ABSTRACT
OBJECTIVE: To describe the prevalence of anxiety symptoms in early pregnancy and identify predictors of early pregnancy anxiety during the COVID-19 pandemic. MATERIALS AND METHODS: We assessed baseline moderate-to-severe anxiety symptoms after enrollment into the UCSF ASPIRE (Assessing the Safety of Pregnancy in the Coronavirus Pandemic) Prospective Cohort from May 2020 through February 2021. Pregnant persons <10 weeks' gestation completed questions regarding sociodemographic characteristics, obstetric/ medical history, and pandemic-related experiences. Chi-square and multivariate hierarchical logistic regression analyses determined predictors of moderate or severe anxiety symptoms (GAD-7 R10). All analyses performed with Statistical Analysis Software (SAS®) version 9.4. RESULTS: 4,303 persons completed the GAD-7 questionnaire. The mean age of this nationwide sample was 33 years and 25.7% of participants received care through a fertility clinic. 12.6% of pregnant persons reported moderate-to-severe anxiety symptoms. On univariate analysis, less than a college education (p<0.0001), pre-existing history of anxiety (p<0.0001), and history of prior miscarriage (p=0.0143) were predictors of moderate-to-severe anxiety symptoms;care at a fertility center was protective (26.6% vs 25.7%, p= 0.0009). COVID-19 related stressors were strongly predictive of anxiety in pregnancy (p<0.0001). Race/ ethnicity and a prior history of live birth were not predictors of moderate- to-severe anxiety. In the hierarchical logistic regression model, pre-existing history of anxiety remained associated with anxiety during pregnancy. While education was no longer significant, there was a trend towards this being predictive. Hierarchical Logistic regression predicting moderate to severe anxiety symptoms CONCLUSIONS: Pre-existing history of anxiety and low maternal educational attainment likely exacerbated the contribution of stressors due to the COVID-19 pandemic on early pregnancy anxiety. IMPACT STATEMENT: Socioeconomic disparities may exacerbate the contribution of pandemic-related stressors to early pregnancy anxiety risk. With limitations in prenatal care administration during the pandemic, continued emotional health support should remain an important focus for providers.