Review Article: Anxiety, depression and stress in pregnancy: A multivariate model of intra-partum risks and pregnancy outcomes

Abstract

This study evaluated a multivariate model in which the influence of maternal anxiety, depression and stress on infant postnatal status are seen as mediated by attitudes toward pregnancy, internal vs. external locus of control and perception of available social supports. Ante-partum and intra-partum complications are also included since they are associated with anxiety, depression and stress and have been shown to influence infant postnatal status.A total of 133 pregnant women completed: Beck Depression Inventory; State-Trait Anxiety Inventory; PER1 Life Events Scale; Rotter I-E Scale, Maternal Attitude Toward Pregnancy; Perceived Social Support Inventory. Composite Perinatal Risk Scales, Outcome-Specific Scales, the Nesbitt-Aubry Maternal-Child Health Care Index and Aubry-Pennington Labor Index were scored from medical records.Anxiety, depression and stress in pregnancy, while weakly correlated with outcome, showed expected relationships with mediating factors predicting gestational age, 5-min Apgar and Neonatal Factors scores. Mediating factors with perinatal scores best predicted 1 -min Apgar and Postnatal Complications scores. Results support the notion that these variables work in synergy. The new risk scales produced stronger beta weights than personality, stress and mediator variables and stronger equations than Nesbitt-Aubry or Aubry-Pennington scales. 01 67-482X/87/%03.50 0 1987 Elsevier Science Publishers B.V. (Biomedical Division) J Psychosom Obstet Gynaecol Downloaded from informahealthcare.com by University of Toronto on 01/03/15 For personal use only. J Psychosom Obstet Gynaecol Downloaded from informahealthcare.com by University of Toronto on 01/03/15 For personal use only.

Psychological Disorders in Women with Spontaneous Preterm Delivery

“…Some studies on depression and frequency of preterm delivery did not detect any significant relationship (18,19). Gorsuch et al and Molfese et al found a significant relationship between anxiety and frequency of preterm delivery, while some other researchers (19,20) failed to find such a relationship (20)(21)(22)(23). We found a significant association between anxiety (one of the nine subscales) and preterm delivery.…”

Conceptualizations, measurement, and effects of prenatal maternal stress on birth outcomes

“…Life events, which were assessed using the Psychiatric Epidemiology Research Interview (PERI; Dohrenwend et al, 1978), were those that occurred during the previous year. Molfese et al (1987b) then conducted regression analyses to predict a variety of specific birth outcomes. The anxiety, depression, and life events stress factor (which the authors labeled "personality") was a significant predictor in four of the regression models--those predicting length of second-stage labor, labor and delivery complications, gestational age, and neonatal complications.…”

“…The particular operational definition of stress differs in each study, although the approaches of some are similar. Molfese et al (1987b) conducted a factor analysis of various standardized anxiety, depression, and stress measures in a mostly white, middleto upper-class sample of 103 women of mixed parity and medical risk. They found that a single factor accounted for 60% of the variance in prenatal state anxiety, trait anxiety, depression, and objectively weighted life events scores.…”

“…The ideal in prenatal stress research would be to examine effects of a single underlying latent construct from a variety of measured environmental, perceptual, and response indicators, casting the "wide net" that is advised by methodologists to establish the construct validity of an abstract concept such as stress (Cook and Campbell, 1979;Selltiz et al, 1976; see also Elliott and Eisdorfer, 1982;Wortman, 1982). Several recent studies of prenatal stress effects have come close to this ideal by incorporating multiple indicators of stress into a multidimensional variable (Molfese et al, 1987b;Nethercut and Adler, 1983;Norbeck and Tilden, 1983;Lobel et al, 1992). These studies are highlighted in the literature review below, for their results may be the most valid tests of prenatal stress effects on birth outcomes.…”

Fathers Matter

“…Higher levels of maternal stress have been associated with an increase in the risk of preterm birth and infant death (Hobel, Goldstein, & Barrett, 2008). Additionally, anxiety during pregnancy is linked to adverse birth outcomes (Brooke, Anderson, Bland, Peacock, & Stewart, 1989;Gorsuch & Key, 1974;Molfese et al, 1987) and shorter gestation periods (Rini, Dunkel-Schetter, Wadhwa, & Sandman, 1999). The multiple social factors accompanied by adolescence may lead to maternal stress that is on the causal pathway to infant mortality.…”