Anxiety is a common experience for many women, particularly during the perinatal period – the time spanning pregnancy and the first year after birth.
This phase involves significant physical, emotional, and lifestyle changes that can trigger or exacerbate anxiety symptoms.
Perinatal anxiety affects 15-20% of women and can have profound impacts on maternal well-being, fetal development, and infant outcomes.
It has been linked to increased risks of preterm birth, postnatal depression, and difficulties in infant emotional development.
Despite its prevalence and potential consequences, perinatal anxiety often goes unrecognized and untreated.
Studying perinatal anxiety is crucial to develop effective screening methods, improve early identification of at-risk women, and implement timely interventions to support maternal mental health and promote positive outcomes for both mothers and babies.
Key Points
Rationale
Perinatal anxiety affects 15-20% of women and can have significant impacts on maternal and infant outcomes (Dennis et al., 2017; Fawcett et al., 2019).
However, there is a lack of consensus on whether and how to screen for perinatal anxiety (Chaudron & Wisner, 2014; Thombs et al., 2017).
Key questions remain about the optimal timing of screening and which questionnaires are most effective.
It also sought to examine the stability and change in perinatal anxiety over time. Providing evidence on these issues is crucial to inform clinical practice, policy, and further research on perinatal mental health screening and care.
Method
The study used a prospective longitudinal cohort design with 2243 women completing questionnaires at four timepoints: early pregnancy (11 weeks), mid-pregnancy (23 weeks), late pregnancy (32 weeks), and postnatally (8 weeks). A subsample of 403 participants also completed diagnostic interviews.
Procedure
Participants completed five anxiety/mental health questionnaires at each timepoint. A subsample underwent diagnostic interviews using the Mini International Neuropsychiatric Interview (MINI) to establish the presence of anxiety disorders.
Sample
The sample was representative of the general UK population in terms of ethnicity, age, and relationship status, but more highly educated.
The majority were white British, educated to degree level or above, and married or cohabiting.
Measures
Results
Insight
This study provides crucial evidence that early pregnancy (around 11 weeks) is the optimal time to screen for perinatal anxiety.
This finding was consistent across all questionnaires examined and for both identifying anxiety disorders and women wanting treatment.
The results suggest that implementing anxiety screening in early pregnancy could help identify women who need support earlier, potentially improving outcomes.
The finding that anxiety symptoms were highest in early pregnancy adds to the literature on the course of perinatal anxiety, though individual variation was observed.
The association between late pregnancy/postnatal screening and receiving treatment highlights potential delays in referral or access to treatment, emphasizing the need for timely follow-up after early screening.
Strengths
This study had several methodological strengths, including:
Limitations
This study also had several methodological limitations, including:
Implications
The findings have clear implications for clinical practice and policy. They support implementing anxiety screening in early pregnancy, around 11 weeks gestation, which often coincides with initial maternity care appointments in many countries.
This consistency across questionnaires simplifies implementation, as services can continue using their current screening tools but ensure they are administered early.
The study highlights the need for timely follow-up and referral after early screening to address the observed delay between screening and treatment.
Future research should examine the effectiveness of early pregnancy screening as part of a comprehensive care pathway for perinatal anxiety.
References
Primary reference
Ayers, S., Sinesi, A., Coates, R., Cheyne, H., Maxwell, M., Best, C., . McNicol, S., Williams, L. R., Uddin, N., Shakespeare, J., Alderdice, F., & MAP Study Team. (2024). When is the best time to screen for perinatal anxiety? A longitudinal cohort study.Journal of Anxiety Disorders,103, 102841.https://doi.org/10.1016/j.janxdis.2024.102841
Other references
Dennis, C. L., Falah-Hassani, K., & Shiri, R. (2017). Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis.The British Journal of Psychiatry,210(5), 315-323.
Fawcett, E. J., Fairbrother, N., Cox, M. L., White, I. R., & Fawcett, J. M. (2019). The prevalence of anxiety disorders during pregnancy and the postpartum period: a multivariate Bayesian meta-analysis.The Journal of clinical psychiatry,80(4), 1181.
Thombs, B. D., Saadat, N., Riehm, K. E., et al. (2017). Consistency and sources of divergence in recommendations on screening with questionnaires for presently experienced health problems or symptoms: a comparison of recommendations from the Canadian Task Force on Preventive Health Care, UK National Screening Committee, and US Preventive Services Task Force.BMC Medicine, 15, 150.https://doi.org/10.1186/s12916-017-0903-8
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Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
