Anxiety and Depressive simptomatology during pregnancy and in the Post-Partum period

ABSTRACT Beckground: Although prevalence, risk factor for and consequences of postpartum depression have been studied extensively, less is known about anxiety disorders and the connections between depression and anxiety during this period. The link between anxiety during pregnancy and perinatal depression (PND) requires special attention due to the high prevalence of anxiety disorders in the general population and the high rates of comorbidity between anxiety and depression. The aims of this present study are: to evaluate whether antenatal anxiety disorders are a significant predictors of postnatal depression and/or low birth-weight; to evaluate the predictive role of Panic- Agoraphobic (PAS-SR) and Obsessive-Compulsive spectrum (OBS-SR) symptomatology; to examine the psychometric properties of the EPDS and State STAI anxiety scale in patients affected by anxiety disorders, mood disorders or anxiety and mood disorders. Methods: 1066 women between the 12th and the 15th week of gestation were recruited at the Department of Obstetrics and Gynaecology of the Azienda Ospedaliera Universitaria Pisana (Pisa, Italy) in the framework of the Program ‘Perinatal Depression - Research & Screening Unit (PND-ReScU)’; Axis-I disorders were diagnosed with the Structured Clinical Interview for Axis-I Disorders (SCID-I); depressive symptoms were investigated with the Edinburgh Post-natal Depression Scale (EPDS); Anxiety symptoms were assessed by the State-Trait Anxiety Inventory (STAI I-II). Women returned the Self-Report version of the Structured Clinical Interview for Panic-Agoraphobic Spectrum at 6th month of pregnancy, while Self- Report version of the Structured Clinical Interview for Obsessive-Compuilsive Spectrum at 8th month of pregnancy. Results: Women with antenatal anxiety disorders have a significantly increased risk of experiencing PND. Women with current Panic Disorder have strongest risk both for minor Depressive Disorder or Major Depressive Disorder and self-report anxiety symptoms during early postpartum period compared to other anxiety disorders. Conclusion: Interestingly, the measurement of maternal anxiety features through spectrum instruments (i.e. PAS-SR and OBS-SR) seems to provide evidence of being practical in predicting the onset or the recurrence of postnatal depressive disorders. Factor analysis identified symptom profiles that may be clinically relevant for understanding the nature of maternal anxiety and their effects on the developing postpartum depression. Thus, the current findings indicate that anxiety should be a focus of increased attention because it forecasts subsequent illness and may also have a direct effect on the foetus. Examining psychological adjustment to pregnancy and transition to parenthood our results highlight the importance of considering comorbid disorders and suggest that it may be possible to identify a substantial proportion of women who are at risk for developing anxiety and mood disturbances during the postnatal period