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


METHODS
Participants 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.


RESULTS
Trait 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.


CONCLUSIONS
This 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.
Domain of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway. mavo@fhi.no.|Psychological Institute, University of Oslo, Oslo, Norway. mavo@fhi.no.
Margarete Erika
ME
Vollrath
Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Verena
V
Sengpiel
University Children's Hospital Zurich, Zurich, Switzerland.|Department of Child and Adolescent Health Psychology, Institute of Psychology, University of Zurich, Zurich, Switzerland.
Markus A
MA
Landolt
Department of Obstetrics and Gynaecology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.|Department of Genes and Environment, Norwegian Institute of Public Health, Oslo, Norway.
Bo
B
Jacobsson
Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland.
Beatrice
B
Latal
Anxiety; Longitudinal; Mental health; Personality; Pregnancy; Preterm; Prospective; Women
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