Abstract
BACKGROUND: Several investigations have delved into the heterogeneity of anxiety symptom trajectories throughout pregnancy. However, the causal relationships between prenatal anxiety, stress, and psychological flexibility remain unclear. This study endeavored to identify distinct trajectory groups and influencing factors for anxiety symptoms in pregnant women, and explore the relationship between stress, psychological flexibility, and anxiety during this period. METHODS: Pregnant women were recruited from March to May 2022 at a hospital in Xi'an City, Shaanxi Province, China. Structured questionnaire surveys were conducted through a WeChat applet at five time points (12, 20, 26, 32, and 37 weeks), collecting information on basic demographics, stress, psychological flexibility, and anxiety throughout their pregnancies. The latent class growth model was employed to identify potential trajectory groups of prenatal anxiety, logistic regression was utilized to analyze the factors associated with these groups, and a linear mixed model was implemented to investigate the relationship between stress, psychological flexibility, and anxiety. RESULTS: Three distinct anxiety trajectory groups were identified. Unplanned pregnancy (OR = 1.76, 95% CI: 1.08-2.87, P = 0.024) and a history of spontaneous abortion (OR = 1.75, 95% CI: 1.10-2.79, P = 0.018) were significantly associated with a heightened risk of developing an anxiety trajectory group. Higher stress at 12 (β = 0.229, 95% CI: 0.187-0.271), 20 (β = 0.249, 95% CI: 0.211-0.287), 26 (β = 0.255, 95% CI: 0.213-0.296), and 32 weeks(β = 0.278, 95% CI: 0.241-0.315) significantly predicted elevated anxiety in late pregnancy (all P < 0.001). While higher psychological flexibility at the same time points predicted lower anxiety (βs from - 0.074 to - 0.099; all P < 0.001). CONCLUSIONS: The trajectories of prenatal anxiety symptoms are dynamic and heterogeneous, with stress and psychological flexibility emerging as significant predictive factors. This study offers critical insights into the characteristics of pregnant women in high-risk trajectory groups, highlighting the potential for early intervention to mitigate worsening symptoms. TRIAL REGISTRATION: The study was approved by the Ethical Committee of Health Science Center, Xi'an Jiaotong University in accordance with the Declaration of Helsinki (Registration number: 2022 - 1436, date:2022.7.4).