While there have been concerns regarding the reproductive safety of psychotropic medications, it must be recognized that withholding or withdrawing pharmacologic treatment for depression or anxiety during pregnancy may not always be the safest option. Untreated psychiatric illness in the mother cannot be considered a benign event, and a number of studies have indicated that depression during pregnancy may negatively affect pregnancy outcomes (reviewed in Bonari 2004).

Several studies have also suggested that maternal anxiety may be associated with negative pregnancy outcomes; however, others have demonstrated no link between anxiety and poor outcomes. A recent study from researchers at the East Carolina University in Greenville, North Carolina suggest that pregnancy-related anxiety – specific worries or concerns related to the pregnancy—is a risk factor for preterm birth.

A total of 1820 women were enrolled after their first prenatal visit, and pregnancy-related anxiety was assessed using six questions from the Prenatal Social Environment Inventory (PSEI). The six items on the PSEI that were used to measure pregnancy-related anxiety asked the women if they experienced worries or concerns about, for example, the health of the baby, labor and delivery, or bleeding or nausea in the current pregnancy. Women received 1 point for each affirmative response to the six items.

Scores on the pregnancy anxiety items ranged from 0 to 6 (median = 2.0). Approximately 28% of the women scored > 4 on the six items, although only 1.8% had a score of 6. After adjusting for other variables that may affect the risk of preterm birth (i.e., first or second trimester bleeding, drug use, employment, prior poor pregnancy outcome, smoking, low body mass index, maternal education, age, and race), it was found that women with higher levels of pregnancy-related anxiety (scores of 5 or 6) were almost three times as likely to have spontaneous preterm birth (birth at <37 weeks of gestation) than women with lower levels of anxiety (scores of < 3).

While anxiety or excessive worrying is not the cause of all cases of preterm birth, these findings suggest that it is an important – and relatively common – risk factor. “If additional research confirms our findings,” the authors comment, “then this might suggest an avenue for intervention to reduce spontaneous preterm birth. Anxiety is a treatable condition.” Providing education and other types of interventions, including relaxation techniques, may help to decrease levels of anxiety and may decrease the risk of preterm delivery.

Ruta Nonacs, MD PhD

Orr ST, Reiter JP, Blazer DG, James SA. Maternal prenatal pregnancy-related anxiety and spontaneous preterm birth in Baltimore, Maryland. Psychosom Med 2007; 69: 566-570.