Pregnancy-Related Anxiety in Saudi Women: A National Study of Prevalence, Predictors, and a Framework for Action

Elhadi Miskeen^1*Dalia Alqarni^1*Nouf Alshammari²Ruba Degriri²Rufaydah Mesawa²Somaya Grami²Hind Alenzi²Khalid Nasralla Habeeballa Hashim³Abdullah M. Alshahrani⁴Mohammed Eltag⁵Muffarah Hamid Alharthi⁴Mohannad Mohammed S Alamri⁴Abdullah Alshahrani⁴Anum S. Hussaini⁶Laila Yahya Alhubaishi⁷

• ¹Department of Obstetrics and Gynecology, College of Medicine, University of Bisha, Bisha, Saudi Arabia
• ²Department of Obstetrics and Gynecology, College of medicine, Taibah University, Taibah, Saudi Arabia
• ³Department of Obstetrics and Gynecology, Faculty of Medicine, Qassim University, Buraydah, Saudi Arabia
• ⁴Department of Family and Community Medicine, College of Medicine, University of Bisha, Bisha, Saudi Arabia
• ⁵Medical intern, Aseer Health Cluster- Bisha, Bisha, Saudi Arabia, Bisha, Saudi Arabia
• ⁶Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Boston, United States
• ⁷Department of Obstetrics and Gynecology, College of Medicine and Health Sciences, Mohammed Bin Rashid University, Dubai, United Arab Emirates

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.