Factors That Moderate or Mediate Pregnancy Complications in Women with Anxiety and Depression

Abstract

Background: Maternal anxiety and depression is noted in approximately 10-20% of pregnant women and can impact pregnancy and neonatal health, however, little is known about the factors. This study explored the roles of specific risk factors such as age, marital status, stress, substance use and ethnicity as either a moderator or a mediator to better understand the relationship between maternal anxiety or depression and major pregnancy complications and birth outcomes. Methods: A cohort of 646 women were studied longitudinally over three time points in early and late pregnancy and early postpartum. Maternal anxiety and depression were considered primary predictors with pregnancy complications i.e., gestational diabetes, edema and birth outcomes, i.e., low birth weight or preterm birth, as outcome variables. Socio-demographic factors were examined as moderator variables and psychosocial and behavioral factors were considered as mediator variables. For moderating and mediating analyses, a series of logistic regression analyses were performed. Results: Almost one-quarter of the women reported to have two or more pregnancy complications, 5.7% had a pre-term birth and 7.6% had a low birth weight baby. Stress in late pregnancy showed both a partial and a full mediating pathway between maternal anxiety and depression and pregnancy complications such as gestational diabetes, hypertension and edema. History of sexual abuse, single or divorced marital status, younger maternal age and Aboriginal ancestry had moderating effects in early and late pregnancy for adverse pregnancy and birth outcomes (i.e., low birth weight). Conclusion: Identifying mothers with stress, history of abuse, unpartnered, younger and of Indigenous ancestry will help clinicians and policy makers target timely interventions for pregnant women with anxiety and depression symptoms.