Generalized anxiety disorder: Course and risk factors in pregnancy

Background: There are limited studies of generalized anxiety disorder (GAD) across pregnancy. Methods: Women (n = 2793) were enrolled in the Yale Pink and Blue study, a cohort enriched with subjects who suffered from major depressive disorder (MDD) within the past five years or used antidepressants in the past year. Subjects were evaluated with the Composite International Diagnostic Interview at three time points: twice in pregnancy and once after delivery. We defined a generalized anxiety disorder (GAD) episode as per DSM IV but with required duration reduced to one month or longer. Course and correlates of GAD were examined in women who had: 1) no GAD during the 6 months prior or in pregnancy (Group A), 2) GAD in the 6 months prior to but not in pregnancy (Group B), 3) GAD in pregnancy only (Group C) and 4) GAD both in the 6 months prior to and during pregnancy (Group D). Results: 9.5% of the cohort suffered from GAD at some point in pregnancy. Anxiety symptoms were highest in the first trimester and decreased across pregnancy. Regression analysis revealed that previous GAD episodes, education, social support and a history of child abuse distinguished between membership in the four groups. Limitations: The sample may not be representational, as it was enhanced with those at risk, and had relatively low representation of socio-economically disadvantaged women. Conclusions: Identification of anxious patients during pregnancy may provide an opportunity to engage those in need of psychiatric treatment. (C) 2011 Elsevier B.V. All rights reserved.