137 couples expecting their first child; they were recruited at the San Filippo Neri and the Santo Spirito hospitals in Rome (ASLROMA1). We used an Actor-Partner Interdependence Model (APIM) to test the interdependence of both partners and the effect of dyadic relationships on psychiatric symptoms in the couple.

RESULTS

The overall test of distinguishability yielded a chi square value of 122.167 (23 df; p < .001). The actor-partner interdependence model showed significant paths between couple coping and psychiatric symptomatology. Specifically, we found that the quality of couple coping perceived by the mother negatively predicted maternal psychiatric symptomatology, and the quality of couple coping perceived by the father negatively predicted paternal psychiatric symptomatology. Furthermore, the quality of couple coping perceived by the father negatively predicted maternal psychiatric symptomatology.

CONCLUSIONS

The results of this study confirm that dyadic adjustment is an important element for the development of effective interpersonal relationships. These data highlight the importance of promoting psycho-educational and clinical courses and programs for the development of social support with future parents.

Probiotics and Maternal Mental Health: A Randomised Controlled Trial among Pregnant Women with Obesity

Poor maternal mental health has been associated with a myriad of pregnancy and child health complications. Obesity in pregnancy is known to increase one’s risk of experiencing poor maternal mental health and associated physical and mental health complications. Probiotics may represent a novel approach to intervene in poor mental health and obesity. We conducted this pre-specified secondary analysis of the Healthy Mums and Babies (HUMBA) randomised controlled trial to investigate whether probiotics would improve maternal mental health outcomes up to 36 weeks of pregnancy. Two-hundred-and-thirty pregnant women with obesity (BMI ≥ 30.0 kg/m²) were recruited and randomised to receive probiotic (Lactobacillus rhamnosus GG and Bifidobacterium lactis BB12, minimum 6.5 × 10⁹ CFU) or placebo capsules. Depression, anxiety, and functional health and well-being were assessed at baseline (12⁰−17⁶ weeks’ gestation) and 36 weeks of pregnancy. Depression scores remained stable and did not differ between the probiotic (M = 7.18, SD = 3.80) and placebo groups (M = 6.76, SD = 4.65) at 36 weeks (p-values > 0.05). Anxiety and physical well-being scores worsened over time irrespective of group allocation, and mental well-being scores did not differ between the two groups at 36 weeks. Probiotics did not improve mental health outcomes in this multi-ethnic cohort of pregnant women with obesity.

Perceived Paternal Involvement, Relationship Satisfaction, Mothers' Mental Health and Parenting Stress: A Multi-Sample Path Analysis

Research has demonstrated the short- and long-term impacts of maternal mental health and well-being on children's emotional and behavioral outcomes. It is thus important to better understand the antecedents of maternal depression and stress. The aim of this study was to determine whether the contribution of perceived paternal involvement to account for mothers' depression and parental stress was mediated by relationship factors such as parenting alliance and dyadic adjustment. A second aim was to determine whether these relationships hold equally true in mothers of infants and young toddlers (0-24 months) and mothers of older children (25 months and older). Cross-sectional data were collected from 447 mothers. Mothers reported on their perceptions of paternal involvement with childcare responsibilities, dyadic adjustment, parenting alliance, parenting stress, and depression. Multi-sample path modeling analyses were conducted. Results revealed that perceived paternal involvement was positively related to both dyadic adjustment and parental alliance, that parenting alliance was negatively related to all three subscales of parenting stress and mothers' depression but that dyadic adjustment was negatively related to parenting distress (one subscale of parenting stress) and mothers' depression. Results from the multi-sample analyses indicated that the pattern of relationships was the same in the two groups, but that the model was not invariant. The most notable difference was that parenting alliance did not significantly account for depression in the mothers of younger children. Correlates of maternal mental health and well-being identified in this study could be useful when designing psychological interventions for mothers and fathers.

Dyadic Adjustment and Prenatal Parental Depression: A Study with Expectant Mothers and Fathers

Introduction: This paper evaluated the relationships between the dyadic adjustment of expectant parents and prenatal maternal and paternal depression.

Method: Participants were 98 couples who were expectant parents in the third trimester of pregnancy. Most couples (97%) were primiparous. Participants' prenatal depression, psychiatric symptomatology, perinatal affectivity, and dyadic adjustment were evaluated.

Results: Hierarchical regression and relative weight analyses showed the importance of various marital adjustment dimensions in predicting prenatal maternal and paternal depression. In particular, the marital relationship variables of dyadic consensus and affective expression of both partners was related to prenatal depression in expectant mothers, with the relationship even stronger in expectant fathers. The results suggested that for both partners, perception of marital relationship quality contributes to the development of depressive symptoms in new mothers and fathers to a greater degree than the single perception of one partner.

Discussion: Clinically, the results suggest that clinicians should focus on partner relationships in the perinatal period. The provision of psychological interventions to improve a couple's functioning may help to protect new parents against depressive symptomatology.

Relationship Between Marital Quality, Social Support and Mental Health During Pregnancy

The aim of this study was to investigate the relationship between marital quality and mental health during pregnancy. This cross-sectional study was conducted on 300 Iranian pregnant women. The ENRICH marital satisfaction subscales, levels of domestic violence, perceived social support, as well as depression and anxiety levels were assessed using a questionnaire. AMOS path analysis was used to explore the causal relationship and the mediating effect of social support among the variables of marital quality subscales and mental health. The results showed that, adjusted for age, the history of infertility and level of anxiety were related to marital satisfaction, marital relationships and level of depression which were related to the level of domestic violence. Sexual satisfaction and the level of perceived social support had a mediating role in such relationships. The study confirmed that marital quality is an important predictor of mental health. Improving the marital quality may lead to improvement in mental health.

The impact of resilience on prenatal anxiety and depression among pregnant women in Shanghai

BACKGROUND

Prenatal anxiety/depression has been a major public health problem globally with higher prevalence in developing countries, which leads to negative health outcomes for both mothers and children. Maternal stress varies over the course of pregnancy and the stress occurring in early pregnancy is the most critical. However, few studies have focused on the impact of resilience to stress on mental health of pregnant women.

AIMS

To explore the effect of resilience to stress on prenatal anxiety/depression in pregnant women.

METHODS

2813 participants were recruited from Shanghai Maternal-Child Pairs Cohort (Shanghai MCPC) in this study. The Life Event Scale for Pregnancy Women (LESPW) was used to assess stress at 12-16 weeks of pregnancy and at 32-36 weeks of pregnancy, respectively. Resilience was assessed by the revised Resilience Scale for Adults (RSA) at 12-16 weeks of pregnancy. The prenatal anxiety and depression were assessed at 32-26 weeks of pregnancy by Self-Rating Anxiety Scale (SAS) and the Center for Epidemiological Survey, Depression Scale (CES-D), respectively. Hierarchical linear regression analyses were conducted to explore the direct effect of stress and resilience on prenatal anxiety and depression. The indirect effects of mediation were analyzed by structural equation models, and the indirect effect of modification was examined by stratification analysis.

RESULTS

There were 11.1% and 10.3% of pregnant women in Shanghai MCPC indicating anxiety and depressive mood, respectively. The stress caused by both subjective and objective events at 32-36 weeks of pregnancy is less than that at 12-16weeks of pregnancy. We found that resilience was a protective factor for maternal mental health and meanwhile it was both an effect modifier and a mediator to the association between stress and prenatal anxiety/depression, with the mediating effect ratio of 15.1% and 23.8%, respectively.

LIMITATIONS

The existence of recall bias, missing data, and restricted residential areas of the participants may limit the generalizability of the study. The measurements of resilience, prenatal anxiety, and depression were not designed specifically for pregnant women, so that they might have missed some important indications of mental issues related to pregnant women only.

CONCLUSIONS

Resilience could be a direct and indirect protective factor for prenatal anxiety and depression caused by pregnancy stress.

Partner support during the prenatal testing period after assisted conception

BACKGROUND

Pregnancy after infertility is a challenging experience. The first-trimester screening test may add stress. Partner support reduces psychological distress in pregnant women after spontaneous conception. No data are available for women who conceive via assisted reproductive technology.

AIM

To assess whether there was a difference between couples who underwent assisted reproductive technology and couples who conceived spontaneously in the support they felt they provided to their partner and whether their perception of support received from their partner reduced their distress.

METHODS

This longitudinal prospective study included 52 women (spontaneous conception) and 53 women (assisted reproductive technology), as well as their partners. Participants completed the state scale of the State-Trait Anxiety Inventory, the Edinburgh Depression Scale, and two partner-support subscales of the Dyadic Coping Inventory: before prenatal testing (gestational age 12 weeks), immediately after receiving the results (gestational age of approximately 14 weeks), and once all the prenatal screenings had been completed (gestational age 22 weeks).

FINDINGS

Women who underwent assisted reproductive technology felt less able to help their partner cope with stress and felt their partner was less able to help them cope with stress than women with spontaneous pregnancy. This difference was not observed in men. Higher perceived partner support lowered the anxiety and depression of couples who conceived spontaneously, but did not benefit couples who followed fertility treatment.

CONCLUSION

These results add to our knowledge of the emotional state of women and their partners during pregnancy after infertility. This knowledge may allow prenatal care providers to offer specialized counselling to women and their partners in the transition from infertility to parenthood.

Predictors of emotional distress in pregnant women: the mediating role of relationship intimacy

Background: Assessment and treatment of emotional distress during pregnancy show that worries during pregnancy and interpersonal relationships with partners are the important factors determining psychological health.Aims: The present study aimed to investigate the impact of worries during pregnancy, relationship intimacy, and marital satisfaction on anxiety, depression, and stress symptoms in pregnant women, as well as to analyse the mediating effect of relationship intimacy between marital satisfaction and emotional distress.Method: During their second and third trimester of pregnancy, 200 Portuguese women were recruited during childbirth preparation consultations and completed the Cambridge Worry Scale (CWS), the Personal Assessment of Intimacy in Relationships Scale (PAIR), the Marital Life Areas Satisfaction Evaluation Scale (MLASES), and the Depression, Anxiety, and Stress Scale (DASS-21).Results: Hierarchical multiple regression analyses showed that being unemployed or on sick leave, being younger, having a history of miscarriage, having more worries during pregnancy, and declaring low-relationship intimacy were the main predictors of emotional distress. Relationship intimacy mediated the relation of marital satisfaction to anxiety and depression symptoms.Conclusions: This study highlights the importance of the worries during pregnancy and relationship intimacy in shaping pregnant women's emotional distress, and identifies both as targets of intervention.

Couples Communication Skills and Anxiety of Pregnancy: A Narrative Review

Background:

physical problems during pregnancy including Anxiety disorders form a large share of health problems. On the other hand, healthy relationship and communication skills are vital to raise a family. For couples who enjoy communication skills, parenthood will be the best and most pleasant experiences in their lives. High levels of positive communication will lead to couples and their children’s mental health and couples’ good relationship can have a protective effect against stressors including anxiety of pregnancy. The current study reviewed the studies on the relationship between communication skills and the anxiety of pregnancy.

Methods:

The current study is a review where the researcher browsed the available databases like Google Scholar, Pubmed, Magiran, SID, and Science Direct and using key words of Communication skills, marital satisfaction, and the anxiety of pregnancy, & the researcher has searched the articles of 2000-2014 & read 150 abstracts & 93 full papers and ultimately, chose 50 to write this study.

Results:

By reviewing the findings literature in three general categories as Communication Skills as the Significant Component to Get Marital Satisfaction, Improving Marital Satisfaction as Pregnancy Anxiety Reducing Factor, and Communication Skills Quality as Component Influencing Pregnancy Anxiety.

Conclusions:

Having communication skills will lead to promotion of marital satisfaction and increased mental health in life. It is, therefore, recommended that communication skills be trained in routine programs for pre-marriage counseling, pre-pregnancy cares and pregnancy so that the mental health of community can be improved.

Predictors of anxiety among pregnant New Zealand women hospitalised for complications and a community comparison group

OBJECTIVE

to investigate predictors of anxiety for women experiencing hospitalisation during pregnancy and a comparison group of pregnant women (with or without medical complications) in the community.

DESIGN

correlational, cross-sectional observational questionnaire study.

SETTING

regional antenatal inpatient unit and community-based settings in New Zealand in 2009 and 2010.

PARTICIPANTS

118 pregnant women in hospital and 114 pregnant women in community.

MEASUREMENTS AND FINDINGS

women in hospital and community groups completed a battery of questionnaires on pregnancy and health history, life events, anxiety, optimism, coping, and relationship factors. Midwives caring for the women provided ratings of health status and psychological distress. Both groups of women had scores on state anxiety significantly above local norms; women in the hospital were significantly higher than those in the community on state anxiety and worry about their pregnancy. The groups did not differ on factors such as life events, optimism, and coping self-efficacy. Ratings of health and distress made by women and their midwives showed poor agreement. Predictors of acute anxiety differed across the groups: for hospitalised women, anxiety was predicted by their rating of their health and their dispositional optimism; for women in the community, anxiety was predicted by stressful life events, dispositional optimism, and coping self-efficacy.

KEY CONCLUSIONS

many women hospitalised during pregnancy are extremely anxious, and those most vulnerable are those who are less optimistic and see their health as poor. Health care professionals may not be aware of how anxious women are, and women and their hospital caregivers had poor agreement on ratings of the woman׳s health status.

IMPLICATIONS FOR RESEARCH AND PRACTICE

women hospitalised during pregnancy are at risk for high levels of anxiety. Midwives are well placed to help women by recognising their distress, supporting informed optimism, and guiding women toward realistic coping strategies and using existing social support networks. Research is needed on strategies for implementation and effectiveness of brief interventions to support women to manage anxiety and stress during pregnancy both in hospital and in the community.

Association of Prepregnancy Dietary Patterns and Anxiety Symptoms from Midpregnancy to Early Postpartum in a Prospective Cohort of Brazilian Women

BACKGROUND

Adherence to unhealthy dietary patterns may alter the risk of mental disorders during pregnancy and the postpartum period.

OBJECTIVE

To analyze the association between prepregnancy dietary patterns and prospective variations on anxiety symptoms from midpregnancy to early postpartum.

METHODS

A prospective cohort of 207 healthy pregnant women was followed at 5 to 13, 20 to 26, and 30 to 36 gestational weeks, and once at 30 to 45 days postpartum. The State-Trait Anxiety Inventory was used to evaluate anxiety symptoms at the second and third gestational trimesters and during the postpartum period. Dietary intake was assessed using a food frequency questionnaire administered during the first trimester of pregnancy that referred to the 6 months before pregnancy. Principal components analysis was used to identify dietary patterns and three prepregnancy dietary patterns were identified: common-Brazilian, healthy, and processed. Three longitudinal mixed-effect models were estimated to verify the association between dietary patterns and anxiety symptoms, adjusted for confounding variables.

RESULTS

The mean anxiety symptom scores were 40.4, 40.5, and 37.2 for the second trimester, third trimester, and postpartum, respectively. The rate of variation of the State-Trait Anxiety Inventory score was 0.535 (95% CI -0.035 to 1.107; P=0.066) and -0.010 (95% CI -0.018 to -0.002; P=0.019) when accounting for gestational age and quadratic gestational age, respectively. The common-Brazilian pattern, comprised mainly of rice and beans (β=-1.200, 95% CI -2.220 to -0.181; P=0.021), and the healthy pattern comprised mostly of vegetables, fruits, fish, and tea (β=-1.290, 95% CI -2.438 to -0.134; P=0.029), were negatively associated with prospective changes in anxiety symptoms.

CONCLUSIONS

High adherence to the common-Brazilian or healthy patterns was negatively associated with higher anxiety symptom scores from mid-pregnancy to early postpartum in this group of Brazilian women.