Association between Prenatal Anxiety and Spontaneous Preterm Birth

Preterm delivery is an important determinant of neonatal and infant morbidity and mortality. The effect of psychological factors on preterm delivery is inconsistent. However some studies have shown psychological factors to increase maternal corticotrophin-releasing factor to play preterm delivery. This study was conducted to determine the effect of prenatal anxiety on spontaneous preterm delivery. We conducted a prospective cohort study of 682 women with singleton pregnancies consecutively recruited between 20 and 28 weeks of gestation in Babol health care centers for prenatal care and received regular antenatal care. Women who had history of psychological disease, chronic diseases, pregnancy complications and taking medicine excluded from the study. The assessment of gestational age was based on last menstrual period or ultrasound examination in first half of pregnancy. Anxiety was assessed using self-administered questionnaires: the Spielberger State-Trait Anxiety Inventory. The women were considered as case group with anxiety score >45. Furthermore, these cases were followed up and compared carefully regarding to preterm delivery The mean Spielberger state and trait anxiety in women with preterm delivery were respectively 42.7± 10.8 and 52.9±3.9, but the mean Spielberger state and trait anxiety in women with term delivery were respectively 37.81± 5.71 and 50.68±5.20. A significant association was found between scores for both Spielberger state anxiety and trait anxiety >45 and preterm and low birth weight (LBW) (p<0.0001). For preterm delivery (RR= 3.1, 95% CI = 2.50-4.7) and for LBW (RR= 2.6, 95% CI = 1.6-4.2). There was a statistically significant relationship. These findings provide evidence that antenatal anxiety is significantly associated with spontaneous preterm birth and LBW. Thus, screening for mental and psychological disorders among women in regular prenatal care is recommended.