Association of antenatal anxiety disorders with antenatal comorbidities and adverse pregnancy outcomes among clinic attendees at a tertiary-care hospital in Sri Lanka

Abstract

Purpose: Evidence on the association between antenatal anxiety disorders (AADs) and adverse pregnancy outcomes with detection of AADs using the gold-standard is scarce despite being vital to make decisions on interventions. We aimed to determine this association in women attending tertiary-care antenatal clinics in Sri Lanka. Material and methods: Presence/absence of AADs in a systematic random sample of 221 antenatal women attending routine antenatal clinics of a teaching hospital who participated in a questionnaire-validation study were confirmed by a psychiatrist. These women were followed up until the end of pregnancy. Information on antenatal comorbidities, adverse pregnancy outcomes was extracted from health records. The association between AADs with antenatal comorbidities and adverse pregnancy outcomes were reported using adjusted odds ratios (ORs) and 95%confidence intervals (CIs) generated from logistic regression models. Results: Mean (±SD) age of the women was 30 (±5.8) years. AADs were diagnosed in 81 (37%) women. Compared to women without AADs, those who had AADs were more at risk of pregnancy-induced hypertension (OR 6.1; 95% CI 1.2–31.9), gestational diabetes mellitus (OR 12.6; 95% CI 1.5–107.2), preterm labour (OR 4.3; 95% CI 1.4–13.0), prolonged labour (OR 19.0; 95% CI 7.1–51.1), lower segment caesarean section (OR 4.7; 95% CI 2.5–8.7) and low birthweight (OR 11.2; 95% CI 4.8–26.3). All miscarriages, stillbirths and assisted labour occurred exclusively in those with AADs. Conclusions: AADs are strongly associated with several adverse pregnancy outcomes. Causal pathways and effect of interventions for AADs must be explored in future research.

Keywords

• Antenatal anxiety disorder
• ICD-10
• Pregnancy outcomes
• Sri Lanka