A cross-sectional study on the prevalence and determinants of antenatal anxiety among pregnant women in the second and third trimesters

BACKGROUND: Globally, anxiety is prevalent during pregnancy and is associated with poor outcomes, yet it is often under-documented, underdiagnosed, and untreated during antenatal care in low- and middle-income countries, and its associated factors remain poorly understood. This study aimed to estimate the prevalence of anxiety among pregnant women in their second and third trimesters and identify associated factors. METHODS: A community-based cross-sectional study was conducted at four primary health centres in a rural western Indian district. Pregnant women in their second or third trimester without prior mental illness were included. Anxiety was assessed using the PRAQ-R2 tool. Data on sociodemographic characteristics, obstetric history, and various psychosocial factors were collected using the Epicollect5 application and analysed with SPSS v25. RESULTS: Among 213 participants, 84% had pregnancy-related anxiety (60.1% mild, 22.5% moderate, and 1.4% severe). The most common PRAQ-R2 item contributing to anxiety was fear of giving birth, followed by worries about bearing an ill child, and concerns about self-appearance. Univariate analysis showed significant association with parity (crude odds ratio [COR] = 4.98, 95% confidence interval [95% CI] = 2.42-10.22), gravida (1.96, 1.04-3.71), history of abortion/intrauterine death (3.47, 1.67-7.20), negative comments or behaviour from family regarding increased appetite (1.99, 1.045-3.79), worried about specific concerns (9.42, 2.20-40.38), difficulty in reaching a healthcare facility (2.17, 1.09-4.31) and past traumatic events (1.92, 1.01-3.64), were significant. In multivariate logistic regression, parity (adjusted odds ratio, AOR = 7.83, 95% CI = 1.68-36.63), history of abortion/intrauterine death (5.08, 1.30-19.83) and worried about specific concerns during pregnancy (9.09, 1.93-42.88) remained independently associated with antenatal anxiety. CONCLUSION: Anxiety was highly prevalent and influenced by a complex interplay of clinical, sociodemographic, and psychosocial factors. The high prevalence in rural settings raises serious public health concerns, suggesting the need for improved screening, early identification, and timely intervention during routine antenatal care to prevent adverse pregnancy outcomes.