Association between high levels of comorbid anxiety and depressive symptoms and decreased likelihood of birth without intervention: a longitudinal prospective cohort study: A longitudinal prospective cohort study

Lianne Hulsbosch, Myrthe G.B.M. Boekhorst, P. Lodder, E.S. Potharst, Ivan Nyklíček, Veerle Bergink, S.G. Oei, C.J. Verhoeven, Victor Pop

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Objective: To assess the association between trajectories of comorbid anxiety and depressive (CAD) symptoms assessed in each pregnancy trimester and physiological birth. Design: Large longitudinal prospective cohort study with recruitment between January 2013 and September 2014. Setting: Primary care, in the Netherlands. Population: Dutch-speaking pregnant women with gestational age at birth ≥37 weeks, and without multiple pregnancy, severe psychiatric disorder or chronic disease history. Methods: Pregnancy-specific anxiety and depressive symptoms were measured prospectively in each trimester of pregnancy using the negative affect subscale of the Tilburg Pregnancy Distress Scale and Edinburgh (Postnatal) Depression Scale. Data on physiological birth were obtained from obstetric records. Multivariate growth mixture modelling was performed in MPLUS to determine longitudinal trajectories of CAD symptoms. Multiple logistic regression analysis was used to examine the association between trajectories and physiological birth. Main outcome measures: Trajectories of CAD symptoms and physiological birth. Results: Seven trajectories (classes) of CAD symptoms were identified in 1682 women and subsequently merged into three groups: group 1—persistently low levels of symptoms (reference class 1; 79.0%), group 2—intermittently high levels of symptoms (classes 3, 6 and 7; 11.2%), and group 3—persistently high levels of symptoms (classes 2, 4 and 5; 9.8%). Persistently high levels of CAD symptoms (group 3) were associated with a lower likelihood of physiological birth (odds ratio 0.67, 95% confidence interval 0.47–0.95, P = 0.027) compared with the reference group (persistently low levels of symptoms), after adjusting for confounders. Conclusions: This study is the first showing evidence that persistently high CAD levels, assessed in each pregnancy trimester, are associated with a lower likelihood of physiological birth.
Original languageEnglish
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Early online date3 Aug 2022
Publication statusE-pub ahead of print - 3 Aug 2022


  • anxiety
  • caesarean
  • comorbid anxiety and depression
  • depression
  • forceps
  • instrumental birth
  • multivariate growth mixture modelling
  • physiological birth
  • pregnancy distress
  • trajectories
  • ventouse

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