Antenatal anxiety in the first trimester: Risk factors and effects on anxiety and depression in the third trimester and 6-week postpartum


Objective: Anxiety is common among pregnant women. However, research attention in the area of reproductive mental health has mainly focused on postpartum depression in past decades. Given adverse outcomes of antenatal anxiety, there is an urgent need to fill the research gaps. The objectives of the present study were to determine the prevalence of antenatal anxiety symptoms and examine the risk factors and effects of anxiety symptoms in early pregnancy on anxiety and depressive symptoms in later pregnancy and early postpartum period. Methodology: A prospective longitudinal design with quantitative approach was adopted. A consecutive sample of 1470 Chinese pregnant women from hospitals in Hong Kong was invited to participate in the study and was assessed using standardized instruments on 3 time points including first and third trimesters of pregnancy and 6-week postpartum. Results: The results showed that 17.7% of pregnant women manifested anxiety symptoms in the first trimester of pregnancy. Single mothers, younger mothers, mothers who smoked before pregnancy and mothers who received low education level reported significantly higher levels of anxiety symptoms in the first trimester. Unwanted pregnancy, low self esteem, low marital satisfaction and perceived low social support were significant psychosocial risk factors for anxiety symptoms in the first trimester. Anxiety symptoms in the first trimester were independent predictors for anxiety symptoms in the third trimester ( QUOTE β = 0.26, t = 5.74, p < 0.001), however anxiety symptoms in the first trimester no longer significantly predicted anxiety and depressive symptoms in 6 weeks postpartum after adjusting for the effects of potential confounders. Discussions: The present study points to the need for greater research and clinical attention to antenatal anxiety given that antenatal anxiety is a prevalent problem and has serious impacts on maternal well-being. Such findings also contribute to the understanding of maternal anxiety and have implications for the design of effective identification, prevention and treatment of these significant clinical problems

Share and Cite:

Chan, C. , Lee, A. , Lam, S. , Lee, C. , Leung, K. , Koh, Y. and Tang, C. (2013) Antenatal anxiety in the first trimester: Risk factors and effects on anxiety and depression in the third trimester and 6-week postpartum. Open Journal of Psychiatry, 3, 301-310. doi: 10.4236/ojpsych.2013.33030.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Kessler, R., Keller, M. and Wittchen, H. (2001) The epidemiology of generalized anxiety disorder. Psychiatric Clinics of North America, 24, 19-39. doi:10.1016/S0193-953X(05)70204-5
[2] Grant, K., McMahon, C. and Austin, M. (2008) Maternal anxiety during the transition the transition to parenthood: A prospective study. Journal of Affective Disorders, 108, 101-111. doi:10.1016/j.jad.2007.10.002
[3] Faisal-Cury, A. and Rossi Menezes, P. (2007) Prevalence of anxiety and depression during pregnancy in a private setting sample. Archives of Women’s Mental Health, 10, 25-32. doi:10.1007/s00737-006-0164-6
[4] Lee, A.M., Lam, S.K., Sze Mun Lau, S.M., Chong, C.S.Y., Chui, H.W. and Fong, D.Y.T. (2007) Prevalence, course, and risk factors for antenatal anxiety and depression. Obstetrics & Gynecology, 110, 1102. doi:10.1097/01.AOG.0000287065.59491.70
[5] Kelly, R.H., Russo, J. and Katon, W. (2001) Somatic complaints among pregnant women cared for in obstetrics: Normal pregnancy or depressive and anxiety symptom amplification revisited? General Hospital Psychiatry, 23, 107-113. doi:10.1016/S0163-8343(01)00129-3
[6] Laursen, M., Johansen, C. and Hedegaard, M. (2009) Fear of childbirth and risk for birth complications in nulliparous women in the Danish National Birth Cohort. BJOG, 116, 1350-1355. doi:10.1111/j.1471-0528.2009.02250.x
[7] DiPietro, J.A., Hilton, S.C., Hawkins, M., Costigan, K.A. and Pressman, E.K. (2002) Maternal stress and affect influence fetal neurobehavioral development. Developmental Psychology, 38, 659. doi:10.1037/0012-1649.38.5.659
[8] Austin, M.P., Tully, L. and Parker, G. (2007) Examining the relationship between antenatal anxiety and postnatal depression. Journal of Affective Disorders, 101, 169-174. doi:10.1016/j.jad.2006.11.015
[9] Brouwers, E., van Baar, A. and Pop, V. (2001) Maternal anxiety during pregnancy and subsequent infant development. Infant Behavior and Development, 24, 95-106. doi:10.1016/S0163-6383(01)00062-5
[10] Heron, J., O’Connor, T., Evans, J., Golding, J. and Glover, V. (2004) The course of anxiety and depression through pregnancy and the postpartum in a community sample. Journal of Affective Disorders, 80, 65-73. doi:10.1016/j.jad.2003.08.004
[11] Zigmond, A.S. and Snaith, R.P. (1983) The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361-370. doi:10.1111/j.1600-0447.1983.tb09716.x
[12] Snaith, R.P. (2003) The hospital anxiety and depression scale. Health and Quality of Life Outcomes, 1, 29. doi:10.1186/1477-7525-1-29
[13] Leung, C., Ho, S., Kan, C. and Hung, C. (1993) Evaluation of the Chinese version of the Hospital Anxiety and Depression Scale: A cross-cultural perspective. International Journal of Psychosomatics, 40, 29-34.
[14] Abiodun, O. (1994) A validity study of the Hospital Anxiety and Depression Scale in general hospital units and a community sample in Nigeria. The British Journal of Psychiatry, 165, 669-672. doi:10.1192/bjp.165.5.669
[15] Cox, J.L., Holden, J. and Sagovsky, R. (1987) Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. The British Journal of Psychiatry, 150, 782-786. doi:10.1192/bjp.150.6.782
[16] Murray, D. and Cox, J.L. (1990) Screening for depression during pregnancy with the Edinburgh Depression Scale (EPDS) Journal of Reproductive and Infant Psychology, 8, 99-107. doi:10.1080/02646839008403615
[17] Bowen, A., Stewart, N., Baetz, M. and Muhajarine, N. (2009) Antenatal depression in socially high-risk women in Canada. Journal of Epidemiology and Community Health, 63, 414-416. doi:10.1136/jech.2008.078832
[18] Lee, D., Yip, S., Chiu, H., Leung, T., Chan, K., Chau I., et al. (1998) Detecting postnatal depression in Chinese women. Validation of the Chinese version of the Edinburgh Postnatal Depression Scale. The British Journal of Psychiatry, 172, 433-437. doi:10.1192/bjp.172.5.433
[19] Rosenberg, M. (1965) The measurement of self-esteem. Society and the Adolescent Self Image, 297-307.
[20] Blascovich, J. and Tomaka, J. (1991) Measures of selfesteem. Measures of Personality and Social Psychological Attitudes, 1, 115-160.
[21] Schumm, W.R., Crock, R.J., Likcani, A., Akagi, C.G. and Bosch, K.R. (2008) Reliability and validity of the Kansas Marital Satisfaction Scale with different response formats in a recent sample of US Army personnel. Individual Differences Research, 6, 26-37.
[22] Shek, D.T. and Tsang, S.K. (1993) The Chinese version of the Kansas Marital Satisfaction Scale: Some psychometric and normative data. Social Behavior and Personality: An International Journal, 21, 205-214.
[23] Schumm, W.R., Scanlon, E.D., Crow, C.L., Green, D.M. and Buckler, D.L. (1983) Characteristics of the Kansas Marital Satisfaction Scale in a sample of 79 married couples. Psychological Reports, 53, 583-588. doi:10.2466/pr0.1983.53.2.583
[24] Yu, D.S., Lee, D.T. and Woo, J. (2004) Psychometric testing of the Chinese version of the medical outcomes study social support survey (MOS-SSS-C) Research in Nursing & Health, 27, 135-143. doi:10.1002/nur.20008
[25] Teixeira, C., Figueiredo, B., Conde, A., Pacheco, A. and Costa, R. (2009) Anxiety and depression during pregnancy in women and men. Journal of Affective Disorders, 119, 142-148. doi:10.1016/j.jad.2009.03.005
[26] Andersson, L., Sundstr?m-Poromaa, I., Wulff, M., ?str?m, M. and Bixo, M. (2006) Depression and anxiety during pregnancy and six months postpartum: A follow-up study. Acta Obstetricia et Gynecologica Scandinavica, 85, 937-944. doi:10.1080/00016340600697652
[27] Gondoli, D.M. and Silverberg, S.B. (1997) Maternal emotional distress and diminished responsiveness: The mediating role of parenting efficacy and parental perspective taking. Developmental Psychology, 33, 861. doi:10.1037/0012-1649.33.5.861
[28] Glassman, A.H., Helzer, J.E., Covey, L.S., Cottler, L.B., Stetner, F., Tipp, J.E., et al. (1990) Smoking, smoking cessation, and major depression. JAMA: The Journal of the American Medical Association, 264, 1546-1549. doi:10.1001/jama.1990.03450120058029
[29] Breslau, N., Kilbey, M.M. and Andreski, P. (1991) Nicotine dependence, major depression, and anxiety in young adults. Archives of General Psychiatry, 48, 1069. doi:10.1001/archpsyc. 1991.01810360033005
[30] Bowen, A. and Muhajarine, N. (2006) Antenatal depression. Can Nurse, 102, 26-30.
[31] Littleton, H.L., Breitkopf, C.R. and Berenson, A.B. (2007) Correlates of anxiety symptoms during pregnancy and association with perinatal outcomes: A meta-analysis. American Journal of Obstetrics and Gynecology, 196, 424-432. doi:10.1016/j.ajog.2007.03.042
[32] Scottish Intercollegiate Guidelines Network (2002) Postnatal depression and puerperal psychosis. A national clinical guideline. SIGN Executive, Edinburgh.
[33] Kahn, J., Hessling, R. and Russell, D. (2003) Social support, health, and well-being among the elderly: What is the role of negative affectivity? Personality and Individual Differences, 35, 5-17. doi:10.1016/S0191-8869(02)00135-6
[34] Sayal, K., Checkley, S., Rees, M., Jacobs, C., Harris, T., Papadopoulos, A., et al. (2002) Effects of social support during weekend leave on cortisol and depression ratings: a pilot study. Journal of Affective Disorders, 71, 153-157. doi:10.1016/S0165-0327(01)00414-1
[35] Kearns, B., Neuwelt, C., Patricia, M., Hitchman, M. and Lennan, B. (1997) Social support and psychological distress before and after childbirth. Health & Social Care in the Community, 5, 296-308. doi:10.1111/j.1365-2524.1997.tb00126.x
[36] Huizink, A.C., Mulder, E.J.H., Robles de Medina, P.G., Visser, G.H.A. and Buitelaar, J.K. (2004) Is pregnancy anxiety a distinctive syndrome? Early Human Development, 79, 81-91. doi:10.1016/j.earlhumdev.2004.04.014
[37] Van den Bergh, B.R.H. and Marcoen, A. (2004) High antenatal maternal anxiety is related to ADHD symptoms, externalizing problems, and anxiety in 8-and 9-year-old. Child Development, 75, 1085-1097. doi:10.1111/j.1467-8624.2004.00727.x
[38] Borri, C., Mauri, M., Oppo, A., Banti, S., Rambelli, C., Ramacciotti, D., et al. (2008) Axis I psychopathology and functional impairment at the third month of pregnancy: Results from the Perinatal Depression-Research and Screening Unit (PND-ReScU) study. The Journal of Clinical Psychiatry, 69, 1617. doi:10.4088/JCP.v69n1012
[39] de Girolamo, G., Polidori, G., Morosini, P., Scarpino, V., Reda, V., Serra, G., et al. (2006) Prevalence of common mental disorders in Italy. Social Psychiatry and Psychiatric Epidemiology, 41, 853-861. doi:10.1007/s00127-006-0097-4

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.