title: Risk factors of transient and persistent anxiety during pregnancy.
abstract: OBJECTIVE
  chronic poor mental health over the course of pregnancy contributes to greater adverse maternal and child outcomes. Identifying women with chronic depressive or anxiety symptoms can provide opportunities to reduce distress and improve pregnancy outcomes. The objective of this study was to determine risk factors of chronic antenatal depressive and anxiety symptoms using a longitudinal pregnancy cohort in Alberta, Canada.
  
  
  METHODS
  women with singleton pregnancies were included (N=3021). Anxiety and depressive symptoms were measured in the second and third trimesters using the Spielberger State-Trait Anxiety Inventory and the Edinburgh Postnatal Depression Scale, respectively. On the basis of the timing and persistence of symptoms, the following three mutually exclusive subgroups for each anxiety and depressive symptoms were created: never symptomatic, symptomatic only in the second trimester, and symptomatic at both time points. Separate logistic regression models were used to derive risk factors for each subgroup.
  
  
  RESULTS
  women with chronic anxiety or depressive symptoms were distinguished from those with transient symptoms or no symptoms by their optimism scores, in which less optimistic pregnant women had a four-fold increased risk for developing chronic depressive or anxiety symptoms compared with more optimistic women (AOR varied from 4.30 to 4.93). Additionally, high perceived stress, low social support, history of mental health issues were common predictors of chronic anxiety and depressive symptoms in pregnancy. Partner tension was the exclusive predictor of anxiety symptoms (AOR varied from 1.94 to 2.31) and poor physical health (AOR 2.54; 95% CI 1.32-4.89), unplanned pregnancy (AOR 3.05; 95% CI 1.61-5.79), and infertility treatments (AOR 4.98; 95% CI 1.85-13.39) were unique predictors of chronic depressive symptoms.
  
  
  CONCLUSIONS
  knowledge of the risk factors of chronic poor mental health during pregnancy might inform the development of effective strategies within the limited resources of health-care systems to target populations with greater needs for interventions.
authors.affiliation: Department of Pediatrics, Faculty of Medicine, University of Calgary, Alberta Centre for Child, Family & Community Research - Child Development Centre, c/o 2888 Shaganappi Trail NW, Calgary, AB, Canada T3B 6A8. Electronic address: hbayramp@ucalgary.ca.
authors.forename: Hamideh
authors.initials: H
authors.lastname: Bayrampour
authors.affiliation: Maternal-Child Health, Research and Innovation, Population, Public, and Aboriginal Health, Alberta Health Services, Southport Atrium, ♯ 2240, 10101 Southport Rd. SW, Calgary, AB, Canada T2W 3N2. Electronic address: Sheila.McDonald@albertahealthservices.ca.
authors.forename: Sheila
authors.initials: S
authors.lastname: McDonald
authors.affiliation: Department of Pediatrics, Faculty of Medicine, University of Calgary, Alberta Centre for Child, Family & Community Research - Child Development Centre, c/o 2888 Shaganappi Trail NW, Calgary, AB, Canada T3B 6A8; Alberta Innovates Health Solutions, Canada. Electronic address: Suzanne.Tough@albertahealthservices.ca.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Tough
mesh_terms: D000328:Adult; D001007:Anxiety / Q000209:etiology*; D002170:Canada; D005260:Female; D006801:Humans; D008603:Mental Health / Q000592:standards*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology*; D015995:Prevalence; D012307:Risk Factors; D012944:Social Support; D011795:Surveys and Questionnaires
keywords: Antenatal mental health; Chronic anxiety; Chronic depression; Risk factors