Anxiety trajectories from pregnancy to one-year postpartum and their contributors during the COVID-19 pandemic

ABSTRACT

Background

Anxiety in the peripartum period (pregnancy through one-year postpartum) has negative impacts on mothers and infants. During the COVID-19 pandemic, high rates of anxiety were reported worldwide, but trajectories for how these symptoms change longitudinally in the peripartum period remain unknown.

Methods

A total of 1,411 women who were pregnant during the second U.S. COVID-19 surge completed four study questionnaires between December 2020 and March 2022, including assessments of anxiety symptoms (GAD-7) and individual and community-level contributors. Latent Class Growth Mixture Models (LCGMM) were used to identify anxiety trajectories, and multinomial logistic regression was used to identify contributors to class membership.

Results

Three classes of anxiety symptom trajectories were identified. Class 1 (n = 956, 67.8%) experienced minimal/mild anxiety throughout the peripartum period. Class 2 (n = 362, 25.7%) experienced initial moderate anxiety that remained stable. Class 3 (n = 93, 6.6%) experienced initial moderate anxiety that increased to severe in the postpartum period. Stress and history of mental health diagnosis contributed to higher initial levels of anxiety and ongoing social support contributed to lower levels of anxiety. In addition, financial insecurity increased the risk of belonging to Class 3.

Conclusions

Screening for anxiety symptoms and psychosocial vulnerabilities in the peripartum period is vital, as is early intervention. This is especially the case among women with limited financial and social resources who may experience chronic or worsening anxiety as they transition to parenthood.

KEYWORDS:

• Peripartum anxiety
• psychosocial vulnerability
• COVID-19 pandemic
• latent class mixture models
• risk and resilience

Acknowledgments

We would like to thank the thousands of women who continuously shared their experiences of giving birth and being a mother during the COVID-19 pandemic. We would also like to thank Yuhang Liu who assisted in the visualisation of the findings. Brittain Mahaffey received support from National Institute of Child Health and Human Development of the National Institutes of Health, Grant K23HD092888 during preparation of this article.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets analysed during the current study are not publicly available to ensure the privacy of research participants but are available from the corresponding author on reasonable request.

Geolocation Information

40.915236835731, -73.122478554817

Additional information

Funding

This study was funded by a Stony Brook University Office of the Vice President for Research and Institute for Engineering-Driven Medicine COVID-19 Seed Grant; and by the National Institutes of Health Office of the Director Urgent Competitive Revision under grant number R21DA049827. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.