More psychologic support needed for pregnant women

Women should be screened for anxiety and depression during pregnancy, say the authors of a Dutch study into psychologic stress and birth outcomes.

The authors found that high levels of anxiety and depression during pregnancy were associated with lower birthweights in the infants of women experiencing moderate work stress, and preterm births in women who were unemployed.

"Addressing the needs of these women at risk (representing almost 30% of the women in our sample) by means of support from public health professionals may enhance the prevention of long-term negative outcomes for both mothers and their offspring," say Eva Loomans (Tilburg University, the Netherlands) and colleagues.

The study included 7740 women who were assessed by questionnaire during their pregnancy for five different measures of psychosocial stress, including depressive symptoms, anxiety, pregnancy-related anxieties, work stress, and parenting stress.

The authors divided the women into five clusters according to their levels of anxiety, depression, and work-related stress. They used the cluster of women characterized as having low depression and anxiety with moderate job strain as a reference group.

They then paired this information with data about their infants' gestational age and birthweight.

The authors found that, after adjusting for confounders, women who reported high levels of depression and anxiety along with moderate job strain had infants with a significantly lower birthweight, by an average of 39 g, than those in the reference group.

Furthermore, women who reported high levels of depression and anxiety but were unemployed had a 40% increased probability of giving birth before 37 weeks' compared with the reference group (8.4 vs 5.7%).

Importantly, the authors found that women who had low levels of anxiety and depression but experienced anxiety around their pregnancy did not have a higher rate of adverse birth outcomes than the reference group. This suggests that pregnancy-related anxiety is distinct from general anxiety, say the authors.

Reporting in the European Journal of Public Health, the authors say that their study design helps to clarify prior inconsistent findings into the relationship between psychosocial stress and birth outcomes, which suffered from the impact of confounding factors.

"Our findings strengthen the argument that pregnant women should be screened for the presence of anxiety and depressive symptoms early in gestation during routine antenatal care."

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