Associations between prematurity, postpartum anxiety, neonatal intensive care unit admission, and stress

Semra Worrall; Paul Christiansen; Asma Khalil; Sergio A Silverio; Victoria Fallon

doi:10.3389/fpsyt.2024.1323773

Associations between prematurity, postpartum anxiety, neonatal intensive care unit admission, and stress

Front Psychiatry. 2024 Feb 23:15:1323773. doi: 10.3389/fpsyt.2024.1323773. eCollection 2024.

Authors

Semra Worrall¹, Paul Christiansen¹, Asma Khalil^{2

3}, Sergio A Silverio^{4

5}, Victoria Fallon¹

Affiliations

¹ Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom.
² Fetal Medicine Unit, Liverpool Women's NHS Foundation Trust, Liverpool, United Kingdom.
³ Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, United Kingdom.
⁴ Department of Women & Children's Health, School of Life Course & Population Sciences, King's College London, London, United Kingdom.
⁵ School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom.

Abstract

Introduction: It is well established that a premature birth increases the likelihood of developing anxiety during the postpartum period, and that the environment of the neonatal intensive care unit (NICU) might be a contributing factor. Mothers of earlier premature infants may experience these anxieties to a higher degree compared to mothers of later premature infants. The aim of this study was to explore the association between prematurity and postpartum-specific anxiety, and the relationship between postpartum-specific anxiety and stress in the NICU.

Materials and methods: Mothers (N = 237) of infants aged between birth and 12 months completed an online survey containing the Postpartum Specific Anxiety Scale - Research Short Form (PSAS-RSF) and the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU). Structural equation modeling was used to analyze the relationship between gestational age and postpartum-specific anxiety, with one-way ANOVAs used to analyze this relationship with respect to categories of gestational age. Hierarchical regression models analyzed the relationship between postpartum-specific anxiety and stress in the NICU.

Results: For the PSAS-RSF, Practical Infant Care Anxieties (p = 0.001), Maternal Competence and Attachment Anxieties (p = 0.033), and Infant Safety and Welfare Anxieties (p = 0.020) were significantly associated with week of gestation. Practical Infant Care and Infant Safety and Welfare Anxieties were significantly higher for mothers of late premature infants, compared to mothers of term infants (p < 0.001; p = 0.019). There were no significant between-group differences with respect to Maternal Competence and Attachment Anxieties. After controlling for potential confounders, Infant Safety and Welfare Anxieties were significantly associated with increased stress in the NICU (p < 0.001) as measured by the PSS:NICU.

Conclusions: Our findings highlight the need for interventions for mothers with premature infants, which specifically target anxieties reflected in the PSAS-RSF, such as routine care and increasing maternal self-efficacy.

Keywords: cross-sectional study; gestational age; maternal mental health; neonatal intensive care unit; postpartum anxiety; preterm birth.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. SW’s PhD is supported financially by the University of Liverpool; however, the institution has no influence over research design, data collection, analysis, write-up, or the decision to submit.