728 - When a Little Worry Helps: Anxiety and Learning in Prenatal Preterm Birth Education

Publication Number: 1705.728

Siobhan M. McDonnell, Medical College of Wisconsin, Willmar, MN, United States; Kathryn E. Flynn, Medical College of Wisconsin, Milwaukee, WI, United States; Sheikh Iqbal Ahamed, Marquette University, Milwaukee, WI, United States; Abbey Kruper, Medical College of Wisconsin, Milwaukee, WI, United States; Mir A Basir, Medical College of Wisconsin, Brookfield, WI, United States

Background: The Yerkes-Dodson principle describes an optimal zone of arousal modeled as a bell curve, in which some anxiety can improve learning before efficacy declines at high levels of anxiety. It is unknown whether some degree of maternal anxiety can positively influence premature birth education.

Objective: Evaluate how maternal levels of anxiety in early pregnancy affect learning from the Preemie Prep for Parents (P3) education program.

Design/Methods: In this ancillary analysis of IRB-approved NCT04093492, 120 patients with risk factors for premature birth (e.g., chronic hypertension) were randomized 1:1 between 18-21 weeks gestational age (GA) to receive either the P3 program or links to American College of Obstetricians and Gynecologists patient webpages. The P3 program sent periodic text messages, each with a link to 1 of 51 short, animated videos. Software tracked video use. Assessments were collected at enrollment (PROMIS Anxiety), and at 25, 30, and 34 weeks GA (PROMIS Anxiety, Parent Prematurity Knowledge Questionnaire). Anxiety t-scores in the general US population are mean (SD) 50 (10); participant anxiety was categorized by below ( < 40), within (40-59), or above (≥60) one SD of the normed mean to test the Yerkes-Dodson bell curve model.

Results: Baseline anxiety (mean 54 [SD 8]) was higher than the general US population, with few participants reporting low anxiety levels, Table 1. There were no differences in anxiety levels between study groups or over time, Figure 1. Participants’ anxiety level at enrollment was not significantly associated with their knowledge scores at 25 weeks GA, p=0.77, Figure 2. However, knowledge scores at 30 weeks were associated with anxiety levels at 25 weeks (p=0.004) and knowledge scores at 34 weeks were associated with anxiety levels at 30 weeks (p=0.040). Post-hoc comparisons indicated that the participants scoring below one SD in anxiety had the lowest knowledge scores, with no significant differences between participants within one SD and above one SD in anxiety scores. Of the 60 participants randomized to the P3 group, anxiety at enrollment did not significantly predict P3 video use (p=0.62).

Conclusion(s): As few participants reported anxiety levels less than one SD of the mean, findings should be interpreted with caution. The group with anxiety levels below one SD showed worse premature birth knowledge; this partially supports the Yerkes-Dodson principle that some anxiety may enhance knowledge retention. Further study is needed to optimize education for emotional states in pregnancy care.

Table 1
Table 1.pdfParticipant anxiety levels at each time point.

Figure 1
Figure 1.pdfAnxiety levels among P3 and control group participants over time. There were no significant differences in anxiety scores between P3 and control groups at baseline (p=0.54), 25 weeks GA (p=0.88), 30 weeks GA (0.07), and 34 weeks GA (p=0.25). Additionally, anxiety scores did not change from baseline at 25 weeks GA (p=0.89), 30 weeks GA (p=0.80), and 34 weeks GA (p=0.62).

Figure 2.
Figure 2.pdfKnowledge scores among P3 participants at each follow up assessment by reported level of anxiety.