Anxiety symptoms during pregnancy and risk of adverse birth outcomes in Gondar Town Ethiopia

Anxiety is the most common complication of pregnancy and childbirth and is reported to have a plethora of adverse maternal, birth, and childhood outcomes. There is a lack of studies that looked at the association between pregnancy-related anxiety and the risk of adverse birth outcomes in Ethiopia. We conducted a community-based prospective cohort study in Gondar Town to explore the link between anxiety symptoms during pregnancy and the risk of adverse birth outcomes (low birth weight (LBW), preterm, and stillbirth). We used the three questions listed in the Edinburgh Postnatal Depression Scale (EPDS-3 A) to assess the presence of anxiety symptoms during pregnancy. We explored both association and causal effects using modified Poisson regression and the Targeted Maximum Likelihood Estimation (TMLE), respectively. We also calculated the population impacts of risk factors significantly associated with adverse birth outcomes. Of 916 mothers who made up a cohort, 895 completed follow-ups and were included in the final analysis. No evidence of an association was found between anxiety symptoms during pregnancy and: LBW (Adjusted incidence rate ratio (aIRR) = 1.20; 95%CI: 0.49, 2.94), preterm birth (aIRR = 0.77; 95%CI: 0.36, 1.64), and stillbirth (aIRR = 3.29; 95%CI: 0.96, 11.29, p = 0.058). However, other psychosocial factors such as maternal fearful thoughts about delivery and poor stress-coping ability contributed to 34.9% (95% CI: 10.3, 52.7) and 38.3% (95% CI: 12.6, 56.5) of preterm births, respectively. Supportive husbands, on the other hand, averted about 14.7% (95% CI: 5.1, 27.1) of premature births. About 90.0% (95%CI: 82.2, 94.4) and 54.1% (95%CI: 15.0, 75.2) of the risk of LBW was attributed to preterm birth and smoking in pregnancy. There was no evidence of an association between anxiety symptoms during pregnancy and adverse birth outcomes. Other psychosocial factors contributed to or averted adverse birth outcomes. Early screening followed by providing proven psychological interventions is key for reducing individual and population-level impacts of psychosocial risk factors associated with adverse birth outcomes.