Pregnancy-related anxiety in Saudi women: a national study of prevalence, predictors, and a framework for action

Introduction: Pregnancy-related anxiety is a significant maternal health concern associated with adverse outcomes for both mother and child. This study aimed to estimate the prevalence and identify the predictors of pregnancy-related anxiety among women in Saudi Arabia, to inform evidence-based healthcare interventions. Methods: A nationwide cross-sectional study was conducted among 687 Saudi women with pregnancy experience. The data were collected through an online survey using the Pregnancy-Related Anxiety Questionnaire - Revised 2 (PRAQ-R2), a validated 10-item scale designed to measure specific anxieties related to pregnancy, childbirth, and fetal health. Multivariable logistic regression was used to identify predictors of pregnancy-related anxiety, adjusting for age, education, and occupation. Results: The prevalence of pregnancy-related anxiety was 71%. Significant predictors included older maternal age (40-50 years: OR = 1.32, 95% CI: 1.01-1.72, p = 0.04), history of pregnancy complications (OR = 1.45, 95% CI: 1.18-1.78, p < 0.001), and prior dilatation and curettage (OR = 1.30, 95% CI: 1.05-1.61, p = 0.02). Strong fears about delivery (OR = 2.10), labor pain (OR = 1.92), and the baby's health (OR = 1.85) were strongly associated with anxiety (all p < 0.001). Anxiety decreased as pregnancy progressed, with significant reductions in concerns about delivery, pain, and appearance across trimesters (p < 0.05). Conclusions: Pregnancy-related anxiety is highly prevalent among Saudi women and influenced by demographic, obstetric, and psychological factors. These findings support the integration of routine anxiety screening, targeted prenatal education addressing specific fears, and enhanced support for high-risk groups into Saudi Arabia's maternal healthcare system to improve pregnancy outcomes and maternal well-being.