Pregnancy-related Anxiety Scale Research Articles

The relationship between pregnancy-related anxiety, trait anxiety, and internet use in pregnant women: a cross-sectional study

Introduction: Pregnancy-related anxiety leads to some negative maternal and fetal complications. Determining prenatal and natal anxiety and associated factors can help identify high-risk women who need intervention during pregnancy and develop early intervention strategies. The aim of this study is to determine pregnancy-related, and trait anxiety in the prenatal period and its affecting factors. Methods: This cross-sectional and descriptive study was conducted with 245 pregnant women in the obstetrics clinic of a tertiary healthcare institution between March and August 2022. The sociodemographic, obstetric, and internet use of the participants were questioned. Pregnancy-related anxiety was assessed by using Pregnancy-Related Anxiety Questionnaire-Revised-2 (PRAQ-R2), and trait anxiety was assessed by using State–Trait Anxiety Inventory-I (STAI-II). Results: Pregnant women’s mean scale score for STAI (trait) was 45.54 ± 6.32, for PRAQ-R2 total score was 27.80 ± 8.32, for PRAQ- Fear of giving birth score was 10.12 ± 3.92, PRAQ- Worries about bearing a physically or mentally handicapped child score was 10.44 ± 4.11, and PRAQ- Concern about own appearance score was 7.24 ± 2.86. Pregnancy-related Anxiety Scale score was higher in nulliparous than multiparous (p=0.002) and 30-35 age groups than others (p=0.014). Having a chronic disease is related to a higher anxiety score (p=0.028). Trait anxiety scores were higher in nulliparous (p=0.005), those with low income, those with chronic diseases (p=0.032), and those with a history of children with congenital diseases (p=0.013). Anxiety scores were higher in pregnant women who used the internet as a source of information about pregnancy (p=0.002), and those who use the internet more (p=0.023). There was a significant positive correlation between STAI (trait) anxiety and PRAQ total score ( r:0.292, p<0.001 ), PRAQ- Fear of giving birth (r:0.145, p=0.024), PRAQ- Worries about bearing a physically or mentally handicapped child (r:0.270, p<0.001), and PRAQ- Concern about own appearance (r:0.254, p=<0.001). Conclusion: Pregnancy-related anxiety was higher in nulliparous, 30-35 age groups, having a chronic disease, husbands' high education status, and having trait anxiety. Information obtained from the internet and the time spent on the internet are associated with increased pregnancy anxiety. Future studies should focus more on predicting factors affecting pregnancy-related anxiety and estimating risks for pregnant women.

Higher prenatal anxiety predicts lower neonatal hair cortisol

BackgroundPrenatal glucocorticoids are one of the most widely proposed prenatal programming mechanisms, yet few studies exist that measure fetal cortisol via neonatal hair. Neonatal hair provides a window into the fetal experience and represents cortisol accumulation in the third trimester of pregnancy. In the current study, we test the links between two types of anxiety over the course of gestation (pregnancy-related anxiety and general anxiety) with neonatal hair cortisol. MethodPregnant individuals (N = 107) and their neonates (59.8% female) participated in the current study. Prenatal pregnancy-related anxiety and general anxiety were measured using the Pregnancy Related Anxiety Scale (PRAS) and the State-Trait Anxiety Inventory (STAI), in each trimester of pregnancy. Hierarchical linear modeling was used to model the intercept and slope of each type of anxiety over gestation. Neonatal hair samples were collected shortly after birth (Median days = 1.17, IQR = 0.75–2.00). ResultsBoth higher pregnancy-related anxiety and general anxiety at the beginning of pregnancy and a flatter decline of pregnancy-related anxiety over gestation were associated with lower neonatal hair cortisol. After inclusion of gestational age at birth and parity as covariates, pregnancy-related anxiety (intercept: β = −0.614, p =.012; slope: β = −0.681, p =.006), but not general anxiety (intercept: β = −0.389, p =.114; slope: β = −0.302, p =.217) remained a significant predictor. Further, when both general and pregnancy-related anxiety were entered into the same model, only pregnancy-related anxiety (intercept and slope) were significant predictors of neonatal hair cortisol, indicating an association with pregnancy-related anxiety above and beyond general anxiety. ConclusionCortisol plays a central role in maturation of fetal organ systems, and at the end of gestation, higher cortisol has beneficial effects such as promoting fetal lung maturation. Further, lower maternal cortisol is linked to less optimal cognitive development and altered brain development. As maternal higher anxiety in early pregnancy and a flatter decrease over time are both associated with lower neonatal hair cortisol, maternal pregnancy-related anxiety could be a target of future intervention efforts.

Perinatal grief creates vulnerability to anxiety in subsequent pregnancy: the mediating role of bereavement-related guilt

ABSTRACT Aim This study examines the associations among perinatal grief symptoms, bereavement-related guilt, and pregnancy-related anxiety in subsequent pregnancy within the framework of a hypothesised mourning model. Method Pregnant women with history of a perinatal loss were recruited using convenience sampling methods and completed a questionnaire set including the Perinatal Grief Scale, Bereavement Guilt Scale, and Pregnancy-related Anxiety Scale. Results Mediation analysis was performed to evaluate the hypothesised model in a sample of pregnant women with history of a perinatal loss (N = 111). The results indicated that bereavement-related guilt functions as a mediator in the relationship between perinatal grief severity and pregnancy-related anxiety experienced in subsequent pregnancies. Conclusion These findings were evaluated in light of previous studies, providing a bereavement-based perspective on the potential transmission of the mental effects of perinatal loss to subsequent pregnancy.

The Mediating Role of Family Functions Between Pregnancy-Related Anxiety and Sleep Quality: A Cross-Sectional Study.

To examine the relationship between pregnancy-related anxiety, family functions, and sleep quality, and to determine whether family functions mediate the relationship between pregnancy-related anxiety and sleep quality. A cross-sectional survey was conducted on pregnant women between April to August in 2022 in the obstetrics outpatient clinic of a tertiary care hospital in the Ningxia Hui Autonomous Region of China. A total of 1014 pregnant women aged 18 years and older were surveyed. They completed questionnaires, including: general demographic characteristics, the Pregnancy-related anxiety scale (PAQ), the Family Adaptation, Partnership, Growth, Affection, and Resolve (APGAR), and the Pittsburgh Sleep Quality Index Questionnaire (PSQI). Model 4 in PROCESS was used to analyze the relationships among pregnancy-related anxiety, family functions, and sleep quality, with family functions as a mediator. Among the 1014 pregnant women, the pregnancy-related anxiety scale score was (21.84 ± 5.64). The total score of the family functions scale was (8.10±2.26), and the overall sleep quality scale score was (7.89±2.99). When participants were grouped according to different socio-demographic characteristics, the study showed that all variables differed from anxiety, family functions or sleep quality, except for age, pre-pregnancy BMI and whether or not they had a first birth, which was not associated with anxiety, family functions, or sleep quality (P<0.05). The pregnancy-related anxiety was positively associated with sleep quality (P<0.01), while family functions were negatively associated with sleep quality (P<0.01). In addition, family functions mediate the relationship between pregnancy-related anxiety and sleep quality during pregnancy, on the first and second trimesters, intermediation rate is 9.31% (P<0.05), and on the third trimesters, intermediation rate is 21.38% (P<0.05). Pregnancy- related anxiety is a risk factor for sleep quality, however, family functions are protective factors for sleep quality. Family functions play an intermediary role in sleep quality caused by pregnancy-related anxiety, especially on the third trimesters. This finding may provide a scientific basis for developing intervention strategies to improve the sleep quality of pregnant women.

The impact of maternal anxiety during pregnancy on children's eczema and allergic rhinitis: The Ma'anshan birth cohort study

ObjectiveThe objective of this study was to investigate the associations between maternal exposure to anxiety during pregnancy and the susceptibility of offspring to eczema and allergic rhinitis and the possibility of sensitivity periods and cumulative effects. MethodsThe study's sample consisted of 3160 mother-child pairs from the Ma'anshan Birth Cohort Study. Maternal anxiety was repeatedly measured in the 1st, 2nd, and 3rd trimesters of pregnancy using the Chinese version of the Pregnancy-Related Anxiety Scale. Information regarding children's eczema and allergic rhinitis diagnoses was collected through parental reports at 12, 24, 36 and 48 months of age. Binary logistic regression models were used for statistical analysis and corrected for multiple comparisons using the false discovery rate (FDR) method. ResultsChildren whose mothers experienced anxiety throughout pregnancy had the highest odds of developing total eczema (aOR 1.45, 95% CI 1.02–2.07) and total allergic rhinitis (aOR 1.67, 95% CI 1.17–2.37) between the ages of 6 and 48 months. The higher the trajectory of the maternal anxiety scores throughout pregnancy, the higher the odds of total eczema (aOR 1.65, 95% CI 1.14–2.40) and allergic rhinitis (aOR 1.84, 95% CI 1.28–2.66) in their offspring. The association between maternal anxiety and children's eczema was mainly concentrated in the first 24 months, whereas the association with allergic rhinitis was mainly concentrated in the 36–48 months. ConclusionMaternal anxiety during any trimester of pregnancy, especially with a consistently high trajectory of anxiety scores, was associated with higher odds of children's eczema and allergic rhinitis.

The effect of mandala coloring on pregnancy-related anxiety

PurposeIn the literature, the efficacy of mandala coloring on pregnancy-related anxiety has been investigated, and no study has been found on its effect on anxiety. This randomized controlled trial was designed to assess the efficacy of mandala coloring application on pregnancy-related anxiety. MethodsThe study included 77 primiparous pregnant women: 39 in the control group and 38 in the experimental group, and was carried out in an education-research hospital's obstetric clinic. Data for the study were gathered using Information Form, the Pregnancy-related Anxiety Scale, and the State Anxiety Inventory. While the experimental group did mandala coloring during a month twice in a week, and the control group was not do anything. The “Pregnancy-related Anxiety Scale” and “The State Anxiety Inventor” were used to assess anxiety in all groups before and after application. In the statistical analysis of the data, the SPSS 23.0 package program was used. In all tests, p < 0.005 was considered statistically significant. ResultsImmediately post-intervention, the women in the experimental group had a significantly higher reduce pregnancy-related anxiety (p < 0.05). Especially in the mandala group within according to control group were found to have significantly reduced anxiety the application (PrAS-1 82,50 ± 2,47 vs. 84,41 ± 4,12; PrAS-2 77,92 ± 2,16 vs. 83,89 ± 3,80; PrAS-3 72,05 ± 3,97 vs. 84,10 ± 4,35; PrAS-Total 77,49 ± 5,21 vs. 84,13 ± 4,07; STAI-1 52,39 ± 2,50 vs. 51,17 ± 1,16; STAI-2 49,73 ± 0,75 vs. 49,05 ± 1,27; STAI-3 48,84 ± 3,17 vs. 49,02 ± 1,22; STAI-Total 50,32 ± 2,8 vs. 49,75 ± 1,58). ConclusionsMandala coloring is effective in reducing pregnancy-related anxiety.Clinical trial number: (NCT05534867)

Validation of the German version of the pregnancy-related anxiety scale (PrAS): psychometric properties across all trimesters of pregnancy

BackgroundPregnancy-related anxiety has received greater research attention recently given its association with adverse outcomes (e.g., negative birth experiences). The Pregnancy-related Anxiety Scale (PrAS) offers the possibility to assess pregnancy-related anxiety, but no German version is available. Therefore, the aim of this study was to validate a German version of the PrAS, a comprehensive measure with eight dimensions.MethodsPregnant women of any parity or gestation completed an online survey consisting of the PrAS, PRAQ-R2, and measures of anxiety, depression, and resilience. The PrAS was translated into German (PrAS-G) using the back-translation method. Data were subjected to confirmatory factor analysis and inferential statistics.ResultsComplete data were provided by 443 women. Participants were predominantly German nationals, partnered, and well-educated with a planned pregnancy. Approximately half were nulliparous. The eight-factor model was well fitting and consistent with the development of the original PrAS. Criterion-related validity was demonstrated by strong correlations with similar measures (PRAQ-R2, anxiety, and depression) and lower correlations with resilience scores. Predictive validity was shown by group comparisons for: planned versus unplanned pregnancy, trimester, and parity.ConclusionsThe PrAS-G provides a broader assessment of pregnancy-related anxiety than existing measures. Initial evaluation has demonstrated convergent, divergent, and predictive validity, excellent internal consistency, and good model fit indicating promising psychometric properties. The PrAS-G offers a comprehensive assessment of pregnancy-related anxiety which will enable tailored interventions aiming to improve birth experience and well-being of expectant mothers.

An interactive childbirth education platform to improve pregnancy-related anxiety: a randomized trial

Perinatal anxiety is one of the most common conditions during pregnancy and is associated with adverse maternal and neonatal outcomes. Interventions that are focused on childbirth education and health literacy have been shown to help decrease pregnancy-related anxiety. These programs, however, have limitations. Transportation, childcare, and work conflicts pose barriers to patients. In addition, many of these programs have not been studied in high-risk patients, who are most at risk for pregnancy-related anxiety. Thus, it is uncertain whether an online childbirth education course can help to improve outcomes in a high-risk patient population. This study aimed to compare an interactive online platform for childbirth education (Birthly) with usual prenatal education on anxiety, emergency healthcare utilization, and delivery outcomes for high-risk pregnancies. We performed a randomized trial comparing an interactive online childbirth education platform combined with usual prenatal education (intervention) with usual prenatal education alone (usual care). Nulliparous, English-speaking patients with internet access and a high-risk pregnancy (medical or mental health disorders) were included. Patients in 2 urban clinics that serve underresourced patients were enrolled at <20 weeks of gestation. The intervention included 3 interactive courses (prenatal bootcamp, breastfeeding, newborn care) and access to a clinician-moderated online community. Pregnancy-related Anxiety Scale questionnaires were administered at randomization and at 34 to 40 weeks. The primary outcome was third-trimester Pregnancy-related Anxiety Scale score. Secondary outcomes included change in Pregnancy-related Anxiety Scale score, unscheduled emergency visits, delivery, and postpartum outcomes. To demonstrate a 15% decrease in Pregnancy-related Anxiety Scale score, 37 patients would be needed per group. Accounting for a 20% loss to follow-up rate, we planned to recruit 90 total patients or 45 per group. A total of 90 patients were randomized with no differences in demographics or baseline Pregnancy-related Anxiety Scale scores. Most patients self-identified as Black and were publicly insured. More than 60% of patients (62.2%) in the intervention arm completed at least 1 Birthly course. Patients in the intervention arm had significantly lower third-trimester Pregnancy-related Anxiety Scale scores (indicating lower anxiety) compared with those receiving usual care (44.6±7.3 vs 53.9±13.8; P<.01), with a decrease in score of 8.3 points vs 0.7 for usual care (P<.01). Patients in the intervention arm also had fewer emergency visits (1 [0-2] vs 2 [1-3]; P=.003). There were no differences in delivery outcomes. Patients in the intervention arm were more likely to breastfeed at delivery, although this was not different by the postpartum visit. Finally, patients who received the intervention were more likely to be satisfied with their childbirth education (94.6% vs 64.9%; P<.01). An interactive online childbirth education platform can reduce pregnancy-related anxiety and emergency healthcare utilization while improving satisfaction in a high-risk patient population.

Individual and collective contribution of antenatal psychosocial distress conditions and preterm birth in Pakistani women.

We determined whether dimensions of psychosocial distress during pregnancy individually and collectively predicted preterm birth (PTB) in Pakistani women as it may be misleading to extrapolate results from literature predominantly conducted in high-income countries. This cohort study included 1603 women recruited from four Aga Khan Hospital for Women and Children in Sindh, Pakistan. The primary binary outcome of PTB (i.e., livebirth before 37 completed weeks' gestation) was regressed on self-reported symptoms of anxiety (Pregnancy-Related Anxiety (PRA) Scale and Spielberger State-Trait Anxiety Inventory Form Y-1), depression (Edinburgh Perinatal Depression Scale (EPDS)), and covariates such as chronic stress (Perceived Stress Scale) assessed with standardized question and scales with established language equivalency (Sindhi and Urdu). All 1603 births occurred between 24 and 43 completed weeks' gestation. PRA was a stronger predictor of PTB than other types of antenatal psychosocial distress conditions. Chronic stress had no effect on the strength of association between PRA and PTB and a slight but non-significant effect on depression. A planned pregnancy significantly lowered risk of PTB among women who experienced PRA. Aggregate antenatal psychosocial distress did not improve model prediction over PRA. Like studies in high-income countries, PRA became a strong predictor of PTB when considering interactive effects of whether the current pregnancy was planned. Women's resilience and abilities to make sexual and reproductive health decisions are important to integrate in future research. Findings should be generalized with caution as socio-cultural context is a likely effect modifier. We did not consider protective/strength-oriented factors, such as resilience among women.

Alcohol consumption after pregnancy awareness and the additive effect of pregnancy-related anxiety and child abuse

This study examined whether pregnant women alter their alcohol consumption upon pregnancy awareness and any additive effect of a maternal history of child abuse and pregnancy-related anxiety in predicting antenatal alcohol consumption. Pregnant women (N = 548, M = 31.44, SD = 4.58) completed an online survey consisting of the Pregnancy-related Anxiety Scale, Adverse Childhood Experience Questionnaire, questions on alcohol consumption and demographics. The Wilcoxon test examined difference scores between pre-pregnancy awareness and post-awareness drinking. More women reduced or ceased drinking after pregnancy awareness (M = 0.15, SD = 1.03) than before pregnancy recognition (M = 3.12, SD = 3.91). Only two women increased their alcohol consumption, with 140 reporting no change. In the hierarchical regression analysis, child abuse was not significant in the model, whereas pregnancy-related anxiety predicted alcohol consumption, with pre-pregnancy drinking the strongest predictor. There was no significant interaction effect between pregnancy-related anxiety and child abuse. While limited by a cross-sectional design and single questions to assess alcohol intake, our findings are consistent with extant literature. Findings related to child abuse were not significant, and likely due to low prevalence in the sample, Despite this, we further established that pregnancy-related anxiety remains a significant predictor of antenatal drinking regardless of how much alcohol a woman may consume pre-pregnancy. This relationship may be explained by drinking used to cope with pregnancy-related anxieties. While current guidelines recommend alcohol screening, many women may not accurately report their alcohol intake screening for pregnancy-related anxiety may provide an avenue to identify women more at risk of drinking during pregnancy.

An evaluation of the feasibility and acceptability of sister circles as an anxiety intervention for pregnant Black women.

Black women and their infants face heightened health risks during pregnancy, labor, and delivery that, for many, cost them their lives. Such health risks during this critical period are linked to increased rates of anxiety among Black pregnant and postpartum women. Black women also endure racism when seeking support from mental health and healthcare providers, which further contributes to pregnancy and postpartum-related anxiety. Evidence on sister circles has demonstrated that this indigenous form of healing may provide Black pregnant and postpartum women with the support and skills needed to cope with stressors associated with mental and physical health concerns and racism. Our study aimed to evaluate the feasibility and acceptability of the Birthing Beautiful Babies Sisters Offering Support, a sister circle cognitive behavioral therapy-based stress and anxiety intervention for Black pregnant and postpartum women. Our study employed a mixed-methods framework. Descriptive analyses, paired samples t-test, and open and selective coding were conducted. We utilized the following measures: Penn State Worry Questionnaire-Abbreviated, Kessler Psychological Distress Scale, Pregnancy-Related Anxiety Scale, focus booklet, and focus group discussion. Participants reported experiencing moderate levels of worry and distress and low levels of pregnancy-related anxiety prior to the start of the Birthing Beautiful Babies Sisters Offering Support intervention. Eighty women participated in Birthing Beautiful Babies Sisters Offering Support. Eleven focus groups were conducted to assess their experience. Participants reported a perceived increase in their knowledge about panic attacks and stress and ability to manage stressors effectively. They found that all completed activities contributed to their development and application of skills. They reported they enjoyed Birthing Beautiful Babies Sisters Offering Support because of the supportive environment, openness, and emphasis on sisterhood. Participants provided helpful feedback about the structure and flow of the intervention. Limitations of the present study and future directions are discussed.

A randomized trial of an interactive childbirth education platform in a high-risk population

To compare an interactive online platform for childbirth education (Birthly), to usual prenatal education on anxiety, emergency healthcare utilization, and delivery outcomes for high-risk pregnancies. We performed a randomized trial comparing an interactive online childbirth education platform along with usual prenatal education (intervention) to usual prenatal education alone. Nulliparous, English-speaking patients with internet access and a high-risk pregnancy (medical or mental health disorders) were included. Patients in 2 urban clinics that serve under-resourced patients were enrolled at < 20 wks. The intervention included 3 interactive courses (prenatal bootcamp, breastfeeding, newborn care) and access to a clinician-moderated online community. Pregnancy-related Anxiety Scale (PrAS) questionnaires were administered at randomization and at 34-40 wks. The primary outcome was 3rd trimester PrAS score. Secondary outcomes included change in PrAS score, unscheduled emergency visits, delivery and postpartum outcomes 90 patients were randomized with no differences in demographics or baseline PrAS scores (Table 1). The majority of patients self-identified as Black and were publicly insured. Patients in the intervention arm had significantly lower third trimester PrAS scores (indicating lower anxiety) compared to usual care, 44.6 ± 7.3 vs. 53.9 ± 13.8, p< 0.01 (Table 2), with a decrease in PrAS score of 8.3 points (intervention) vs. 0.7 (usual care), p< 0.01. Patients in the intervention arm also had fewer emergency visits (1[0-2] vs. 2[1-3], p=0.003; Table 2). There were no differences in delivery outcomes. Patients in the intervention arm were more likely to breastfeed at delivery, though this was not different by the postpartum visit. Finally, patients who received the intervention were more likely to be satisfied with their childbirth education (94.6% vs. 64.9%, p< 0.01). An interactive online childbirth education platform can reduce pregnancy-related anxiety and emergency healthcare utilization while improving satisfaction in a high-risk patient population.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

The relationship among pregnancy-related anxiety, perceived social support, family function and resilience in Chinese pregnant women: a structural equation modeling analysis

BackgroundAccumulating evidence suggests that pregnancy-related anxiety (PRA) has adverse impacts on maternity health and infant development. A substantial body of literature has documented the important influence of family function, perceived social support and resilience on PRA. However, research identifying the mediating mechanisms underlying this relationship in China are still lacking. Therefore, the current study aimed to investigate the prevalence of PRA under the three-child policy in China, and also explore the interrelationships among perceived social support, family function, resilience, and PRA.MethodsIn this cross-sectional study, a convenient sampling method was used to select 579 pregnant women who underwent prenatal examination at the maternity outpatient departments of the First Affiliated Hospital of Chongqing Medical University in China from December 2021 to April 2022. Participants were required to complete the following questionnaires: the demographic form, the Chinese Pregnancy-related Anxiety scale, the 10-item Connor-Davidson Resilience Scale, the APGAR Family Care Index Scale, and Multidimensional Scale of Perceived Social Support. Pearson correlation analysis was utilized to examine the rudimentary relationship among the study variables. Bootstrapping analyses in the structural equation modeling were applied to identify the significance of indirect effects.ResultsThere were 41.4% of pregnant Chinese women indicating PRA. Correlational analyses indicated that perceived social support, family function and resilience were negatively associated with PRA (r = − 0.47, P < 0.01; r = − 0.43, P < 0.01; r = − 0.37, P < 0.01, respectively). The results of bootstrapping analyses demonstrated significant indirect effects of perceived social support (β = − 0.098, 95% CI [− 0.184, − 0.021]) and family function (β = − 0.049, 95% CI [− 0.103, − 0.011]) on PRA via resilience.ConclusionsChinese pregnant women are suffering from high levels of PRA. Better family function and perceived social support might reduce the occurrence of PRA, as well as by the mediating effects of resilience. Healthcare providers must be concerned about PRA and perform corresponding actions to reduce it. By strengthening social support and improving family function, antenatal care providers could effectively reduce or prevent PRA. And more importantly, implementing resilience-promoting measures are also essential to relieve anxiety and support mental health in pregnant women.

Screening for Pregnancy-Related Anxiety: Evaluation of the Pregnancy-Related Anxiety Scale-Screener Using Rasch Methodology.

Pregnancy-related anxiety has been linked to many maternal and child-related negative outcomes. However, there is an absence of free, well-validated screeners for this condition. The Pregnancy-related Anxiety Scale-Screener (PrAS-Screener) was evaluated using robust Rasch methodology. This study also aimed to develop a shorter version to meet the need of settings governed by professional guidelines stipulating the use of brief instruments. Data from 400 pregnant women (Mage = 27.82, SD = 5.38) were subjected to Rasch analyses and the resulting Rasch models confirmed in a second sample (N = 400, Mage = 26.29, SD = 4.95). After minor modifications, the original 15-item PrAS-Screener demonstrated good fit, unidimensionality, excellent targeting, invariance, and internal consistency. After removal of items with content overlap, an 11-item version was developed, with this version showing good fit, unidimensionality, reasonable targeting, and sound internal consistency. The PrAS-Screeners show promise as psychometrically sound clinical scales for screening pregnancy-related anxiety.

Psychometric analysis of the Edinburgh Postnatal Depression Scale and Pregnancy Related Anxiety Questionnaire in Pakistani pregnant women.

The Edinburgh Postnatal Depression Scale (EPDS) and the Pregnancy-Related Anxiety Scale (PRAQ) are frequently used perinatal mental health scales. To identify the factor structure of the Urdu language versions of EPDS and PRAQ in 280 Pakistani pregnant women. The tools were administered at 12-19 weeks' and 22-29 weeks' gestational age (GA). Exploratory factor analyses were undertaken on data collected at 12-19 weeks' GA, to assess both scales. Results obtained at the second time point were used to examine test-retest reliability. The correlation between the scales was computed. A two-factor model yielded the best fit for both scales, which is consistent with findings from previous studies. For the EPDS, acceptable reliability was attained for the overall score (α=0.77) and for the factor related to depressive symptoms (α=0.73), but not for the factor related to anhedonia/suicide (α=0.64). For the PRAQ, acceptable reliability was attained for the overall score (α=0.83) and for the factor related to pregnancy concerns (α=0.84), but not for the factor related to childbirth (α=0.64). Test-retest reliability was acceptable for both overall scales EPDS: r=0.50; PRAQ: r=0.45; both p<.001). The Pearson correlation between the EPDS and PRAQ were r=0.145, p<.05. Analysis of the tools confirmed a two-factor structure for both depression and anxiety among Pakistani pregnant women. A weak correlation was found between the EPDS and PRAQ. Further research is required to develop screening instruments for perinatal mental disorders that are applicable to cultural contexts.

Psychometric properties of the Pregnancy-Related Anxiety Scale-Screener.

Pregnancy-related anxiety, a distinct anxiety characterized by pregnancy-specific concerns, has consistently been associated with adverse birth outcomes and obstetric and pediatric risk factors. Despite this, widespread screening for pregnancy-related anxiety has not been integrated into routine antenatal care likely due to the absence of a psychometrically sound screener. This study reports on the initial development of a brief screener derived from the 32-item pregnancy-related anxiety scale (PrAS). Three datasets (comprising pregnant women recruited online) were utilized in the development and evaluation of the PrAS screener (PrAS-Screener). Dataset one (N = 1,084) was used to derive two potential screeners from the PrAS using principal axis factoring (PAF). The factor structure of the models was evaluated using PAF and model fit assessed with confirmatory factor analysis (CFA) using datasets two (N = 638) and three (N = 581). The model comprised 15 items and five subscales was selected as the superior model. The selected model (i.e., PrAS-Screener) was evaluated for convergent and discriminant validity demonstrating higher correlations with similar measures and lower correlations with dissimilar measures and high internal consistency reliability (α = .93). The PrAS-Screener assesses the three core areas of pregnancy-related anxiety (childbirth, body image, baby concerns) but has the advantage of also assessing anxiety symptoms and medical staff concerns, an area integral to providing optimal antenatal care through trusted relationships with clinicians. Initial evidence indicates that the PrAS-Screener is promising as a brief and easy-to-administer screener suitable for use in routine antenatal care. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Cognitive behavioral stress management effects on prenatal anxiety among low-income women.

Few studies have tested cognitive behavioral therapy to reduce prenatal anxiety despite substantial empirical support among individuals seeking treatment for anxiety symptoms. We examined whether a brief cognitive behavioral intervention delivered to low-income pregnant women would be efficacious for reducing prenatal anxiety. A sample of 100 primarily ethnic and racial minority pregnant women with subclinical anxiety (74% Latina, 18% Black; Mage = 26.5) were randomized to an 8-week cognitive behavioral stress management (CBSM) intervention (n = 55), or to an attentional control condition (n = 45). Two forms of anxiety (state and pregnancy-specific) were measured at baseline, post-treatment, and at follow-up in the postpartum using the State-Trait Personality Inventory-State and the Pregnancy Related Anxiety scale, respectively. Intent-to-treat (ITT) and completer analyses were conducted using linear mixed models to test mean differences in both forms of anxiety by group assignment and by intervention completion (< 7 vs. ≥ 7 sessions) at post-treatment and follow-up timepoints. ITT results revealed no intervention Group × Time interactions for state, F(3, 356) = .51, p = .68, or pregnancy-specific anxiety, F(2, 184.39) = .75, p = .47, indicating no intervention effect post-treatment or at follow-up. Completer analyses showed that women who received all intervention content (34.5%) had significantly less state anxiety at post-treatment compared to women who had not completed the intervention, (65.5%; Msessions = 3.62); F(6, 270.67) = 2.35, p = .03, and those in the control condition. While we did not find support for the use of CBSM to treat prenatal anxiety among low-income women, those who received a full dose benefited in state anxiety immediately postintervention. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Supplemental Material for Psychometric Properties of the Pregnancy-Related Anxiety Scale—Screener

Supplemental Material for Psychometric Properties of the Pregnancy-Related Anxiety Scale—Screener

Racial Differences in the Risk of Prenatal Depression Among Women Experiencing Childhood and Adult Stressors.

Stress exposure during a woman's own childhood and adulthood likely elevate risk of prenatal depression (PND). However, most PND screening tools fail to assess for events prior to conception. This study examined the differential effects of adverse childhood experiences (ACE) and adult life stressors on PND. This cross-sectional study was conducted among 199 racially diverse pregnant women, ages 18 to 43, recruited from clinics and ongoing university-based studies between 2012 and 2018. The ACE Scale assessed maternal childhood trauma exposure. Validated scales examining subjective stressors assessed for chronic adult stressors. PND was assessed with the Edinburgh Depression Scale, with the Rini Pregnancy-Related Anxiety Scale as a covariate. Associations were measured using multivariable linear regression modeling. Results were stratified by self-identified Black or white race. Among 199 participants, mean age was 26.8years and 67.8% were Black. Controlling for age, race, education, and prenatal anxiety, all participants reporting both childhood trauma and adult stressors were at increased risk for PND (p < 0.0001). PND risk was increased among Black women with childhood stressors (p < 0.01) or three or more adult stressors (p < 0.0001) and among White women following any number of adult stressors (p < 0.001). These findings highlight the importance of cumulative exposure to stress and trauma across the life span as indicators of risk for PND. Black and white participants had differential development of risk, depending on timing and number of exposures. Prenatal depression risk screening during routine prenatal care should include an assessment of current and historical trauma and stressors.

Validation of the Tilburg Pregnancy Distress Scale among pregnant women in Capricorn District, South Africa

ABSTRACT Background:The Tilburg Pregnancy Distress Scale (TPDS) was developed to measure pregnancy-specific psychological distress among pregnant women. Method:The present study evaluated the psychometric properties of the TPDS in a South African location. Analysis was conducted using data obtained from a sample of 205 participants (average age = 27.69 years [SD = 5.977], average gestation weeks = 25.37 weeks [SD = 8.448]; domicile = 63% rural) attending their antenatal check-ups at various medical health facilities in the Capricorn District, Limpopo Province. The analysis involved structural and convergent validation. Results:Fit indices showed that the three-factor, second-order solution fitted the data better. The reliability estimates of the main TPDS factors, partner involvement (PI) and negative affect (NA), were good, and were obviously not influenced by gravidity. The associations of the TPDS factors with the Patient Health Questionnaire (PHQ-4) Depression and Anxiety, the Edinburgh Postnatal Depression Scale (EPDS), and the Pregnancy-Related Anxiety Scale (PRAS) were not generally good. Conclusion:The results suggest that in spite of the TPDS having potential to be used in South Africa, further validation studies are required.