Anxiety, prenatal distress, and resilience during the first trimester of gestation

Liébana-Presa, Cristina; García-Fernández, Rubén; Martín-Vázquez, Cristian; Martínez-Fernández, María Cristina; Hidalgo-Lopezosa, Pedro

doi:10.1590/1980-220X-REEUSP-2023-0290en

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 58 • 2024 • https://doi.org/10.1590/1980-220X-REEUSP-2023-0290en copy

Anxiety, prenatal distress, and resilience during the first trimester of gestation

Ansiedade, estresse pré-natal e resiliência durante o primeiro trimestre de gestação

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To describe and analyze the relationship between pregnancy-related anxiety, prenatal distress, and individual resilience in pregnant women during the first trimester of pregnancy and compare it with the obstetric variable of parity.

Method:

Quantitative, descriptive, cross-sectional study using non-probabilistic circumstantial sampling. A total of 144 women participated. The Prenatal Distress Questionnaire, the Resilience Scale, and the Pregnancy-Related Anxiety Questionnaire were used. A descriptive analysis with measures of central tendency was performed, and the reliability of the instruments was assessed.

Results:

The average age was 33.57 years. 58.3% were multiparous and 41.7% primiparous. Anxiety was found in 21.5% and very high levels of resilience in 54.9%. Primiparous women showed higher levels of worry about the future and fear of childbirth than multiparous women. Pregnant women with high resilience showed lower levels of anxiety and stress.

Conclusion:

Pregnant women with higher levels of resilience show less anxiety and stress during the first trimester of pregnancy. Primiparous women show more anxiety and stress than multiparous women.

DESCRIPTORS
Pregnancy; Stress, Psychological; Anxiety; Resilience, Psychological

Variable		Mean ± Standard Deviation	n (100%)
Age (years)*		33.57 ± 4.80
	<35		75 (52.8%)
	≥35		68 (47.2%)
Marital status	Married/cohabiting		123 (85.4%)
Marital status	Single/widowed		21 (14.6%)
Nationality	Spanish		130 (90.3%)
Nationality	Other		14 (9.7%)
Area of residence	Rural		41 (28.5%)
Area of residence	Urban		103 (71.5%)
Type of pregnancy	Normal		132 (91.7%)
Type of pregnancy	Assisted Reproduction		12 (8.3%)
Parity	Primiparous		60 (41.7%)
Parity	Multiparous		84 (58.3%)
Abortions	No		105 (72.9%)
Abortions	One or more		39 (27.1%)
Caesareans	No		123 (85.4%)
Caesareans	One or more		21 (14.6%)
Duration of gestation (weeks)*		38.96 ± 2.31
Type of delivery	Euthocic birth		72 (50%)
Type of delivery	Dystocic birth		72 (50%)
Epidural	Yes		104 (72.2%)
Epidural	No		40 (27.8%)
Episiotomy	Yes		27 (18.8%)
Episiotomy	No		117 (81.3%)
Vaginal tearing	Yes		47 (32.9%)
Vaginal tearing	No		96 (67.1%)
Weight of newborn (g)*		3138.89 ± 574.73
Size*		49.24 ± 2.54
Resuscitation	Yes		17 (11.8%)
Resuscitation	No		127 (88.2%)

Variable/ Sub-variable		n (%)	Min	Max	M	SD	α
Prenatal distress	Total	144 (100%)	0	43	18.40	8.40	0.82
	Concern about childbirth	144 (100%)	0	22	10.42	4.37	0.65
	Relationship concerns	144 (100%)	0	8	3.06	2.34	0.81
	Concern about physical symptoms	144 (100%)	0	12	3.01	2.74	0.68
Pregnancy-related anxiety	Total	144 (100%)	20	100	55.95	15.32	0.91
	Anxiety	31 (21.5%)	67	100	77.16	7.72
	Without anxiety	113 (78.5%)	20	66	50.13	11.18
	Concern about changes in oneself	144 (100%)	3	15	6.85	3.29	0.81
	Fear for the baby’s integrity	144 (100%)	7	47	27.42	7.10	0.90
	Feelings about oneself	144 (100%)	3	15	6.89	3.36	0.85
	Fear of childbirth	144 (100%)	4	20	10.36	4.60	0.80
	Concern for the future	144 (100%)	3	15	4.44	2.14	0.75
Resilience	Total	144 (100%)	31	98	80.28	12.64	0.91
	Little	5 (3.4%)	31	47	40.40	6.46
	Normal	9 (6.3%)	54	62	60	2.69
	High	51 (35.4%)	64	81	74.06	4.80
	Very high	79 (54.9%)	82	98	89.13	4.63

Questionnaire / Variables		Primiparous		Multiparous		U	p
Questionnaire / Variables		M	SD	M	SD	U	p
Prenatal distress	Total	18.88	8.18	1805	8.59	2276.5	0.323
	Concern about childbirth	11.15	4.58	9.90	4.18	2038.5	0.050^* Note: M: mean; SD: standard deviation; U: Mann-Whitney U test; : p ≤ 0.05; *: p ≤ 0.001.
	Relationship concerns	2.70	2.02	3.31	2.53	2209	0.203
	Concern about physical symptoms	3.25	2.78	2.85	2.73	2274	0.314
Pregnancy-related anxiety	Total	57.75	16.93	54.67	14.02	2231.5	0.242
	Concern about changes in oneself	6.78	3.13	6.89	3.43	2514.5	0.982
	Fear for the baby’s integrity	26.83	7.48	27.83	6.83	2279.5	0.328
	Feelings about oneself	6.90	3.52	6.88	3.25	2494	0.915
	Fear of childbirth	12.32	4.81	8.96	3.91	1519.5	<0.001^** Note: M: mean; SD: standard deviation; U: Mann-Whitney U test; : p ≤ 0.05; *: p ≤ 0.001.
	Concerns about the future	4.92	2.42	4.10	1.86	1905	0.007^* Note: M: mean; SD: standard deviation; U: Mann-Whitney U test; : p ≤ 0.05; *: p ≤ 0.001.
Resilience	Total	79.82	12.62	80.61	12.72	2385	0.585

Questionnaires/ Variables/ Resilience			M (SD)	Kruskal-Wallis
Questionnaires/ Variables/ Resilience			M (SD)	H	p
Prenatal Stress	Total	Little	25.6 (6.07)	18.40	<0.001^** Note: M: mean; SD: standard deviation; H: Kruskal-Wallis H-test.; : p ≤ 0.05; *: p ≤ 0.001.
		Normal	26.56 (8.89)
		High	20.06 (8.75)
		Very high	15.94 (7.18)
	Concern about childbirth	Little	4.80 (2.05)	11.73	0.008^* Note: M: mean; SD: standard deviation; H: Kruskal-Wallis H-test.; : p ≤ 0.05; *: p ≤ 0.001.
		Normal	8.89 (3.62)
		High	7.67 (3.13)
		Very high	6.22 (3.23)
	Relationship concerns	Little	30.20 (4.76)	7.80	0.050
		Normal	32.33 (4.12)
		High	28.31 (5.75)
		Very high	26.10 (7.92)
	Concern about physical symptoms	Little	9.20 (3.11)	21.18	<0.001^** Note: M: mean; SD: standard deviation; H: Kruskal-Wallis H-test.; : p ≤ 0.05; *: p ≤ 0.001.
		Normal	8.89 (3.82)
		High	7.75 (3.11)
		Very high	5.96 (3.21)
Pregnancy-related anxiety	Total	Little	64.20 (11.58)	19.79	<0.001^** Note: M: mean; SD: standard deviation; H: Kruskal-Wallis H-test.; : p ≤ 0.05; *: p ≤ 0.001.
		Normal	70.11 (12.49)
		High	59.35 (12.68)
		Very high	51.62 (15.82)
	Concern about changes in oneself	Little	4.80 (2.05)	12.82	0.005^* Note: M: mean; SD: standard deviation; H: Kruskal-Wallis H-test.; : p ≤ 0.05; *: p ≤ 0.001.
		Normal	8.89 (3.62)
		High	7.67 (3.13)
		Very high	6.22 (3.23)
	Fear for the baby’s integrity	Little	30.20 (4.76)	8.97	0.030^* Note: M: mean; SD: standard deviation; H: Kruskal-Wallis H-test.; : p ≤ 0.05; *: p ≤ 0.001.
		Normal	32.33 (4.12)
		High	28.31 (5.75)
		Very high	26.10 (7.92)
	Concern about changes in oneself	Little	9.20 (3.11)	17.17	0.001^** Note: M: mean; SD: standard deviation; H: Kruskal-Wallis H-test.; : p ≤ 0.05; *: p ≤ 0.001.
		Normal	8.89 (3.82)
		High	7.75 (3.11)
		Very high	5.96 (3.21)
	Fear of childbirth	Little	14.80 (5.72)	14.98	0.002^* Note: M: mean; SD: standard deviation; H: Kruskal-Wallis H-test.; : p ≤ 0.05; *: p ≤ 0.001.
		Normal	13.56 (3.28)
		High	11.12 (4.72)
		Very high	9.23 (4.21)
	Concerns about the future	Little	5.20 (2.28)	12.12	0.007^* Note: M: mean; SD: standard deviation; H: Kruskal-Wallis H-test.; : p ≤ 0.05; *: p ≤ 0.001.
		Normal	6.44 (3.17)
		High	4.51 (1.69)
		Very high	4.11 (2.16)

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E-mail: reeusp@usp.br

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[1] Corresponding author: Rubén García-Fernández Av. Astorga, s/n, 24401, Ponferrada, León, Spain rgarcf@unileon.es