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To assess the association between trajectories of comorbid anxiety and depressive (CAD) symptoms assessed in each pregnancy trimester and physiological birth.Design: Large longitudinal prospective cohort study with recruitment between January 2013 and September 2014.Setting: Primary care, in the Netherlands.Population: Dutch-speaking pregnant women with gestational age at birth ≥37 weeks, and without multiple pregnancy, severe psychiatric disorder or chronic disease history.
Pregnancy-specific anxiety and depressive symptoms were measured pro-spectively in each trimester of pregnancy using the negative affect subscale of the Tilburg Pregnancy Distress Scale and Edinburgh (Postnatal) Depression Scale. Data on physiological birth were obtained from obstetric records. Multivariate growth mixture modelling was performed in MPLUS to determine longitudinal trajectories of CAD symptoms. Multiple logistic regression analysis was used to examine the association between trajectories and physiological birth.Main outcome measures: Trajectories of CAD symptoms and physiological birth.
Seven trajectories (classes) of CAD symptoms were identified in 1682 women and subsequently merged into three groups: group 1—persistently low levels of symptoms (reference class 1; 79.0%), group 2—intermittently high levels of symp-toms (classes 3, 6 and 7; 11.2%), and group 3—persistently high levels of symptoms (classes 2, 4 and 5; 9.8%). Persistently high levels of CAD symptoms (group 3) were associated with a lower likelihood of physiological birth (odds ratio 0.67, 95% confi-dence interval 0.47–0.95, P = 0.027) compared with the reference group (persistently low levels of symptoms), after adjusting for confounders.