title: Pregnancy-specific anxiety and its association with background characteristics and health-related behaviors in a low-risk population.
abstract: Pregnancy-specific anxiety is an important risk factor for adverse pregnancy outcomes. It is therefore needed to gain insight in which women are at risk for elevated levels (> 85th percentile) of pregnancy-specific anxiety. Additionally, given that unhealthy behaviour has been suggested as a possible pathway linking pregnancy-specific anxiety to adverse pregnancy outcomes, it is important to examine whether higher levels of pregnancy-specific anxiety are associated with negative health-related behaviours (smoking, alcohol use and too much weight gain).
  
  
  
  Using a study sample of 4541 low-risk pregnant women who filled in the Pregnancy Related Anxiety Questionnaire-Revised (PRAQ-R), we first examined which socio-demographic, pregnancy-related and psychological background characteristics were significantly associated with a PRAQ-R score above the 85th percentile. Secondly, we examined the association between pregnancy-specific anxiety and self-reported health-related behaviours (smoking, alcohol use and too much weight gain) while controlling for significant background characteristics. For both research questions, backward regression analysis was applied.
  
  
  
  Results showed that nulliparity (OR=2.33, 95% confidence interval (CI)=1.97-2.77), anxious or depressed mood (OR=3.29, 95% CI=2.74-3.94) and non-Dutch ethnicity, especially Turkish (OR=3.47, 95% CI=2.16-5.59) or Moroccan (OR=2.97, 95% CI=1.84-4.81), were most strongly associated with elevated pregnancy-specific anxiety levels. Women with higher pregnancy-specific anxiety levels were more likely to gain too much weight during pregnancy (odds ratio (OR) linear term=1.49, 95% CI=1.21-1.83), while both very low and high levels of pregnancy-specific anxiety were associated with smoking (OR linear term=0.13, 95% CI=0.04-0.45, OR quadratic term=1.81, 95% CI=1.32-2.47). No association with alcohol use was found.
  
  
  
  In conclusion, our results show nulliparity, anxious or depressed mood and non-Dutch ethnicity as three major vulnerability factors for elevated levels of pregnancy-specific anxiety. Furthermore, our results show an association between pregnancy-specific anxiety and negative health-related behaviours, which is worth examining in future studies.
authors.affiliation: Department of Midwifery Science, AVAG, Amsterdam Public Health research institute, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, the Netherlands. Electronic address: m.westerneng@vumc.nl.
authors.forename: Myrte
authors.initials: M
authors.lastname: Westerneng
authors.affiliation: Department of Midwifery Science, AVAG, Amsterdam Public Health research institute, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, the Netherlands. Electronic address: a.witteveen@vumc.nl.
authors.forename: Anke B
authors.initials: AB
authors.lastname: Witteveen
authors.affiliation: Department of Midwifery Science, AVAG, Amsterdam Public Health research institute, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, the Netherlands. Electronic address: catja.warmelink@inholland.nl.
authors.forename: J Catja
authors.initials: JC
authors.lastname: Warmelink
authors.affiliation: Department of Midwifery Science, AVAG, Amsterdam Public Health research institute, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, the Netherlands; Rural Health School, Public Health, La Trobe University, Melbourne, Victoria 3086, Australia. Electronic address: e.spelten@latrobe.edu.au.
authors.forename: Evelien
authors.initials: E
authors.lastname: Spelten
authors.affiliation: Department of Psychiatry, Onze Lieve Vrouwe Gasthuis, West, P.O. Box 9243, 1006 AE Amsterdam, the Netherlands; Department of Psychiatry, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, the Netherlands. Electronic address: a.honig@olvg.nl.
authors.forename: Adriaan
authors.initials: A
authors.lastname: Honig
authors.affiliation: Department of Midwifery Science, AVAG, Amsterdam Public Health research institute, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, the Netherlands. Electronic address: pauldc@hotmail.co.uk.
authors.forename: Paul
authors.initials: P
authors.lastname: de Cock
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000523:psychology; D001007:Anxiety / Q000208:ethnology / Q000523:psychology*; D003863:Depression / Q000208:ethnology / Q000523:psychology; D005006:Ethnicity / Q000523:psychology; D005260:Female; D015438:Health Behavior; D006801:Humans; D009018:Morocco / Q000208:ethnology; D009426:Netherlands; D016017:Odds Ratio; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000208:ethnology / Q000523:psychology*; D012307:Risk Factors; D057566:Self Report; D012907:Smoking / Q000523:psychology; D011795:Surveys and Questionnaires; D014421:Turkey / Q000208:ethnology; D015430:Weight Gain