Prevalence of pregnancy anxiety and associated factors Girija Kalayil Madhavanprabhakaran a,⇑ , Melba Sheila D’Souza b , Karkada Subrahmanya Nairy c a Maternal and Child Health Nursing, College of Nursing, Sultan Qaboos University, P.O. Box 66, Alkhod, Muscat, Oman b Adult Health and Critical Care, College of Nursing, Sultan Qaboos University, Oman c Department of Business Studies, Higher College of Technology, Al Khuwair, Muscat, Oman article info Article history: Received 7 December 2014 Received in revised form 8 May 2015 Accepted 26 June 2015 Available online 3 July 2015 Keywords: Pregnancy-specific anxiety Childbirth anxiety Fear of childbirth Pregnancy anxiety Nulliparous women abstract Objective: To determine the prevalence of pregnancy-specific anxiety (PSA) and its associated factors among pregnant women during the three trimesters of pregnancy. Design: A prospective explorative survey was conducted among 500 low-risk Indian pregnant women of age 18–35 years. Setting: A major maternity government hospital in southern state of Kerala, India. Participants: 500 low risk pregnant women who attended the major maternity government hospital dur- ing the period June 2004–July 2005 were selected as convenient sample. Methods: An exploratory research design with a prospective cohort approach was adopted for the study. State Trait Anxiety Inventory (STAI) and Pregnancy-Specific Anxiety Inventory (PSAI) were used to collect the data. Results: Highest prevalence of pregnancy-specific anxiety (PSA) was reported during the third trimester of pregnancy. All pregnant women rated high levels of third trimester childbirth anxiety compared to other three components of pregnancy-specific anxiety. Nulliparous pregnant women reported higher levels of PSA than parous pregnant women (M = 134.40, M = 116.8). Young age, nulliparous status and nuclear family nature were identified as common risk factors of pregnancy-specific anxiety. Conclusion: During the transition to motherhood, the risk factors and timing of heightened pregnancy-specific anxiety differ. Higher prevalence of pregnancy anxiety among nulliparous and younger pregnant women necessitates an integrated routine screening of PSA during prenatal care. Early detection, prevention and management of pregnancy anxiety will enable women to cope with the challenges of pregnancy. Ó 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). 1. Introduction Pregnancy is not only a period of great joy, but also one of great stress to a woman both physically and mentally. Even in healthy women, pregnancy may give rise to many anxieties because of anticipated uncertainty associated with it. Evidences show that pregnancy anxiety not only affects pregnant women’s health but also have an impact on labour outcomes such as preterm delivery, prolonged labour, caesarean birth, low birth weight (Catov, Abatemarco, Markovic, & Roberts, 2010; Hernandez-Martinez, Val, Murphy, Busquets, & Sans, 2011; Lobel et al., 2008; Rauchfuss & Maier, 2011). Findings of Lee et al. (2007) and Teixeira, Figueiredo, Conde, Pacheco, and Costa (2009) revealed a varied prevalence of pregnancy anxiety at different trimesters of pregnancy with high levels in first and third trimesters. Previous studies on pregnancy anxiety from different part of the world reported a high and diverse prevalence rate of 14–54%. However, most of these studies explored general pregnancy anxi- ety than pregnancy-specific anxiety (García Rico, Rodríguez, Díez, & Real, 2010; Hernandez-Martinez et al., 2011; Nieminen, Stephansson, & Ryding, 2009; Teixeira et al., 2009). Pregnancy-specific anxiety is defined as worries, concerns and fears about pregnancy, childbirth, and health of infant and future parenting (Huizink, Mulder, Robles de Medina, Visser, & Buitelaar, 2004). Serçekus ß and Okumus ß (2009) reported that nulli- parous women’s childbirth fears were related to labour pain, birth-related problems and procedures. Previous researches on pregnancy anxiety concluded that pregnancy-specific anxieties are the real predictors of adverse labour outcomes than general anxiety. These researchers http://dx.doi.org/10.1016/j.ijans.2015.06.002 2214-1391/Ó 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). ⇑ Corresponding author. Tel.: +968 2414(5411), GSM: +968 92797342 (O); fax: +968 2441 3536. E-mail addresses: girija@squ.edu.om, km_girija@yahoo.com (G.K. Madhavan- prabhakaran), melba123@rediffmail.com (M.S. D’Souza), ksnairy@gmail.com (K.S. Nairy). 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