Psychological aspects of premature birth
AbstractThe prevalence of anxiety during pregnancy, which increases the risk of premature birth, varies from 14 to 54% in different countries. Early diagnosis of high levels of anxiety and timely psychocorrective therapy will help to avoid the development of complications of pregnancy, childbirth and the postpartum period.
The aim of the study was to assess the psychoemotional state of pregnant women, to study the symptoms of anxiety and their relationship with premature birth.
Material and methods. The study involved 156 pregnant women with threatening premature births who were in obstetric departments of maternity hospitals in Kazan, who were ready to cooperate and signed a written informed voluntary consent to participate in the survey. The questionnaires were filled out in Google forms and analyzed using descriptive statistics. According to the gestation period, the respondents were distributed as follows: 59 (37.82%) – in the gestation period 22–27⁺⁶ weeks, 42 (26.92%) – in the gestation period 28–31⁺⁶ weeks, 30 (19.23%) – in terms of 32–33⁺⁶ and 25 (16.03%) – in terms of 34–36⁺⁶ weeks. All patients underwent a determination of their psychoemotional state on the scale of V.V. Abramchenko and T.A. Nemchin and an assessment of their anxiety level on the scale of Spielberger–Khanin.
Results. Of all those who took part in the study, according to the scale of V.V. Abramchenko and T.A. Nemchin, 94 (60.26%) respondents had changes in their neuropsychiatric state associated with fears for the outcome of childbirth, and in 85 (54.49%) women these fears persisted after a psychotherapeutic conversation, and in 10 (6.41%) women they intensified after conversations with other pregnant or postpartum women. Before pregnancy 11 (7.05%) women experienced some kind of traumatic event, and in 8 (5.13%) patients it happened during this pregnancy. In addition, 105 (67.31%) respondents noted that hospitalization during pregnancy for various obstetric complications was a significant stressful factor.
40 (25.64%) of the respondents revealed a high level of anxiety on the Spielberger–Khanin scale, distributed according to the terms of pregnancy as follows: at 22–27⁺⁶ weeks – at 21 (13.46%), at 28–31⁺⁶ weeks – at 9 (5.77%), at 6 (3.85%) – in 32–33⁺⁶ weeks and in four (2.56%) – in 34–36⁺⁶ weeks. In all cases, the predictors were various stressful and emotional situations during this pregnancy. Increased anxiety was also associated with fear of impending childbirth, possible pregnancy complications, and anxiety about the health of the unborn child. The maximum values of all anxiety levels were in the terms of 22–27⁺⁶ weeks – 59 (37.82%) respondents and the minimum values in the terms of 34–36⁺⁶ weeks – in 25 (16.03%) patients.
A moderate level of anxiety was detected in 64 (41.02%) pregnant women: 22 (14.10%) at 22–27⁺⁶ weeks, 18 (11.54%) at 28–31⁺⁶ weeks, 13 (8.33%) women at 32–33⁺⁶ weeks, and 11 (7.05%) at 34–36⁺⁶ weeks.
20 (12.81%) out of 156 women had premature births. 4 (20%) out of 20 women with a high level of anxiety had childbirth at 22–27⁺⁶ weeks. With a moderate level of anxiety, premature birth occurred in 6 (30.0%) patients and was distributed by timing as follows: 1 (5.0%) at 28–31⁺⁶ weeks, 2 (10.0%) at 32–33⁺⁶ weeks, 3 (15.0%) at 34–36⁺⁶ weeks. In 10 (50.0%) women with low anxiety, 4 (20.0%) gave birth at 32–33⁺⁶ weeks and 6 (30.0%) at 34–36⁺⁶ weeks.
Conclusion. The results obtained in this study demonstrate the relationship between high levels of anxiety, perinatal stress and premature birth. Women with premature birth have a high level of anxiety. The higher the anxiety level, the higher the probability of very early preterm birth. Conversely, the lower the anxiety, the higher the chances of carrying the pregnancy to term and the likelihood of an urgent birth.
Premature termination of pregnancy can be expected in women with high psycho-emotional stress in everyday life, with the presence of traumatic situations before and during pregnancy. A pregnant woman experiencing a high level of anxiety and perinatal stress, a priory should be classified as a high-risk group for the development of complications. Such women need timely diagnosis, correction of a negative psycho-emotional state, and medical and psychological support during pregnancy and childbirth.
Keywords: premature birth; psychological factors; psychosomatics; perinatal stress; anxiety
Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
Contribution. The author of the idea, working with literary sources, data processing and analysis, writing an article, approving the final version for publication – Fatkullina L.S.; research design, editing, approving the final version for publication – Fatkullin I.F.; editing, approving the final version for publication – Knyazev S.A.; conducting a survey, collecting data – Volkova E.E., Mansurova E.I.
For citation: Fatkullina L.S., Fatkullin I.F., Knyazev S.A., Volkova E.E., Mansurova E.I. Psychological aspects of premature birth. Akusherstvo i ginekologiya: novosti, mneniya, obuchenie [Obstetrics and Gynecology: News, Opinions, Training]. 2024; 12 (3): 86–93. DOI: https://doi.org/10.33029/2303-9698-2024-12-3-86-93 (in Russian)
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