Is maternal trait anxiety a risk factor for late preterm and early term deliveries?

Margarete Erika Vollrath,Beatrice Latal,Bo Jacobsson,Markus A Landolt,Verena Sengpiel

doi:10.1186/s12884-016-1070-1

Abstract

BackgroundAnxiety is associated with preterm deliveries in general (before week 37 of pregnancy), but is that also true for late preterm (weeks 34/0–36/6) and early term deliveries (weeks 37/0–38/6)? We aim to examine this association separately for spontaneous and provider-initiated deliveries.MethodsParticipants were pregnant women from the Norwegian Mother and Child Cohort Study (MoBa), which has been following 95 200 pregnant women since 1999. After excluding pregnancies with serious health complications, 81 244 participants remained. National ultrasound records were used to delineate late preterm, early term, and full-term deliveries, which then were subdivided into spontaneous and provider-initiated deliveries. We measured trait anxiety based on two ratings of the anxiety items on the Symptom Checklist-8 (Acta Psychiatr Scand 87:364–7, 1993). Trait anxiety was transformed into categorizing the score at the mean and at ± 2 standard deviations.ResultsTrait anxiety was substantially associated with late preterm and early term deliveries after adjusting for confounders. In the whole sample, women with the highest anxiety scores (+2 standard deviations) were more likely [(odds ratio (OR) = 1.7; 95 % confidence-interval (CI) 1.3-2.0)] to delivering late preterm than women with the lowest anxiety scores. Their odds of delivering early term were also high (OR = 1.4; CI 1.3-1.6). Women with spontaneous deliveries and the highest anxiety scores had higher odds (OR = 1.4; CI 1.1-1.8) of delivering late preterm and early term (OR = 1.3; CI = 1.3-1.5). The corresponding odds for women with provider-initiated deliveries were OR = 1.7 (CI = 1.2-2.4) for late preterm and OR = 1.3 for early term (CI = 1.01-1.6). Irrespective of delivery onset, women with provider-initiated deliveries had higher levels of anxiety than women delivering spontaneously. However, women with high anxiety were equally likely to have provider-initiated or spontaneous deliveries.ConclusionsThis study is the first to show substantial associations between high levels of trait anxiety and late preterm delivery. Increased attention should be given to the mechanism underlying this association, including factors preceding the pregnancy. In addition, acute treatment should be offered to women displaying high levels of anxiety throughout pregnancy to avoid suffering for the mother and the child.

Highlights

IntroductionAnxiety is associated with preterm deliveries in general (before week 37 of pregnancy), but is that true for late preterm (weeks 34/0–36/6) and early term deliveries (weeks 37/0–38/6)? We aim to examine this association separately for spontaneous and provider-initiated deliveries
Anxiety is associated with preterm deliveries in general, but is that true for late preterm and early term deliveries? We aim to examine this association separately for spontaneous and provider-initiated deliveries
Women’s trait anxiety was distributed as follows in the whole sample: 2.3 % had very high anxiety, 3.3 % had high anxiety, 33.5 % had low anxiety, and 60.9 % had very low anxiety

Summary

Introduction

Anxiety is associated with preterm deliveries in general (before week 37 of pregnancy), but is that true for late preterm (weeks 34/0–36/6) and early term deliveries (weeks 37/0–38/6)? We aim to examine this association separately for spontaneous and provider-initiated deliveries. Anxiety is associated with preterm deliveries in general (before week 37 of pregnancy), but is that true for late preterm (weeks 34/0–36/6) and early term deliveries (weeks 37/0–38/6)? The substantial increase in shortened gestations noted in the last decades occurred late in the preterm period, between 34 and weeks (late preterm), and in deliveries in weeks and 38 (early term). These two forms of delivery onset together reach a share of up to 30 % of births in the United States [1, 2]. There has been a focus on birth anxiety, which involves fears concerning pregnancy and birth. Feeling anxious and worried in turn triggers the biological stress response, which again activates neuroendocrinological mechanisms involving the hypothalamic-pituitary-adrenal axis [10]

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