Does maternal anxiety influence pregnancy?

While maternal anxiety does not appear to be associated with adverse perinatal outcomes, it does present a risk for hypertensive disorders of pregnancy (HDP), according to data presented at SMFM 2022.

Not tied to adverse perinatal outcomes

In a prospective study on 192 consecutive women hospitalized at high-risk pregnancy departments, nearly a third (31 percent) screened positive for current anxiety symptoms, suggesting that maternal antenatal anxiety is common among women with high-risk pregnancies. [SMFM 2022, abstract 161]

Nonetheless, maternal antenatal anxiety was not an independent risk factor for preterm birth (adjusted odds ratio [aOR], 0.9; p=0.86), Caesarean delivery (aOR, 1.1; p=0.71), or low birth weight (aOR, 1.0; p=0.93) on multivariate analysis after accounting for maternal age, academic status, and risk for post-partum depression.

“[These findings suggest that] in a population of women hospitalized in high-risk pregnancy departments, maternal antenatal anxiety was not found to be associated with adverse perinatal outcomes,” said presenting author Dr Shanny Sade from the Soroka University Medical Center, Be’er Sheva, Hadarom, Israel.

Hypertensive risk

However, a population-based retrospective analysis involving >9M pregnant women in the US showed an association between maternal anxiety and HDP, including gestational hypertension, eclampsia, and preeclampsia. [SMFM 2022, abstract 383]

“The rates of maternal mental disorders are increasing,” said presenting author Dr Jason Raina from the McGill University, Montreal, Quebec, Canada. “The rates of pregnant women with anxiety disorder and gestational hypertension significantly increased from 1.75/10,000 women in 2004 to 12.99/10,000 women by 2014.”

Similarly, the rates of pregnant women with anxiety and preeclampsia increased from 2.21 to 12.85/10,000 women over the same 10-year period, added Raina.

When adjusting for sociodemographic variables, anxiety was consistently associated with an increased risk of gestational hypertension and preeclampsia (aORs, 1.3 and 1.5, respectively), more so with eclampsia (aOR, 1.8).

“[Our findings show that pregnant women] with anxiety had an increased risk of HDP,” said Raina. “Targeted mental health screening early in pregnancy and prudent surveillance is recommended to reduce and prevent the development of HDP.”

What can help quell anxiety during delivery

In another trial, 157 participants were randomized 1:1 to watch an informative video or not prior to undergoing Caesarean delivery. The analysis was based on data from 132 participants who completed all questionnaires. [SMFM 2022, abstract 110]

On the day of operation, anxiety levels were significantly lower among women who saw the video as opposed to those who did not (State-Trait Anxiety Inventory score, 41.3 vs 49.3; p<0.001). This effect was sustained by postpartum day 1 (p<0.001).

“The 6-minute video described in detail the expected Caesarean delivery process – preparations before entering the operation room, regional anaesthesia administration, sterile covering, the surgical procedure itself, and recovery (including mobilization and lactation),” said presenting author Dr Hadas Miremberg from the Edith Wolfson Medical Center, Holon, Israel.

“[Our findings show that] a detailed informative video prior to primary Caesarean delivery decreased maternal anxiety before and after the procedure,” said Miremberg.