Pregnancy-related anxiety

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Pregnancy-related anxiety
Specialty Psychiatry

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] [2] [9]

Contents

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. [13] Health risk behaviors such as alcohol consumption and continued smoking during pregnancy have also been associated with pregnancy-related anxiety. [14] [15] [16] This is particularly concerning given that these behaviors introduce harmful teratogens into the baby's environment during critical developmental periods. [17]

Diagnosis

Several instruments assess pregnancy-related anxiety. These include unidimensional scales such as Levin's Pregnancy Anxiety Scale, [18] Cote-Arsenault's Pregnancy Anxiety Scale, [19] the Pregnancy Related Thoughts Scale, [20] and the Pregnancy Specific Anxiety Scale. [21] 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). [2] The PRAQ-R2 is the revised version applicable for women of any parity. [22]

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%, [23] [24] whereas, in low-income or less developed countries, it is as high as 56%. [25] 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. [26] 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. [27] [28]

Related Research Articles

Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a surgical field.

<span class="mw-page-title-main">Childbirth</span> Expulsion of a fetus from the pregnant mothers uterus

Childbirth, also known as labour, parturition and delivery, is the completion of pregnancy where one or more babies exits the internal environment of the mother via vaginal delivery or caesarean section. In 2019, there were about 140.11 million human births globally. In the developed countries, most deliveries occur in hospitals, while in the developing countries most are home births.

<span class="mw-page-title-main">Postpartum depression</span> Mood disorder experienced after childbirth

Postpartum depression (PPD), also called postnatal depression, is a type of mood disorder experienced after childbirth, which can affect both sexes. Symptoms may include extreme sadness, low energy, anxiety, crying episodes, irritability, and changes in sleeping or eating patterns. PPD can also negatively affect the newborn child.

Postpartum blues, also known as baby blues and maternity blues, is a very common but self-limited condition that begins shortly after childbirth and can present with a variety of symptoms such as mood swings, irritability, and tearfulness. Mothers may experience negative mood symptoms mixed with intense periods of joy. Up to 85% of new mothers are affected by postpartum blues, with symptoms starting within a few days after childbirth and lasting up to two weeks in duration. Treatment is supportive, including ensuring adequate sleep and emotional support. If symptoms are severe enough to affect daily functioning or last longer than two weeks, the individual should be evaluated for related postpartum psychiatric conditions, such as postpartum depression and postpartum anxiety. It is unclear whether the condition can be prevented, however education and reassurance are important to help alleviate patient distress.

Tokophobia is a significant fear of childbirth. It is a common reason why some women request an elective cesarean section. The fear often includes fear of injury to the baby, genital tract, or death. Treatment may occur via counselling.

Maternal health is the health of women during pregnancy, childbirth, and the postpartum period. In most cases, maternal health encompasses the health care dimensions of family planning, preconception, prenatal, and postnatal care in order to ensure a positive and fulfilling experience. In other cases, maternal health can reduce maternal morbidity and mortality. Maternal health revolves around the health and wellness of pregnant women, particularly when they are pregnant, at the time they give birth, and during child-raising. WHO has indicated that even though motherhood has been considered as a fulfilling natural experience that is emotional to the mother, a high percentage of women develop health problems and sometimes even die. Because of this, there is a need to invest in the health of women. The investment can be achieved in different ways, among the main ones being subsidizing the healthcare cost, education on maternal health, encouraging effective family planning, and ensuring progressive check up on the health of women with children. Maternal morbidity and mortality particularly affects women of color and women living in low and lower-middle income countries.

Unintended pregnancies are pregnancies that are mistimed, unplanned or unwanted at the time of conception.

Sex after pregnancy is often delayed for several weeks or months, and may be difficult and painful for women. Painful intercourse is the most common sexual activity-related complication after childbirth. Since there are no guidelines on resuming sexual intercourse after childbirth, the postpartum patients are generally advised to resume sex when they feel comfortable to do so. Injury to the perineum or surgical cuts (episiotomy) to the vagina during childbirth can cause sexual dysfunction. Sexual activity in the postpartum period other than sexual intercourse is possible sooner, but some women experience a prolonged loss of sexual desire after giving birth, which may be associated with postnatal depression. Common issues that may last more than a year after birth are greater desire by the man than the woman, and a worsening of the woman's body image.

Psychiatric disorders of childbirth, as opposed to those of pregnancy or the postpartum period, are psychiatric complications that develop during or immediately following childbirth. Despite modern obstetrics and pain control, these disorders are still observed. Most often, psychiatric disorders of childbirth present as delirium, stupor, rage, acts of desperation, or neonaticide. These psychiatric complications are rarely seen in patients under modern medical supervision. However, care disparities between Europe, North America, Australia, Japan, and other countries with advanced medical care and the rest of the world persist. The wealthiest nations represent 10 million births each year out of the world's total of 135 million. These nations have a maternal mortality rate (MMR) of 6–20/100,000. Poorer nations with high birth rates can have an MMR more than 100 times higher. In Africa, India & South East Asia, as well as Latin America, these complications of parturition may still be as prevalent as they have been throughout human history.

Childbirth-related post-traumatic stress disorder is a psychological disorder that can develop in women who have recently given birth. This disorder can also affect men or partners who have observed a difficult birth. Its symptoms are not distinct from post-traumatic stress disorder (PTSD). It may also be called post-traumatic stress disorder following childbirth (PTSD-FC).

<span class="mw-page-title-main">High-risk pregnancy</span> Medical condition

A high-risk pregnancy is a pregnancy where the mother or the fetus has an increased risk of adverse outcomes compared to uncomplicated pregnancies. No concrete guidelines currently exist for distinguishing “high-risk” pregnancies from “low-risk” pregnancies; however, there are certain studied conditions that have been shown to put the mother or fetus at a higher risk of poor outcomes. These conditions can be classified into three main categories: health problems in the mother that occur before she becomes pregnant, health problems in the mother that occur during pregnancy, and certain health conditions with the fetus.

Antenatal depression, also known as prenatal or perinatal depression, is a form of clinical depression that can affect a woman during pregnancy, and can be a precursor to postpartum depression if not properly treated. It is estimated that 7% to 20% of pregnant women are affected by this condition. Any form of prenatal stress felt by the mother can have negative effects on various aspects of fetal development, which can cause harm to the mother and child. Even after birth, a child born from a depressed or stressed mother feels the affects. The child is less active and can also experience emotional distress. Antenatal depression can be caused by the stress and worry that pregnancy can bring, but at a more severe level. Other triggers include unplanned pregnancy, difficulty becoming pregnant, history of abuse, and economic or family situations.

A pre-existing disease in pregnancy is a disease that is not directly caused by the pregnancy, in contrast to various complications of pregnancy, but which may become worse or be a potential risk to the pregnancy. A major component of this risk can result from necessary use of drugs in pregnancy to manage the disease.

Abuse during childbirth is generally defined as interactions or conditions deemed humiliating or undignified by local consensus and interactions or conditions experienced as or intended to be humiliating or undignifying. Bowser and Hill's 2010 landscape analysis defined seven categories of abusive or disrespectful care, including physical abuse, non-consented clinical care, non-confidential care, non-dignified care, discrimination, abandonment, and detention in health facilities.

<span class="mw-page-title-main">Alcohol and pregnancy</span> Medical condition

Alcohol use in pregnancy includes use of alcohol at any time during gestation, including the time before a mother-to-be is aware that she is pregnant. Alcohol use at some point during pregnancy is common and appears to be rising in prevalence in the United States.

Evolutionary approaches to postpartum depression examine the syndrome from the framework of evolutionary theory.

<span class="mw-page-title-main">Gestational weight gain</span> Increase in body weight during pregnancy

Gestational weight gain is defined as the amount of weight gain a woman experiences between conception and birth of an infant.

Paternal depression is a psychological disorder derived from parental depression. Paternal depression affects the mood of men; fathers and caregivers in particular. 'Father' may refer to the biological father, foster parent, social parent, step-parent or simply the carer of the child. This mood disorder exhibits symptoms similar to postpartum depression (PPD) including anxiety, insomnia, irritability, consistent breakdown and crying episodes, and low energy. This may negatively impact family relationships and the upbringing of children. Parents diagnosed with parental depression often experience increased stress and anxiety levels during early pregnancy, labor and postpartum. Those with parental depression may have developed it early on but some are diagnosed later on from when the child is a toddler up until a young adult.

Maternal health outcomes differ significantly between racial groups within the United States. The American College of Obstetricians and Gynecologists describes these disparities in obstetric outcomes as "prevalent and persistent." Black, indigenous, and people of color are disproportionately affected by many of the maternal health outcomes listed as national objectives in the U.S. Department of Health and Human Services's national health objectives program, Healthy People 2030. The American Public Health Association considers maternal mortality to be a human rights issue, also noting the disparate rates of Black maternal death. Race affects maternal health throughout the pregnancy continuum, beginning prior to conception and continuing through pregnancy (antepartum), during labor and childbirth (intrapartum), and after birth (postpartum).

Marci Lobel is a health psychologist known for her research on women's reproductive health, effects of prenatal stress on pregnancy and newborn health, and how mothers learn to cope with stress.

References

  1. ↑ Brunton, RJ; Dryer, R; Saliba, A; Kohlhoff, J (2015). "Pregnancy anxiety: A systematic review of current scales". Journal of Affective Disorders. 176: 24–34. doi:10.1016/j.jad.2015.01.039. PMID   25687280.
  2. 1 2 3 Huizink, AC; Mulder, EJ; Robles de Medina, PG; Visser, GH; Buitelaar, JK (2004). "Is pregnancy anxiety a distinctive syndrome?". Early Human Development. 79 (2): 81–91. doi:10.1016/j.earlhumdev.2004.04.014. PMID   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. doi:10.1146/annurev.psych.031809.130727. ISSN   0066-4308. PMID   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. 32 (1): e118–e130. doi:10.1016/j.wombi.2018.05.004. ISSN   1871-5192. PMID   29859678. S2CID   44164114.
  5. ↑ Dryer, Rachel; Brunton, Robyn, eds. (2021). Pregnancy-Related Anxiety: Theory, Research, and Practice. Routledge. doi:10.4324/9781003014003. ISBN   9781003014003. S2CID   244225796.
  6. ↑ Pleshette, Norman; Asch, S; Chase, J (1956). "A study of anxieties during pregnancy, labor, the early and late puerperium". Bulletin of the New York Academy of Medicine. 32 (6): 436–455. PMC   1805940 . PMID   13316338.
  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. doi:10.1097/00004583-198805000-00004. ISSN   0890-8567. PMID   3379012.
  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. doi:10.1111/ap.12365. ISSN   0005-0067. S2CID   150295282.
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  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. 16 (5): 363–369. doi:10.1007/s00737-013-0344-0. ISSN   1434-1816. PMID   23558948. S2CID   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. doi:10.1097/00004583-200209000-00008. ISSN   0890-8567. PMID   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. 25 (2): 141–148. doi:10.1097/YCO.0b013e3283503680. ISSN   0951-7367. PMC   4447112 . PMID   22262028.
  13. ↑ Garcia, Sarah E.; Perzow, Sarah E. D.; Hennessey, Ella-Marie P.; Glynn, Laura M.; Davis, Elysia Poggi (2021), "Examining the relation between maternal pregnancy-related anxiety and child development", Pregnancy-Related Anxiety, pp. 74–96, doi:10.4324/9781003014003-8, ISBN   9781003014003, S2CID   244176091 , retrieved 2022-08-23
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  17. ↑ Keegan, Joan; Parva, Mehdi; Finnegan, Mark; Gerson, Andrew; Belden, Michael (2010-04-16). "Addiction in Pregnancy". Journal of Addictive Diseases. 29 (2): 175–191. doi: 10.1080/10550881003684723 . ISSN   1055-0887. PMID   20407975. S2CID   21010797.
  18. ↑ Levin, Jeffrey S (1991). "The factor structure of the Pregnancy Anxiety Scale". Journal of Health & Social Behavior. 32 (4): 368–381. doi:10.2307/2137104. JSTOR   2137104. PMID   1765627.
  19. ↑ 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. doi:10.1080/07399330127171. ISSN   0739-9332. PMID   12141842. S2CID   45388763.
  20. ↑ 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. 18 (4): 333–345. doi:10.1037/0278-6133.18.4.333. ISSN   1930-7810. PMID   10431934. S2CID   3479575.
  21. ↑ 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. 66 (5): 762–769. doi:10.1097/01.psy.0000138284.70670.d5. ISSN   0033-3174. PMID   15385704. S2CID   18957226.
  22. ↑ 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. 19 (1): 125–132. doi:10.1007/s00737-015-0531-2. ISSN   1434-1816. PMC   4728175 . PMID   25971851.
  23. ↑ 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. doi:10.1089/jwh.2008.0998. ISSN   1540-9996. PMC   2851128 . PMID   19563244.
  24. ↑ 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. 7 (5): e013413. doi:10.1136/bmjopen-2016-013413. ISSN   2044-6055. PMC   5623367 . PMID   28490549.
  25. ↑ 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. 11: 241–248. doi: 10.2147/IJWH.S193306 . PMC   6489575 . PMID   31114392.
  26. ↑ 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. 3: 1–7. doi: 10.1016/j.ijans.2015.06.002 . ISSN   2214-1391.
  27. ↑ 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. 197: 251–258. doi:10.1016/j.jad.2016.03.008. ISSN   0165-0327. PMC   4837058 . PMID   26999549.
  28. ↑ 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. 116 (1): 67–73. doi:10.1111/j.1471-0528.2008.02002.x. PMID   19055652. S2CID   40951634.
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