Assessment of anxiety during pregnancy: are existing multiple anxiety scales suitable and comparable in measuring anxiety during pregnancy?

Can EPDS and EPDS-3A be used to replace GAD-7 to screen the anxiety of pregnant women during pregnancy examination?

OBJECTIVE

To examine the screening ability and cut-off scores of the Edinburgh Postnatal Depression Scale (EPDS) and EPDS-3A for pregnancy anxiety in pregnancy examination.

METHODS

This was a prospective repetitive measurement study. A follow-up survey was performed in Chinese pregnant women with the EPDS, the 7-item Generalized Anxiety Disorder (GAD-7) scale and a basic information questionnaire. A total of 609 women participated in all surveys at three trimesters, and all data were complete with no missing values. Receiver operating characteristic curves, Cohen's kappa and cross-tabulation were used to test the single and combined screening ability of EPDS and EPDS-3A for pregnancy anxiety.

RESULTS

The areas under the curves of EPDS and EPDS-3A were close to or more than 0.90. EPDS scores greater than 14 in the first trimester and greater than 13 in the second and third trimesters could be used as the cut-off values. EPDS-3A score greater than 4 could be used as the cut-off value in each trimester. Adding the EPDS-3A to the EPDS would lead to correct identification of an additional 6.33%, 6.35%, and 7.25% of anxious women and misdiagnosis of an additional 6.60%, 2.56%, and 2.41% of normal women in each trimester, respectively.

CONCLUSION

The EPDS and EPDS-3A can be used alone or in combination for initially screening of pregnancy anxiety. Under certain conditions, they can even be used to replace GAD-7 for anxiety screening to reduce the adverse influence of excessive screening on pregnant women, and improve the quality of survey data and efficiency of clinical services.

Associations among maternal lifetime trauma, psychological symptoms in pregnancy, and infant stress reactivity and regulation

Maternal trauma has intergenerational implications, including worse birth outcomes, altered brain morphology, and poorer mental health. Research investigating intergenerational effects of maternal trauma on infant stress reactivity and regulation is limited. Maternal mental health during pregnancy may be a contributor: psychopathology is a sequela of trauma exposure and predictor of altered self-regulatory capacity in offspring of affected mothers. We assessed associations among maternal lifetime trauma and infant stress responsivity, mediated by psychological symptoms in pregnancy. Mothers reported lifetime trauma history and anxiety, depressive, and posttraumatic stress symptoms during pregnancy. At infant age 6 months, stress reactivity and regulation were assessed via maternal behavior ratings (Infant Behavior Questionnaire-Revised, IBQ-R) and behavioral (negative mood) and physiological (respiratory sinus arrhythmia, RSA) markers during a laboratory stressor (Still-Face Paradigm). Maternal trauma was directly associated with lower infant physiological regulation and indirectly associated with lower levels of both infant behavioral and physiological regulation via higher maternal anxiety during pregnancy. Maternal trauma was also indirectly associated with higher infant reactivity via higher maternal anxiety during pregnancy. Post hoc analyses indicated differential contributions of maternal prenatal versus postnatal anxiety to infant outcomes. Findings highlight potential contributory mechanisms toward maladaptive child stress response, which has been associated with poor behavioral, cognitive, and academic outcomes.

Women's Mental Health up to Eight Years after Childbirth and Associated Risk Factors: Longitudinal Findings from the All Our Families Cohort in Canada

OBJECTIVE

This study examined the prevalence of elevated maternal anxiety and/or depression symptoms up to eight years after childbirth and the association between role and relationship strains during parenting and mental health challenges from three to eight years after childbirth.

METHODS

This study used data from the All Our Families longitudinal pregnancy cohort. Role and relationship strain factors and anxiety and depression symptoms were measured at repeated time points from four months to eight years after childbirth. The proportion of women with elevated anxiety and/or depression was calculated at each available time point. Generalized estimating equation models were used to examine the association between role and relationship strain factors and anxiety and/or depression from three to eight years after childbirth. Predicted probability of having anxiety and/or depression was estimated across those with and without challenges with roles and relationships. The models were adjusted for known risk factors such as maternal income and perinatal anxiety and/or depression.

RESULTS

The prevalence of elevated anxiety and/or depression ranged from 18.8% (at four months) to 26.2% (at eight years). The adjusted odds ratio of anxiety and/or depression was 3.5 (95% CI = 2.9, 4.3) for those juggling family responsibilities and 2.4 (95% CI = 2.0, 3.0) for those with stressful partner relationship compared to their counterparts. Similarly, experiencing financial crunch and poor partner relationship were associated with increased mental health difficulties. Women without challenges in roles or relationships had a 23% lower predicted probability of anxiety and/or depression than those with the challenges.

CONCLUSIONS

Monitoring mothers for anxiety and depression beyond the postpartum period and strategies that address role and relationship challenges may be valuable to women at risk of anxiety and depression.

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.

Effect of individual or comorbid antenatal depression and anxiety on birth outcomes and moderation by maternal traumatic experiences and resilience

Background

Although antenatal depression and anxiety (e.g., negative antenatal mental health; NAMH) are individually associated with preterm birth (PTB) and infant neurological impairment, few studies account for comorbidity. Understanding how NAMH impacts PTB and infant neurological functioning by either singular (depression or anxiety) or comorbid status, as well as the way in which these effects can be moderated by additional risk or protective factors (traumatic experiences and trait resiliency) can contribute further understanding of NAMH effects on birth outcomes.

Methods

The sample included 3042 mother-infant dyads from U.S. and South Africa cohorts of the Safe Passage Study (N = 3042). A four-category NAMH variable was created to categorize depression-only, anxiety-only, comorbid, or no NAMH statuses.

Results

There were no NAMH main effects on PTB, however, anxiety-only and comorbid NAMH increased odds of PTB for mothers with higher rates of traumatic life experiences. Anxiety-only and comorbid NAMH were associated with increased odds of newborn neurological impairment, and the effect of comorbid NAMH was stronger for mothers with higher rates of traumatic experiences. Resiliency decreased odds of neurological impairment for mothers who reported depression-only or anxiety-only NAMH.

Limitations

Limitations included potential artefacts of two cohorts that differed in rates of almost all variables, a single time point for measuring NAMH, and lack of pregnancy-specific NAMH measures.

Conclusions

Especially when compared to mothers with no NAMH, comorbidity or singular-condition NAMH statuses associate with negative birth outcomes in nuanced ways, especially when considering additional contexts that may foster or protect against NAMH.

The factor structure of the Edinburgh Postnatal Depression Scale among perinatal high-risk and community samples in London

Timely and accurate detection of perinatal mental health problems is essential for the wellbeing of both mother and child. Growing evidence has suggested that the Edinburgh Postnatal Depression Scale (EPDS) is not a unidimensional measure of perinatal depression, but can be used to screen for anxiety disorders. We aimed to assess the factor structure of the EPDS in 3 different groups of women: n = 266 pregnant women at high-risk of depression ("Perinatal Stress Study"), n = 471 pregnant women from a community sample, and n = 637 early postnatal women from a community sample ("developing Human Connectome Project"). Exploratory factor analysis (40% of each sample) and confirmatory factor analysis (60% of each sample) were performed. The relationship between EPDS scores and history of mental health concerns was investigated. Results suggested that a 3-factor model (depression, anxiety, and anhedonia) is the most appropriate across groups. The anxiety subscale (EPDS-3A) emerged consistently and was related to maternal history of anxiety disorders in the prenatal sample (W = 6861, p < 0.001). EPDS total score was related to history of mental health problems in both the prenatal (W = 12,185, p < 0.001) and postnatal samples (W = 30,044, p < 0.001). In both high-risk and community samples in the perinatal period, the EPDS appears to consist of depression, anxiety, and anhedonia subscales. A better understanding of the multifactorial structure of the EPDS can inform diagnosis and management of women in the prenatal and postnatal period. Further research is required to validate the EPDS-3A as a screening tool for anxiety.

The pregnancy-related anxiety characteristics in women with gestational diabetes mellitus: why should we care?

Background

Gestational diabetes mellitus (GDM) is very commonly-seen in clinical settings, and GDM patients may have higher levels of anxiety. It’s necessary to evaluate the anxiety level and potentially influencing factors in patients with GDM, to provide insights for the management of anxiety of GDM patients.

Methods

Patients with GDM treated in our hospital from May, 2018 to May, 2020 were included. We evaluated the characteristics of patients and the scores of pregnancy-related anxiety scale for anxiety level, vulnerable personality style questionnaire (VPSQ) for personality, general self-efficacy scale (GSES) for self-efficacy, social support rating scale (SSRS) for social support level. Logistic regression analyses were conducted to identify the potential influencing factors of anxiety in GDM patients.

Results

A total of 386 GDM patients were included, the incidence of anxiety in patients with GDM was 59.07%. Anxiety was positively correlated with the susceptible personality (r = 0.604, p = 0.023), and it was negatively correlated with self-efficacy and social support (r = -0.586 and -0.598 respectively, all p < 0.05). The education level, monthly income, abnormal pregnancy (miscarriage, premature rupture of membranes) and cesarean section history and first pregnancy were the independent influencing factors for the anxiety in the patients with GDM (all p < 0.05).

Conclusions

The anxiety of GDM patients is very common, early care and interventions are warranted for those patients with abnormal pregnancy and cesarean section history, first pregnancy, lower education level, and less monthly income.