Anxiety often results in the activation of the sympathetic nervous system. This activation is commonly known as the “fight or flight response”; symptoms may include increased heart rate, shortness of breath, perspiration, chest pain, and nausea or diarrhea. Activation of the fight or flight response is also associated with the activation of numerous other responses in the body, including the production of various stress hormones, including cortisol.
Various studies suggest that stress or anxiety may be associated with adverse birth outcomes, such as preterm birth and small for gestational age infants. Little is known about the effect that specific anxiety disorders (versus “every day” stress or anxiety) may have on birth outcomes.
Approximately 30% of women experience some type of anxiety disorder during their lifetime; these disorders tend to cluster during the childbearing years. The lifetime prevalence rate for panic disorder is 2.7%; rates ranging between 1.3% and 2.5% have been documented in pregnant and postpartum women.
In a recent paper, Chen and colleagues sought to examine pregnancy outcomes among women with panic disorder, especially those women who experienced panic attacks during pregnancy. These researchers studied the medical records of 371 women who had a diagnosis of panic disorder in the two years prior to pregnancy. Outcomes were compared to a control group of 1585 women who delivered a baby around the same time but who did not have a diagnosis of panic disorder, any other psychiatric illness, or a chronic disease. Women were identified using the National Health Insurance Research Dataset and the Taiwanese birth certificate registry.
For the analyses, women with a diagnosis of panic disorder were separated into two groups: those who were treated in the emergency room for a panic attack during pregnancy and those who were not. Other variables that could impact birth outcomes (such as age of the mother, educational level of the parents, gender of the infant and socioeconomic status) were controlled for.
Results from the study indicated that mothers with panic disorder were 1.56 times more likely to deliver a infant who was small for gestational age than women without panic disorder; the odds of having a small for gestational age infant was slightly less (1.45 times) for women with panic disorder who were not treated for a panic attack in the emergency room during pregnancy. Among women with panic disorder, those women who were treated in the emergency room for a panic attack were 2.54 times more likely to experience preterm birth and 2.29 times more likely to have a small for gestational age infant than mothers with panic disorder who were not treated in the emergency room for a panic attack. No differences between the groups were detected for low birth weight, and analyses for preeclampsia were not conducted due to a small number of cases.
While this study suggests that women with panic disorder are at greater risk for certain adverse birth outcomes, including having a preterm delivery and an infant smaller for gestational age, there are some notable limitations. First, it is possible that some women experienced panic attacks and did not present to the emergency room for treatment, or that women who went to the emergency room for their panic attacks had more severe panic disorder than those who did not. In addition, Chen and colleagues were not able to control for the use of psychotropic medications during pregnancy, nor were they able to control other factors which may have affected birth outcomes, including nutritional habits or smoking. Lastly, only women with panic disorder listed as a primary diagnosis were included in the analyses, which may have resulted in the omission of some women with panic disorder.
In sum, this study contributes to our understanding of the association between panic disorder and adverse birth outcomes. The findings suggest that panic symptoms may affect birth outcomes and thus women should be screened for panic disorder during pregnancy. These women should review the data on the efficacy, safety and side effects of treatments (including psychotherapy, psychotropic medications, and lifestyle changes) for panic disorder with their health care providers.
Christina Psaros, Ph.D.
Chen Y, Herng-Ching L, Hsin-Chien L. Pregnancy outcomes among women with panic disorder – Do panic attacks during pregnancy matter? J Affect Disord (2009).
Bandelow B et al. Panic disorder during pregnancy and the postpartum period. European Psychiatry (2006) 21: 495-500.
Bánhidy et al. Association between maternal panic disorders and pregnancy complications and delivery outcomes. European Journal of Obstetrics, Gynecology, and Reproductive Biology (2006) 124: 47-52.