| ObjectiveThis study aims to examine the characteristics of pregnancy-related anxiety in 1stand 3rdtrimester of pregnancy and analyze the potential influencing factors.It also targets to explore the effect of pregnancy-related anxiety on preschool children’s executive function and gender difference.MethodsThis study was part of the China-Anhui Birth Cohort Study（C-ABCS）,a prospective population-based cohort study that recruited pregnant women from Ma’anshan Maternal and Child Health Care Hospital,Anhui province in China between October 2008 and October 2010.The demographic characteristics and previous medical history of pregnant women were collected prospectively in the 1stand 3rdtrimester of pregnancy,and the pregnancy-related anxiety was assessed by Pregnancy-Related Anxiety Questionnaire.A total of 4 669 singleton live births were followed up from this cohort.Children born in this cohort that were aged 3-5 were followed up from April 2014 to June 2015.Guardians filled out a questionnaire to collect children’s basic characteristics.Executive function of preschool children was assessed by Behavior Rating Inventory of Executive Function-Preschool（BRIEF）（parent version）.For this study,eligible participants were mother-and-singleton-offspring pairs in which mother’s anxiety data were complete and offspring who had detailed birth records and pre-school follow-up information.A final sample size of 3 556 entered the main data analysis.Independent sample t-test and variance analysis was used to compare the continuous variables with normal distribution.Pearson?2test was used to compare the rate of abnormal EFs in preschool children with different demographic and obstetric characteristics and pregnancy-related anxiety status.ResultsThe average age of pregnant women wereyears old,and children wereyears old.There were 1 915 boys（53.9%）and 1641 girls（46.1%）in the study population.The rate of abnormal global executive composite（GEC）was 8.5%（304/3556）,in which 9.4%（180/1 915）in boys and 7.6%（124/1 641）in girls.The prevalence of pregnancy-related anxiety in the 1stand 3rdtrimester was 17.6%and 6.3%respectively.The prevalence of anxiety in both trimesters was 7.7%.Compared with the group without pregnancy-related anxiety in either 1stor 3rdtrimester,old maternal age and high paternal educational level were related to low risk of pregnancy-related anxiety in 1sttrimester;women’s having pregnancy complications were related to the high risk of pregnancy-related anxiety in 3rdtrimester;existence of previous adverse pregnant outcomes was related to the high risk of pregnancy-related anxiety in 1sttrimester.Among the four pregnancy-related anxiety groups,the rate of abnormal GEC was 11.5%,9.8%,15.4%,6.9%,respectively.In detail,the rate of inhibition abnormality was 9.3%,8.9%,12.8%,5.5%,rate of shifting function abnormality was 4.2%,3.6%,4.8%,2.9%,rate of emotional control function abnormality was 2.9%,2.7%,4.0%,2.3%,rate of working memory abnormality was28.1%,24.1%,37.0%,20.2%and that of planning/organization abnormality was 8.3%,7.1%,8.4%,4.8%,respectively.The rate of abnormal inhibition function,working memory,planning/organization function and GEC in the group with pregnancy-related anxiety in 1sttrimester was significantly higher than that in the group without pregnancy-related anxiety in either 1stor 3rdtrimester.The rate of abnormal inhibition function,working memory function and GEC in the group with pregnancy-related anxiety in both trimesters was significantly higher than that in the group without pregnancy-related anxiety in either 1stor 3rdtrimester.The rate of abnormal working memory function in the group with pregnancy-related anxiety in both trimesters was significantly higher than that in the group with pregnancy-related anxiety in 1sttrimester and the group with pregnancy-related anxiety in 3rdtrimester.After controlling for maternal age,pre-pregnancy BMI,education years of parents,monthly family income,previous adverse pregnant outcomes,pregnant complications,parity,children’s age,proportion of parents raising before 3 years old and after 3 years old,the main residence of the children in the past six months,and Z score of birth weight,compared with the group without pregnancy-related anxiety in either 1stor 3rdtrimester,pregnancy-related anxiety in the 1sttrimester increased the risk of preschool boy’s abnormality in working memory,planning/organization and GEC,and OR（95%CI）was 1.40（1.06-1.85）,1.64（1.06-2.54）,1.89（1.27-2.82）,respectively.Anxiety in the both trimesters increased the risk of boy’s abnormality in inhibition,working memory,planning/organization and GEC,and OR（95%CI）was 2.60（1.45-4.67）,2.45（1.69-3.57）,2.23（1.28-3.88）,3.27（2.03-5.28）,respectively.Pregnancy-related anxiety in the 1sttrimester increased the risk of preschool girl’s abnormality in inhibition working memory,and OR（95%CI）was 1.79（1.13-2.83）,1.45（1.07-1.98）,respectively.Anxiety in the 3rdtrimester increased the risk of girl’s abnormality in inhibition,and OR（95%CI）was 2.26（1.17-4.38）.Anxiety in the both trimesters increased the risk of girl’s abnormality in inhibition,working memory,and OR（95%CI）was 2.45（1.40-4.28）,2.02（1.35-3.01）,respectively.ConclusionPregnancy-related anxiety is found to significantly affect preschool children’s executive function,which primarily acts on working memory,planning/organization function and GEC function in boys,and the inhibition function and working memory function in girls.The prevalence of abnormal EFs in the group with pregnancy-related anxiety in both trimesters is significantly higher than that in any other groups,and there exists a dose-response relationship.Early pregnancy may be the critical period for the influence of pregnancy-related anxiety on preschool children’s executive function. |
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