American Journal of Epidemiology Vol. 155, No. 4 : 293-301
Copyright © 2002 by The Johns Hopkins University School of Hygiene and Public Health
ORIGINAL CONTRIBUTIONS |
Role of Anxiety and Depression in the Onset of Spontaneous Preterm Labor
1 Service de Psychiatrie de l'Enfant et de l'Adolescent, CHU Clemenceau, Caen, France.
2 Laboratoire d'Informatique Médicale et Épidémiologie, CHU Clemenceau, Caen, France.
3 Clinique de Gynécologie-Obstétrique et de la Reproduction Humaine, CHU Clemenceau, Caen, France.
The aim of this cohort study conducted in France in 1997–1998 was to investigate the effects of antenatal anxiety and depression on spontaneous preterm labor. A consecutive series of 634 pregnant women with singleton pregnancies was included. Anxiety and depression were assessed using self-administered questionnaires: Spielberger's State-Trait Anxiety Inventory and the Edinburgh depression scale. Depression scores were dichotomized with a cutoff value suggestive of major depression. The 75th percentile was used for anxiety scores. A logistic regression analysis, controlling for sociodemographic and biomedical factors and including interaction terms, revealed that depression was positively associated with the outcome among underweight women, defined as women with a prepregnancy body mass index below 19 (adjusted odds ratio (OR) = 6.9, 95% confidence interval (CI): 1.8, 26.2). A similar result was observed for trait anxiety in women with a history of preterm labor (adjusted OR = 4.8, 95% CI: 1.1, 20.4). The association was close to significance for state anxiety in women with vaginal bleeding (adjusted OR = 3.6, 95% CI: 0.9, 14.7). These findings show that anxiety and depression, when combined with specific biomedical factors, are associated with spontaneous preterm labor. A synergic action of psychological and biomedical factors on the secretion of placental corticotropin-releasing factor is hypothesized.
anxiety; body mass index; corticotropin-releasing hormone; depression; labor, premature; pregnancy; risk factors
Abbreviations: CI, confidence interval; OR, odds ratio; SD, standard deviation
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