Screening antenatal anxiety: Predicting its effect on fetal growth.

Abstract

Maternal anxiety has an association with low birth weight. However, studies are scarce to determine any association between maternal anxiety and fetal growth. This study aims to determine the effect of maternal anxiety on fetal growth, measured by gestational age-dependent increase in fetal abdominal circumference (AC). The secondary objective is to determine the effect of maternal anxiety on other fetal parameters (biparietal diameter [BPD], head circumference [HC], femur length [FL]). This cross-sectional study was conducted in a tertiary care hospital, Kolkata. Four hundred and ten pregnant mothers, between 14 and 40 weeks of gestation, were interviewed with socioeconomic and obstetric profile questionnaire and examined for anthropometric profile and presence and severity of pallor. Anxiety was assessed using Generalized Anxiety Disorder-7 (GAD) questionnaire. HC, AC, BPD, and FL were measured by ultrasound biometry. A multivariable logistic regression analysis was done to determine the predictors of small-for-gestational-age (SGA). A robust mediation analysis was done to determine mediating effect of anxiety on gestational age-dependent increase in fetal AC. Mild (odds ratio [OR]_Adjusted = 6.23, [2.41, 16.15]) and moderate (OR_Adjusted = 22.42, [5.00, 100.57]) anxiety was significantly associated with SGA fetus. Anxiety increased with the progression of gestation (β_GAD: 0.011 [0.007-0.015]) and it had a negative effect on fetal growth (standardized indirect effect of gestational age-mediated by anxiety on AC: -0.037 [-0.059, -0.022]). Anxiety also attenuated gestational age-dependent increment of HC. Mother's anxiety has a gestational age-dependent temporally incremental negative effect on fetal growth and brain development.