<?xml version="1.0" encoding="UTF-8"?><!DOCTYPE article  PUBLIC "-//NLM//DTD Journal Publishing DTD v3.0 20080202//EN" "http://dtd.nlm.nih.gov/publishing/3.0/journalpublishing3.dtd"><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" dtd-version="3.0" xml:lang="en" article-type="research article"><front><journal-meta><journal-id journal-id-type="publisher-id">OJPsych</journal-id><journal-title-group><journal-title>Open Journal of Psychiatry</journal-title></journal-title-group><issn pub-type="epub">2161-7325</issn><publisher><publisher-name>Scientific Research Publishing</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.4236/ojpsych.2019.93018</article-id><article-id pub-id-type="publisher-id">OJPsych-93533</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Biomedical&amp;Life Sciences</subject></subj-group></article-categories><title-group><article-title>
 
 
  Prevalence and Factors Associated with Anxiety and Depression in Expectant Mothers at Parakou in 2018
 
</article-title></title-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Anselme</surname><given-names>Djidonou</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Francis</surname><given-names>Tognon Tchegnonsi</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Christel</surname><given-names>Crédo Mahugnon Ahouandjinou</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Boris</surname><given-names>Houinou Ebo</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Covali</surname><given-names>Melic Bokossa</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Jivaterd</surname><given-names>Degla</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Emilie</surname><given-names>Fiossi-Kpadonou</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib></contrib-group><aff id="aff1"><addr-line>Medicine and Medical Specialties Department, Faculty of Medicine, University of Parakou, Parakou, Benin</addr-line></aff><aff id="aff3"><addr-line>Faculty of Health Sciences, University of Abomey-Calavi, Abomey-Calavi, Benin</addr-line></aff><aff id="aff2"><addr-line>National School for Higher Technicians Training in Public Health and Epidemiology (ENATSE), University of Parakou, Parakou, Benin</addr-line></aff><pub-date pub-type="epub"><day>24</day><month>05</month><year>2019</year></pub-date><volume>09</volume><issue>03</issue><fpage>235</fpage><lpage>247</lpage><history><date date-type="received"><day>24,</day>	<month>April</month>	<year>2019</year></date><date date-type="rev-recd"><day>2,</day>	<month>July</month>	<year>2019</year>	</date><date date-type="accepted"><day>5,</day>	<month>July</month>	<year>2019</year></date></history><permissions><copyright-statement>&#169; Copyright  2014 by authors and Scientific Research Publishing Inc. </copyright-statement><copyright-year>2014</copyright-year><license><license-p>This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/</license-p></license></permissions><abstract><p>
 
 
   
   <b>Background:</b> Anxiety and depressive disorders can disturb the development of pregnancies. The goal was to study the prevalence and factors associated with anxiety and depression in expectant mothers followed in public maternity wards of Parakou in 2018. 
   <b>Population</b> 
   <b>and</b> 
   <b>methods:</b> It was a cross- sectional study which consisted in an exhaustive census and a consecutive recruitment of 835 expectant mothers from June 14th to September 14th, 2018. Data collection was realized through interview between the investigator and the respondent basing on a questionnaire in which were integrated Edinburgh Postnatal Depression 
   Scale-3 (EPDS-3), EPDS and modular Integrated Household Living Conditions Survey (IHLCS-2015) to assess respectively anxiety, depression and expectant mothers’ socio-economic level. 
   <b>Results:</b> The prevalences of anxiety and depression were respectively 44.91% and 35.33%. Many factors were associated with anxiety and depression. Low socio-economic level increased 6.7 times the risk of developing anxiety (OR = 6.70; IC
   <sub>95%</sub> [2.83 - 13.00]; 
   p = 0.000) and 8.64 times the risk for the onset of depression (OR = 8.64; IC
   <sub>95%</sub> [3.09 - 17.18]; 
   p = 0.000). Celibacy increased 2.67 times the risk of developing anxiety (OR = 2.67; IC
   <sub>95%</sub> [1.19 - 5.98]; 
   p = 0.000) and 2.18 times the one of depression (OR = 2.18; IC
   <sub>95%</sub> [1.07 - 4.40]; 
   p = 0.000). Low economic level and celibacy were the main psychosocial determinants of anxiety and depression in expectant mothers. 
   <b>Conclusion:</b> The implementation of multidisciplinary action program centred on improving purchasing power would reduce the risk of anxiety and depression in expectant mothers. 
  
 
</p></abstract><kwd-group><kwd>Anxiety</kwd><kwd> Depression</kwd><kwd> Social Determinants</kwd><kwd> Expectant Mothers</kwd></kwd-group></article-meta></front><body><sec id="s1"><title>1. Introduction</title><p>Pregnancy and childbirth allow women to access the status of mother. But, the physiological and psychosomatic modifications induced during that period weaken the woman and expose her to many psychiatric disorders including anxiety and depression. Their onset during pregnancy constitutes a risk for both the mother and the child. About 10% of pregnant women are affected [<xref ref-type="bibr" rid="scirp.93533-ref1">1</xref>] [<xref ref-type="bibr" rid="scirp.93533-ref2">2</xref>] . At least, one expectant mother out of ten coming at the regular appointments for pregnancy follow-up is or will be depressed. However, very few of them are diagnosed. They refrain from revealing their feelings or consulting a health care professional due to the symptoms minimization or the stigma attached to mental health issues. During pregnancy, the pre-existing psychotic disorders can resurface, like a substance abuse or a suicide attempt when they are combined with an undesired pregnancy. According to Gourine et al. [<xref ref-type="bibr" rid="scirp.93533-ref3">3</xref>] , more than 15 years as duration of diabetes is predictive of developing a depression during pregnancy. Depression rates are also high at the end of the pregnancy and during postpartum. Postpartum depression affects more than 15% of new mothers [<xref ref-type="bibr" rid="scirp.93533-ref4">4</xref>] .</p><p>In Benin and particularly at Parakou, no study was submitted on psychiatric disorders during pregnancy and puerperium. That is the reason for this study.</p></sec><sec id="s2"><title>2. Population and Methods</title><sec id="s2_1"><title>2.1. Type and Period of the Study</title><p>It was a cross-sectional study with analytical aim and prospective data collection of all the expectant mothers followed from June 14th to September 14th, 2018 in Parakou maternity wards.</p></sec><sec id="s2_2"><title>2.2. Population and Inclusion Criteria</title><p>The sample size was the sum of the encountered expectant mothers who have given their prior consent during data collection. Non available expectant mothers were excluded. A total number of 835 expectant mothers was retained.</p></sec><sec id="s2_3"><title>2.3. Study Variables</title><p>The dependent variables were related to anxiety and depression.</p><p>The independent variables were related to sociodemographic and gynaeco-obstetrical factors; a previous psychological vulnerability such as personal and family history of psychiatric disorders, abuse or rape in childhood; psychosocial factors during pregnancy and personal history such as the desire of pregnancy, existence of marital conflicts, a child or a close relative death, a stressful life event during pregnancy, the absence of social support, Difficulties or pathologies about the current pregnancy, the lesser follow-up of the pregnancy; risky maternal behaviour; alcohol, tobacco and others psychoactive substances consumption.</p></sec><sec id="s2_4"><title>2.4. Data Collection Tools and Technique</title><p>Data collection was realized through individual semi-structured interviews basing on a questionnaire in which were integrated the scales: Edinburgh Postnatal Depression Scale-3 (EPDS-3), EPDS [<xref ref-type="bibr" rid="scirp.93533-ref5">5</xref>] and modular Integrated Household Living Conditions Survey (IHLCS-2015) [<xref ref-type="bibr" rid="scirp.93533-ref6">6</xref>] to assess respectively anxiety, depression (the threshold value used to assess depression was 11 and 4 for anxiety) and expectant mothers’ socio-economic level 5 (SEL: high SEL = total score ≥ 85%, average SEL = 50% ≤ total score ≤ 85%, low SEL = total score ≤ 50%). The scales used in the study were translated and validated for local population.</p></sec><sec id="s2_5"><title>2.5. Ethical Considerations and Data Processing</title><p>The study follows a medical thesis. It has been conducted after the approval from the local research ethics board and biomedical research of Parakou University. The data collection was carried out through a semi-structured individual interview using a pre-tested questionnaire, in accordance with the ethical principles set out in the Helsinki Declaration of the Medical World [<xref ref-type="bibr" rid="scirp.93533-ref7">7</xref>] ; the informed consent of the respondents was required, as well as the preservation of their anonymity. Data have been collected on a sheet survey by the personnel who usually perform the childbirth at the survey location and recycled for the circumstance.</p><p>For the study of association’s stability between anxiety, depression and the different factors, a univariate analysis (p &lt; 0.05) was simultaneously included in a logistic regression model using a downward and step by step successive iterations. The comparison of factors percentages between dependent variables and the factors associated was made basing on a “chi-2” test. The association strength, meaning and stability were estimated using Odd ratios and 95% as their confidence intervals. The significance level was set at 5%.</p></sec></sec><sec id="s3"><title>3. Results</title><sec id="s3_1"><title>3.1. Prevalence of Anxiety and Depression in Encountered Expectant Mothers</title><p>According to the scales EPDS 3A and EPDS, the number of the survey respondents having an anxiety or a depression was respectively 375 (44.91%) and 295 (35.33%).</p></sec><sec id="s3_2"><title>3.2. Factors Associated with Anxiety</title><p>The mean age of the interviewed expectant mothers was 25 &#177; 5.1 years with the extremes 15 and 45 years. The age group 15 to 24 years was the most represented (47.12%). The socioeconomic level and the previous onset of a spontaneous miscarriage is associated with anxiety in the interviewed expectant mothers. <xref ref-type="table" rid="table1">Table 1</xref> and <xref ref-type="table" rid="table2">Table 2</xref> present the factors associated with anxiety in encountered expectant mothers.</p></sec><sec id="s3_3"><title>3.3. Factors Associated with Depression</title><p>The educational level and difficulties during pregnancy were associated with depression in expectants mothers. <xref ref-type="table" rid="table3">Table 3</xref> and <xref ref-type="table" rid="table4">Table 4</xref> show the factors associated with depression in the encountered expectant mothers.</p></sec><sec id="s3_4"><title>3.4. Determinants of Anxiety in Encountered Expectant Mothers</title><p>In the multivariate logistic regression, low socioeconomic level, third trimester of pregnancy respectively increase 6.70 times and 2.47 times the risk of developing anxiety. <xref ref-type="table" rid="table5">Table 5</xref> shows the determinants of anxiety during pregnancy in expectant mothers.</p></sec><sec id="s3_5"><title>3.5. Determinants of Depression in the Encountered Expectant Mothers</title><p>In this multivariate logistic regression, low socioeconomic level increases 8.64 times the risk of developing depression. <xref ref-type="table" rid="table6">Table 6</xref> presents psychosocial determinants of depression during pregnancy in expectant mothers.</p><table-wrap-group id="1"><label><xref ref-type="table" rid="table1">Table 1</xref></label><caption><title> Distribution of patients by profession, marital status, socioeconomic level and previous onset of spontaneous miscarriage, according to anxiety. (Parakou, 2018; N = 835)</title></caption><table-wrap id="1_1"><table><tbody><thead><tr><th align="center" valign="middle"  rowspan="2"  ></th><th align="center" valign="middle"  colspan="4"  >ANXIETY</th><th align="center" valign="middle"  rowspan="2"  >Total (N)</th><th align="center" valign="middle"  rowspan="2"  >p</th></tr></thead><tr><td align="center" valign="middle"  colspan="2"  >Yes</td><td align="center" valign="middle"  colspan="2"  >No</td></tr><tr><td align="center" valign="middle" ></td><td align="center" valign="middle" >n</td><td align="center" valign="middle" >%</td><td align="center" valign="middle" >n’</td><td align="center" valign="middle" >%</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Profession</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" >0.016</td></tr><tr><td align="center" valign="middle" >Official</td><td align="center" valign="middle" >8</td><td align="center" valign="middle" >26.67</td><td align="center" valign="middle" >22</td><td align="center" valign="middle" >73.33</td><td align="center" valign="middle" >30</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Private sector worker</td><td align="center" valign="middle" >32</td><td align="center" valign="middle" >32.65</td><td align="center" valign="middle" >66</td><td align="center" valign="middle" >67.35</td><td align="center" valign="middle" >98</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Trader/Reseller</td><td align="center" valign="middle" >115</td><td align="center" valign="middle" >43.56</td><td align="center" valign="middle" >149</td><td align="center" valign="middle" >56.44</td><td align="center" valign="middle" >264</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Artisan</td><td align="center" valign="middle" >108</td><td align="center" valign="middle" >47.79</td><td align="center" valign="middle" >118</td><td align="center" valign="middle" >52.21</td><td align="center" valign="middle" >226</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Pupil/student</td><td align="center" valign="middle" >45</td><td align="center" valign="middle" >48.91</td><td align="center" valign="middle" >47</td><td align="center" valign="middle" >51.09</td><td align="center" valign="middle" >92</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Unemployment</td><td align="center" valign="middle" >60</td><td align="center" valign="middle" >53.10</td><td align="center" valign="middle" >53</td><td align="center" valign="middle" >46.90</td><td align="center" valign="middle" >113</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Others</td><td align="center" valign="middle" >7</td><td align="center" valign="middle" >58.33</td><td align="center" valign="middle" >5</td><td align="center" valign="middle" >41.67</td><td align="center" valign="middle" >12</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Marital status</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" >0.005</td></tr><tr><td align="center" valign="middle" >Single</td><td align="center" valign="middle" >17</td><td align="center" valign="middle" >45.95</td><td align="center" valign="middle" >20</td><td align="center" valign="middle" >54.05</td><td align="center" valign="middle" >37</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >cohabitation</td><td align="center" valign="middle" >162</td><td align="center" valign="middle" >38.85</td><td align="center" valign="middle" >255</td><td align="center" valign="middle" >61.15</td><td align="center" valign="middle" >417</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Married</td><td align="center" valign="middle" >195</td><td align="center" valign="middle" >51.45</td><td align="center" valign="middle" >184</td><td align="center" valign="middle" >48.55</td><td align="center" valign="middle" >379</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >divorced</td><td align="center" valign="middle" >1</td><td align="center" valign="middle" >100.00</td><td align="center" valign="middle" >0</td><td align="center" valign="middle" >0.00</td><td align="center" valign="middle" >1</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Widow</td><td align="center" valign="middle" >0</td><td align="center" valign="middle" >0.00</td><td align="center" valign="middle" >1</td><td align="center" valign="middle" >100.00</td><td align="center" valign="middle" >1</td><td align="center" valign="middle" ></td></tr></tbody></table></table-wrap><table-wrap id="1_2"><table><tbody><thead><tr><th align="center" valign="middle" >Socioeconomic Level</th><th align="center" valign="middle" ></th><th align="center" valign="middle" ></th><th align="center" valign="middle" ></th><th align="center" valign="middle" ></th><th align="center" valign="middle" ></th><th align="center" valign="middle" >0.000</th></tr></thead><tr><td align="center" valign="middle" >Low</td><td align="center" valign="middle" >251</td><td align="center" valign="middle" >47.36</td><td align="center" valign="middle" >279</td><td align="center" valign="middle" >52.64</td><td align="center" valign="middle" >530</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Average</td><td align="center" valign="middle" >116</td><td align="center" valign="middle" >47.74</td><td align="center" valign="middle" >127</td><td align="center" valign="middle" >52.26</td><td align="center" valign="middle" >243</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >High</td><td align="center" valign="middle" >8</td><td align="center" valign="middle" >12.90</td><td align="center" valign="middle" >54</td><td align="center" valign="middle" >87.10</td><td align="center" valign="middle" >62</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Spontaneous Miscarriage</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" >0.001</td></tr><tr><td align="center" valign="middle" >Yes</td><td align="center" valign="middle" >50</td><td align="center" valign="middle" >29.41</td><td align="center" valign="middle" >120</td><td align="center" valign="middle" >70.59</td><td align="center" valign="middle" >170</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >No</td><td align="center" valign="middle" >119</td><td align="center" valign="middle" >44.74</td><td align="center" valign="middle" >147</td><td align="center" valign="middle" >55.26</td><td align="center" valign="middle" >266</td><td align="center" valign="middle" ></td></tr></tbody></table></table-wrap></table-wrap-group><table-wrap id="table2" ><label><xref ref-type="table" rid="table2">Table 2</xref></label><caption><title> Distribution of encountered expectant mothers by previous onset of an induced abortion, absence of social support, gestational age, dear parent or perinatal death, abuse or rape in childhood, according to anxiety. (Parakou, 2018; N = 835)</title></caption><table><tbody><thead><tr><th align="center" valign="middle"  rowspan="2"  ></th><th align="center" valign="middle"  colspan="4"  >ANXIETY</th><th align="center" valign="middle"  colspan="2"   rowspan="2"  >Total (N)</th><th align="center" valign="middle"  rowspan="2"  >p</th></tr></thead><tr><td align="center" valign="middle"  colspan="2"  >Yes</td><td align="center" valign="middle"  colspan="2"  >No</td></tr><tr><td align="center" valign="middle" ></td><td align="center" valign="middle" >n</td><td align="center" valign="middle" >%</td><td align="center" valign="middle" >n’</td><td align="center" valign="middle" >%</td><td align="center" valign="middle"  colspan="2"  ></td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Induced Miscarriage</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle"  colspan="2"  ></td><td align="center" valign="middle" >0.023</td></tr><tr><td align="center" valign="middle" >Yes</td><td align="center" valign="middle" >18</td><td align="center" valign="middle" >26.47</td><td align="center" valign="middle" >50</td><td align="center" valign="middle" >73.53</td><td align="center" valign="middle"  colspan="2"  >68</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >No</td><td align="center" valign="middle" >151</td><td align="center" valign="middle" >41.03</td><td align="center" valign="middle" >217</td><td align="center" valign="middle" >58.97</td><td align="center" valign="middle"  colspan="2"  >368</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Absence of social support</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle"  colspan="2"  >0.022</td></tr><tr><td align="center" valign="middle" >Yes</td><td align="center" valign="middle" >32</td><td align="center" valign="middle" >60.38</td><td align="center" valign="middle" >21</td><td align="center" valign="middle" >39.62</td><td align="center" valign="middle" >53</td><td align="center" valign="middle"  colspan="2"  ></td></tr><tr><td align="center" valign="middle" >No</td><td align="center" valign="middle" >343</td><td align="center" valign="middle" >43.86</td><td align="center" valign="middle" >439</td><td align="center" valign="middle" >56.14</td><td align="center" valign="middle" >782</td><td align="center" valign="middle"  colspan="2"  ></td></tr><tr><td align="center" valign="middle" >Gestational age</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle"  colspan="2"  ></td><td align="center" valign="middle" >0.000</td></tr><tr><td align="center" valign="middle" >1st trimester</td><td align="center" valign="middle" >54</td><td align="center" valign="middle" >31.03</td><td align="center" valign="middle" >120</td><td align="center" valign="middle" >68.97</td><td align="center" valign="middle"  colspan="2"  >174</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >2nd trimester</td><td align="center" valign="middle" >143</td><td align="center" valign="middle" >44.27</td><td align="center" valign="middle" >180</td><td align="center" valign="middle" >55.73</td><td align="center" valign="middle"  colspan="2"  >323</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >3rd trimester</td><td align="center" valign="middle" >178</td><td align="center" valign="middle" >52.66</td><td align="center" valign="middle" >160</td><td align="center" valign="middle" >47.34</td><td align="center" valign="middle"  colspan="2"  >338</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle"  colspan="4"  >A dear parent or a child death</td><td align="center" valign="middle" ></td><td align="center" valign="middle"  colspan="2"  ></td><td align="center" valign="middle" >0.003</td></tr><tr><td align="center" valign="middle" >Yes</td><td align="center" valign="middle" >42</td><td align="center" valign="middle" >61.76</td><td align="center" valign="middle" >26</td><td align="center" valign="middle" >38.24</td><td align="center" valign="middle"  colspan="2"  >68</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >No</td><td align="center" valign="middle" >333</td><td align="center" valign="middle" >43.42</td><td align="center" valign="middle" >434</td><td align="center" valign="middle" >56.58</td><td align="center" valign="middle"  colspan="2"  >767</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle"  colspan="2"  >Abuse or rape in childhood</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle"  colspan="2"  ></td><td align="center" valign="middle" >0.032</td></tr><tr><td align="center" valign="middle" >Yes</td><td align="center" valign="middle" >39</td><td align="center" valign="middle" >35.45</td><td align="center" valign="middle" >71</td><td align="center" valign="middle" >64.55</td><td align="center" valign="middle"  colspan="2"  >110</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >No</td><td align="center" valign="middle" >336</td><td align="center" valign="middle" >46.34</td><td align="center" valign="middle" >389</td><td align="center" valign="middle" >53.66</td><td align="center" valign="middle"  colspan="2"  >725</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td></tr></tbody></table></table-wrap><table-wrap-group id="3"><label><xref ref-type="table" rid="table3">Table 3</xref></label><caption><title> Distribution of expectant mothers according to the educational level, socio-economic level and a previous spontaneous miscarriage, according to depression. (Parakou, 2018; N = 835)</title></caption><table-wrap id="3_1"><table><tbody><thead><tr><th align="center" valign="middle"  rowspan="2"  ></th><th align="center" valign="middle"  colspan="4"  >DEPRESSION</th><th align="center" valign="middle"  rowspan="2"  >Total (N)</th><th align="center" valign="middle"  rowspan="2"  >p</th></tr></thead><tr><td align="center" valign="middle"  colspan="2"  >Yes</td><td align="center" valign="middle"  colspan="2"  >No</td></tr><tr><td align="center" valign="middle" ></td><td align="center" valign="middle" >n</td><td align="center" valign="middle" >%</td><td align="center" valign="middle" >n’</td><td align="center" valign="middle" >%</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Educational Level</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" >0.004</td></tr><tr><td align="center" valign="middle" >Out of school</td><td align="center" valign="middle" >85</td><td align="center" valign="middle" >44.27</td><td align="center" valign="middle" >107</td><td align="center" valign="middle" >55.73</td><td align="center" valign="middle" >192</td><td align="center" valign="middle" ></td></tr></tbody></table></table-wrap><table-wrap id="3_2"><table><tbody><thead><tr><th align="center" valign="middle" >Primary</th><th align="center" valign="middle" >55</th><th align="center" valign="middle" >27.50</th><th align="center" valign="middle"  colspan="2"  >145</th><th align="center" valign="middle" >72.50</th><th align="center" valign="middle" >200</th><th align="center" valign="middle" ></th></tr></thead><tr><td align="center" valign="middle" >Secondary</td><td align="center" valign="middle" >131</td><td align="center" valign="middle" >36.09</td><td align="center" valign="middle"  colspan="2"  >232</td><td align="center" valign="middle" >63.91</td><td align="center" valign="middle" >363</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Higher</td><td align="center" valign="middle" >24</td><td align="center" valign="middle" >30.00</td><td align="center" valign="middle"  colspan="2"  >56</td><td align="center" valign="middle" >70.00</td><td align="center" valign="middle" >80</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Socioeconomic level</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle"  colspan="2"  ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" >0.000</td></tr><tr><td align="center" valign="middle" >Low</td><td align="center" valign="middle" >198</td><td align="center" valign="middle" >37.36</td><td align="center" valign="middle"  colspan="2"  >332</td><td align="center" valign="middle" >62.64</td><td align="center" valign="middle" >530</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Average</td><td align="center" valign="middle" >93</td><td align="center" valign="middle" >38.27</td><td align="center" valign="middle"  colspan="2"  >150</td><td align="center" valign="middle" >61.73</td><td align="center" valign="middle" >243</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >High</td><td align="center" valign="middle" >4</td><td align="center" valign="middle" >6.45</td><td align="center" valign="middle"  colspan="2"  >58</td><td align="center" valign="middle" >93.55</td><td align="center" valign="middle" >62</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Marital status</td><td align="center" valign="middle" ></td><td align="center" valign="middle"  colspan="2"  ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" >0.000</td></tr><tr><td align="center" valign="middle" >Single</td><td align="center" valign="middle" >14</td><td align="center" valign="middle"  colspan="2"  >37.84</td><td align="center" valign="middle" >23</td><td align="center" valign="middle" >62.16</td><td align="center" valign="middle" >37</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Cohabitation</td><td align="center" valign="middle" >91</td><td align="center" valign="middle"  colspan="2"  >21.82</td><td align="center" valign="middle" >326</td><td align="center" valign="middle" >78.18</td><td align="center" valign="middle" >417</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Married</td><td align="center" valign="middle" >188</td><td align="center" valign="middle"  colspan="2"  >49.60</td><td align="center" valign="middle" >191</td><td align="center" valign="middle" >50.40</td><td align="center" valign="middle" >379</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Divorced</td><td align="center" valign="middle" >1</td><td align="center" valign="middle"  colspan="2"  >100.00</td><td align="center" valign="middle" >0</td><td align="center" valign="middle" >0.00</td><td align="center" valign="middle" >1</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Widow</td><td align="center" valign="middle" >1</td><td align="center" valign="middle"  colspan="2"  >100.00</td><td align="center" valign="middle" >0</td><td align="center" valign="middle" >0.00</td><td align="center" valign="middle" >1</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Spontaneous miscarriage</td><td align="center" valign="middle" ></td><td align="center" valign="middle"  colspan="2"  ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" >0.000</td></tr><tr><td align="center" valign="middle" >Yes</td><td align="center" valign="middle" >100</td><td align="center" valign="middle"  colspan="2"  >58.82</td><td align="center" valign="middle" >70</td><td align="center" valign="middle" >41.18</td><td align="center" valign="middle" >170</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >No</td><td align="center" valign="middle" >74</td><td align="center" valign="middle"  colspan="2"  >27.82</td><td align="center" valign="middle" >192</td><td align="center" valign="middle" >72.18</td><td align="center" valign="middle" >266</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td></tr></tbody></table></table-wrap></table-wrap-group><table-wrap id="table4" ><label><xref ref-type="table" rid="table4">Table 4</xref></label><caption><title> Distribution of expectant mothers by onset of previous induced abortion, gestational age, difficulties during the current pregnancy, alcohol consumption, according to depression (Parakou, 2018; N = 835)</title></caption><table><tbody><thead><tr><th align="center" valign="middle"  colspan="2"   rowspan="2"  ></th><th align="center" valign="middle"  colspan="4"  >DEPRESSION</th><th align="center" valign="middle"  rowspan="2"  >Total (N)</th><th align="center" valign="middle"  colspan="2"   rowspan="2"  >p</th></tr></thead><tr><td align="center" valign="middle"  colspan="2"  >Yes</td><td align="center" valign="middle"  colspan="2"  >No</td></tr><tr><td align="center" valign="middle"  colspan="2"  ></td><td align="center" valign="middle" >n</td><td align="center" valign="middle" >%</td><td align="center" valign="middle" >n’</td><td align="center" valign="middle" >%</td><td align="center" valign="middle" ></td><td align="center" valign="middle"  colspan="2"  ></td></tr><tr><td align="center" valign="middle"  colspan="2"  >Induced abortion</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle"  colspan="2"  >0.000</td></tr><tr><td align="center" valign="middle"  colspan="2"  >Yes</td><td align="center" valign="middle" >43</td><td align="center" valign="middle" >63.24</td><td align="center" valign="middle" >25</td><td align="center" valign="middle" >36.76</td><td align="center" valign="middle" >68</td><td align="center" valign="middle"  colspan="2"  ></td></tr><tr><td align="center" valign="middle"  colspan="2"  >No</td><td align="center" valign="middle" >131</td><td align="center" valign="middle" >35.60</td><td align="center" valign="middle" >237</td><td align="center" valign="middle" >64.40</td><td align="center" valign="middle" >368</td><td align="center" valign="middle"  colspan="2"  ></td></tr><tr><td align="center" valign="middle"  colspan="2"  >Gestational age</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle"  colspan="2"  >0.032</td></tr><tr><td align="center" valign="middle"  colspan="2"  >1st trimester</td><td align="center" valign="middle" >57</td><td align="center" valign="middle" >32.76</td><td align="center" valign="middle" >117</td><td align="center" valign="middle" >67.24</td><td align="center" valign="middle" >174</td><td align="center" valign="middle"  colspan="2"  ></td></tr><tr><td align="center" valign="middle"  colspan="2"  >2nd trimester</td><td align="center" valign="middle" >101</td><td align="center" valign="middle" >31.27</td><td align="center" valign="middle" >222</td><td align="center" valign="middle" >68.73</td><td align="center" valign="middle" >323</td><td align="center" valign="middle"  colspan="2"  ></td></tr><tr><td align="center" valign="middle"  colspan="2"  >3rd trimester</td><td align="center" valign="middle" >137</td><td align="center" valign="middle" >40.53</td><td align="center" valign="middle" >201</td><td align="center" valign="middle" >59.47</td><td align="center" valign="middle" >338</td><td align="center" valign="middle"  colspan="2"  ></td></tr><tr><td align="center" valign="middle"  colspan="4"  >Difficulties duringthe current pregnancy</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle"  colspan="2"  ></td><td align="center" valign="middle" >0.000</td></tr><tr><td align="center" valign="middle" >Yes</td><td align="center" valign="middle"  colspan="2"  >116</td><td align="center" valign="middle" >50.00</td><td align="center" valign="middle" >116</td><td align="center" valign="middle" >50.00</td><td align="center" valign="middle"  colspan="2"  >232</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >No</td><td align="center" valign="middle"  colspan="2"  >179</td><td align="center" valign="middle" >29.68</td><td align="center" valign="middle" >424</td><td align="center" valign="middle" >70.32</td><td align="center" valign="middle"  colspan="2"  >603</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle"  colspan="2"  >Alcohol consumption</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle"  colspan="2"  >0.012</td></tr><tr><td align="center" valign="middle"  colspan="2"  >Yes</td><td align="center" valign="middle" >28</td><td align="center" valign="middle" >50.91</td><td align="center" valign="middle" >27</td><td align="center" valign="middle" >49.09</td><td align="center" valign="middle" >55</td><td align="center" valign="middle"  colspan="2"  ></td></tr><tr><td align="center" valign="middle"  colspan="2"  >No</td><td align="center" valign="middle" >267</td><td align="center" valign="middle" >34.23</td><td align="center" valign="middle" >513</td><td align="center" valign="middle" >65.77</td><td align="center" valign="middle" >780</td><td align="center" valign="middle"  colspan="2"  ></td></tr><tr><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td></tr></tbody></table></table-wrap><table-wrap id="table5" ><label><xref ref-type="table" rid="table5">Table 5</xref></label><caption><title> Determinants of anxiety in encountered expectant mothers (Parakou, 2018; N = 835)</title></caption><table><tbody><thead><tr><th align="center" valign="middle"  rowspan="2"  ></th><th align="center" valign="middle"  rowspan="2"  >n</th><th align="center" valign="middle"  colspan="2"  >ANXIETY</th><th align="center" valign="middle"  rowspan="2"  >OR</th><th align="center" valign="middle"  colspan="2"   rowspan="2"  >IC <sub>95%</sub></th><th align="center" valign="middle"  colspan="2"   rowspan="2"  >p-value</th></tr></thead><tr><td align="center" valign="middle" >Yes</td><td align="center" valign="middle" >%</td></tr><tr><td align="center" valign="middle" >Marital status</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle"  colspan="2"  ></td><td align="center" valign="middle"  colspan="2"  ></td></tr><tr><td align="center" valign="middle" >Single</td><td align="center" valign="middle" >37</td><td align="center" valign="middle" >17</td><td align="center" valign="middle" >45.95</td><td align="center" valign="middle" >1.33</td><td align="center" valign="middle"  colspan="2"  >0.68 - 2.63</td><td align="center" valign="middle"  colspan="2"  >0.397</td></tr><tr><td align="center" valign="middle" >Cohabitation</td><td align="center" valign="middle" >417</td><td align="center" valign="middle" >162</td><td align="center" valign="middle" >38.85</td><td align="center" valign="middle" >1</td><td align="center" valign="middle"  colspan="2"  ></td><td align="center" valign="middle"  colspan="2"  ></td></tr><tr><td align="center" valign="middle" >Married</td><td align="center" valign="middle" >379</td><td align="center" valign="middle" >195</td><td align="center" valign="middle" >51.45</td><td align="center" valign="middle" >1.66</td><td align="center" valign="middle"  colspan="2"  >1.25 - 2.21</td><td align="center" valign="middle"  colspan="2"  >0.001</td></tr><tr><td align="center" valign="middle" >Socioeconomic level</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle"  colspan="2"  ></td><td align="center" valign="middle"  colspan="2"  ></td></tr><tr><td align="center" valign="middle" >Low</td><td align="center" valign="middle" >530</td><td align="center" valign="middle" >251</td><td align="center" valign="middle" >47.36</td><td align="center" valign="middle" >6.07</td><td align="center" valign="middle"  colspan="2"  >2.83 - 13.00</td><td align="center" valign="middle"  colspan="2"  >0.000</td></tr><tr><td align="center" valign="middle" >Average</td><td align="center" valign="middle" >243</td><td align="center" valign="middle" >116</td><td align="center" valign="middle" >47.74</td><td align="center" valign="middle" >6.16</td><td align="center" valign="middle"  colspan="2"  >2.81 - 13.50</td><td align="center" valign="middle"  colspan="2"  >0.000</td></tr><tr><td align="center" valign="middle" >High</td><td align="center" valign="middle" >62</td><td align="center" valign="middle" >8</td><td align="center" valign="middle" >12.90</td><td align="center" valign="middle" >1</td><td align="center" valign="middle"  colspan="2"  ></td><td align="center" valign="middle"  colspan="2"  ></td></tr><tr><td align="center" valign="middle" >Profession</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle"  colspan="2"  ></td><td align="center" valign="middle"  colspan="2"  ></td></tr><tr><td align="center" valign="middle" >Official</td><td align="center" valign="middle" >30</td><td align="center" valign="middle" >8</td><td align="center" valign="middle" >26.67</td><td align="center" valign="middle" >1</td><td align="center" valign="middle"  colspan="2"  ></td><td align="center" valign="middle"  colspan="2"  ></td></tr><tr><td align="center" valign="middle" >Private sector worker</td><td align="center" valign="middle" >98</td><td align="center" valign="middle" >32</td><td align="center" valign="middle" >32.65</td><td align="center" valign="middle" >1.33</td><td align="center" valign="middle"  colspan="2"  >0.53 - 3.32</td><td align="center" valign="middle"  colspan="2"  >0.535</td></tr><tr><td align="center" valign="middle" >Trader/ Reseller</td><td align="center" valign="middle" >264</td><td align="center" valign="middle" >115</td><td align="center" valign="middle" >43.56</td><td align="center" valign="middle" >2.12</td><td align="center" valign="middle"  colspan="2"  >0.91 - 4.94</td><td align="center" valign="middle"  colspan="2"  >0.075</td></tr><tr><td align="center" valign="middle" >Artisan</td><td align="center" valign="middle" >226</td><td align="center" valign="middle" >108</td><td align="center" valign="middle" >47.79</td><td align="center" valign="middle" >2.51</td><td align="center" valign="middle"  colspan="2"  >1.07 - 5.89</td><td align="center" valign="middle"  colspan="2"  >0.029</td></tr><tr><td align="center" valign="middle" >Pupil/Student</td><td align="center" valign="middle" >92</td><td align="center" valign="middle" >45</td><td align="center" valign="middle" >48.91</td><td align="center" valign="middle" >2.63</td><td align="center" valign="middle"  colspan="2"  >1.06 - 6.51</td><td align="center" valign="middle"  colspan="2"  >0.032</td></tr><tr><td align="center" valign="middle" >Unemployment</td><td align="center" valign="middle" >113</td><td align="center" valign="middle" >60</td><td align="center" valign="middle" >53.10</td><td align="center" valign="middle" >3.11</td><td align="center" valign="middle"  colspan="2"  >1.27 - 7.57</td><td align="center" valign="middle"  colspan="2"  >0.009</td></tr><tr><td align="center" valign="middle" >Others</td><td align="center" valign="middle" >12</td><td align="center" valign="middle" >7</td><td align="center" valign="middle" >58.33</td><td align="center" valign="middle" >3.85</td><td align="center" valign="middle"  colspan="2"  >0.94 - 9.67</td><td align="center" valign="middle"  colspan="2"  >0.053</td></tr><tr><td align="center" valign="middle" >Trimester of pregnancy</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle"  colspan="2"  ></td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >1st trimester</td><td align="center" valign="middle" >174</td><td align="center" valign="middle" >54</td><td align="center" valign="middle" >31.03</td><td align="center" valign="middle" >1</td><td align="center" valign="middle" ></td><td align="center" valign="middle"  colspan="2"  ></td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >2nd trimester</td><td align="center" valign="middle" >323</td><td align="center" valign="middle" >143</td><td align="center" valign="middle" >44.27</td><td align="center" valign="middle" >1.76</td><td align="center" valign="middle" >1.19 - 2.60</td><td align="center" valign="middle"  colspan="2"  >0.004</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >3rd trimester</td><td align="center" valign="middle" >338</td><td align="center" valign="middle" >178</td><td align="center" valign="middle" >52.66</td><td align="center" valign="middle" >2.47</td><td align="center" valign="middle" >1.68 - 3.64</td><td align="center" valign="middle"  colspan="2"  >0.000</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Spontaneous miscarriage</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle"  colspan="2"  ></td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Yes</td><td align="center" valign="middle" >170</td><td align="center" valign="middle" >50</td><td align="center" valign="middle" >29.41</td><td align="center" valign="middle" >0.51</td><td align="center" valign="middle" >0.34 - 0.77</td><td align="center" valign="middle"  colspan="2"  >0.001</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >No</td><td align="center" valign="middle" >266</td><td align="center" valign="middle" >119</td><td align="center" valign="middle" >44.74</td><td align="center" valign="middle" >1</td><td align="center" valign="middle" ></td><td align="center" valign="middle"  colspan="2"  ></td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Induced abortion</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle"  colspan="2"  ></td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Yes</td><td align="center" valign="middle" >68</td><td align="center" valign="middle" >18</td><td align="center" valign="middle" >26.47</td><td align="center" valign="middle" >0.52</td><td align="center" valign="middle" >0.29 - 0.92</td><td align="center" valign="middle"  colspan="2"  >0.025</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >No</td><td align="center" valign="middle" >368</td><td align="center" valign="middle" >151</td><td align="center" valign="middle" >41.03</td><td align="center" valign="middle" >1</td><td align="center" valign="middle" ></td><td align="center" valign="middle"  colspan="2"  ></td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle"  colspan="3"  >Abuse or rape in childhood</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle"  colspan="2"  ></td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Yes</td><td align="center" valign="middle" >110</td><td align="center" valign="middle" >39</td><td align="center" valign="middle" >35.45</td><td align="center" valign="middle" >0.64</td><td align="center" valign="middle" >0.42 - 0.98</td><td align="center" valign="middle"  colspan="2"  >0.039</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >No</td><td align="center" valign="middle" >725</td><td align="center" valign="middle" >336</td><td align="center" valign="middle" >46.34</td><td align="center" valign="middle" >1</td><td align="center" valign="middle" ></td><td align="center" valign="middle"  colspan="2"  ></td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle"  colspan="3"  >A close one or perinatal death</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle"  colspan="2"  ></td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Yes</td><td align="center" valign="middle" >68</td><td align="center" valign="middle" >42</td><td align="center" valign="middle" >61.76</td><td align="center" valign="middle" >2.10</td><td align="center" valign="middle" >1.26 - 3.50</td><td align="center" valign="middle"  colspan="2"  >0.003</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >No</td><td align="center" valign="middle" >767</td><td align="center" valign="middle" >333</td><td align="center" valign="middle" >43.42</td><td align="center" valign="middle" >1</td><td align="center" valign="middle" ></td><td align="center" valign="middle"  colspan="2"  ></td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Absence ofsocial support</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle"  colspan="2"  ></td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Yes</td><td align="center" valign="middle" >53</td><td align="center" valign="middle" >32</td><td align="center" valign="middle" >60.38</td><td align="center" valign="middle" >1.50</td><td align="center" valign="middle" >0.85 - 2.66</td><td align="center" valign="middle"  colspan="2"  >0.157</td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >No</td><td align="center" valign="middle" >782</td><td align="center" valign="middle" >343</td><td align="center" valign="middle" >43.86</td><td align="center" valign="middle" >1</td><td align="center" valign="middle" ></td><td align="center" valign="middle"  colspan="2"  ></td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td></tr></tbody></table></table-wrap><table-wrap id="table6" ><label><xref ref-type="table" rid="table6">Table 6</xref></label><caption><title> Determinants of depression inexpectant mothers (Parakou, 2018; N = 835)</title></caption><table><tbody><thead><tr><th align="center" valign="middle"  rowspan="2"  ></th><th align="center" valign="middle"  rowspan="2"  >n</th><th align="center" valign="middle"  colspan="2"  >DEPRESSION</th><th align="center" valign="middle"  rowspan="2"  >OR</th><th align="center" valign="middle"  rowspan="2"  >IC <sub>95%</sub></th><th align="center" valign="middle"  rowspan="2"  >p-value</th></tr></thead><tr><td align="center" valign="middle" >Yes</td><td align="center" valign="middle" >%</td></tr><tr><td align="center" valign="middle" >Marital status</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Single</td><td align="center" valign="middle" >37</td><td align="center" valign="middle" >14</td><td align="center" valign="middle" >37.84</td><td align="center" valign="middle" >2.18</td><td align="center" valign="middle" >1.07 - 4.40</td><td align="center" valign="middle" >0.026</td></tr><tr><td align="center" valign="middle" >Cohabitation</td><td align="center" valign="middle" >417</td><td align="center" valign="middle" >91</td><td align="center" valign="middle" >21.82</td><td align="center" valign="middle" >1</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Married</td><td align="center" valign="middle" >379</td><td align="center" valign="middle" >188</td><td align="center" valign="middle" >49.60</td><td align="center" valign="middle" >3.52</td><td align="center" valign="middle" >2.59 - 4.79</td><td align="center" valign="middle" >0.000</td></tr><tr><td align="center" valign="middle" >Educational level</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Out of school</td><td align="center" valign="middle" >192</td><td align="center" valign="middle" >85</td><td align="center" valign="middle" >44.27</td><td align="center" valign="middle" >1.85</td><td align="center" valign="middle" >1.06 - 3.23</td><td align="center" valign="middle" >0.028</td></tr><tr><td align="center" valign="middle" >Primary</td><td align="center" valign="middle" >200</td><td align="center" valign="middle" >55</td><td align="center" valign="middle" >27.50</td><td align="center" valign="middle" >0.88</td><td align="center" valign="middle" >0.50 - 1.56</td><td align="center" valign="middle" >0.674</td></tr><tr><td align="center" valign="middle" >Secondary</td><td align="center" valign="middle" >363</td><td align="center" valign="middle" >131</td><td align="center" valign="middle" >36.09</td><td align="center" valign="middle" >1.31</td><td align="center" valign="middle" >0.78 - 2.22</td><td align="center" valign="middle" >0.301</td></tr><tr><td align="center" valign="middle" >Higher</td><td align="center" valign="middle" >80</td><td align="center" valign="middle" >24</td><td align="center" valign="middle" >30.00</td><td align="center" valign="middle" >1</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle"  colspan="2"  >Socioeconomic level</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Low</td><td align="center" valign="middle" >530</td><td align="center" valign="middle" >198</td><td align="center" valign="middle" >37.36</td><td align="center" valign="middle" >8.64</td><td align="center" valign="middle" >3.09 - 17.18</td><td align="center" valign="middle" >0.000</td></tr><tr><td align="center" valign="middle" >Average</td><td align="center" valign="middle" >243</td><td align="center" valign="middle" >93</td><td align="center" valign="middle" >38.27</td><td align="center" valign="middle" >5.93</td><td align="center" valign="middle" >2.26 - 15.51</td><td align="center" valign="middle" >0.000</td></tr><tr><td align="center" valign="middle" >High</td><td align="center" valign="middle" >62</td><td align="center" valign="middle" >4</td><td align="center" valign="middle" >6.45</td><td align="center" valign="middle" >1</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Spontaneous miscarriage</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Yes</td><td align="center" valign="middle" >170</td><td align="center" valign="middle" >100</td><td align="center" valign="middle" >58.82</td><td align="center" valign="middle" >3.70</td><td align="center" valign="middle" >2.46 - 5.56</td><td align="center" valign="middle" >0.001</td></tr><tr><td align="center" valign="middle" >No</td><td align="center" valign="middle" >266</td><td align="center" valign="middle" >74</td><td align="center" valign="middle" >27.82</td><td align="center" valign="middle" >1</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle"  colspan="2"  >Induced abortion</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Yes</td><td align="center" valign="middle" >68</td><td align="center" valign="middle" >43</td><td align="center" valign="middle" >63.24</td><td align="center" valign="middle" >3.11</td><td align="center" valign="middle" >1.81 - 5.32</td><td align="center" valign="middle" >0.000</td></tr><tr><td align="center" valign="middle" >No</td><td align="center" valign="middle" >368</td><td align="center" valign="middle" >131</td><td align="center" valign="middle" >35.60</td><td align="center" valign="middle" >1</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Trimester of pregnancy</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >1st trimester</td><td align="center" valign="middle" >174</td><td align="center" valign="middle" >57</td><td align="center" valign="middle" >32.76</td><td align="center" valign="middle" >1.07</td><td align="center" valign="middle" >0.72 - 1.58</td><td align="center" valign="middle" >0.733</td></tr><tr><td align="center" valign="middle" >2nd trimester</td><td align="center" valign="middle" >323</td><td align="center" valign="middle" >101</td><td align="center" valign="middle" >31.27</td><td align="center" valign="middle" >1</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >3rd trimester</td><td align="center" valign="middle" >338</td><td align="center" valign="middle" >137</td><td align="center" valign="middle" >40.53</td><td align="center" valign="middle" >1.49</td><td align="center" valign="middle" >1.08 - 2.06</td><td align="center" valign="middle" >0.013</td></tr><tr><td align="center" valign="middle"  colspan="4"  >Difficulties during the current pregnancy</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Yes</td><td align="center" valign="middle" >232</td><td align="center" valign="middle" >116</td><td align="center" valign="middle" >50.00</td><td align="center" valign="middle" >2.36</td><td align="center" valign="middle" >1.73 - 3.23</td><td align="center" valign="middle" >0.000</td></tr><tr><td align="center" valign="middle" >No</td><td align="center" valign="middle" >603</td><td align="center" valign="middle" >179</td><td align="center" valign="middle" >29.68</td><td align="center" valign="middle" >1</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle"  colspan="2"  >Alcohol consumption</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td></tr><tr><td align="center" valign="middle" >Yes</td><td align="center" valign="middle" >55</td><td align="center" valign="middle" >28</td><td align="center" valign="middle" >50.91</td><td align="center" valign="middle" >1.99</td><td align="center" valign="middle" >1.15 - 3.44</td><td align="center" valign="middle" >0.012</td></tr><tr><td align="center" valign="middle" >No</td><td align="center" valign="middle" >780</td><td align="center" valign="middle" >267</td><td align="center" valign="middle" >34.23</td><td align="center" valign="middle" >1</td><td align="center" valign="middle" ></td><td align="center" valign="middle" ></td></tr></tbody></table></table-wrap></sec></sec><sec id="s4"><title>4. Discussion</title><sec id="s4_1"><title>4.1. Limitations of the Study</title><p>A depression screening strategy in expectant mothers should take into account the potential chronicity of depression symptoms through repeated assessment in order to provide an intervention to the vulnerable women.</p></sec><sec id="s4_2"><title>4.2. Prevalence of Anxiety and Depression</title><sec id="s4_2_1"><title>4.2.1. Prevalence of Anxiety</title><p>The prevalence of anxiety disorders in expectant mothers was 44.91%. Unemployed pregnant women were more affected (see <xref ref-type="table" rid="table1">Table 1</xref>). Studies on maternal anxiety prevalence reported rate from 12% to 59% during pregnancy [<xref ref-type="bibr" rid="scirp.93533-ref8">8</xref>] [<xref ref-type="bibr" rid="scirp.93533-ref9">9</xref>] . Basing on Hospital Anxiety and Depression Scale, Lee et al. [<xref ref-type="bibr" rid="scirp.93533-ref10">10</xref>] found a prevalence of anxiety close to 54% in a Chinese population. However, a lower prevalence of anxiety at 23% has been reported by Heyningen et al. [<xref ref-type="bibr" rid="scirp.93533-ref11">11</xref>] , in South Africa basing on the Mini International Neuropsychiatric Interview scale. The variability of those prevalences confirm the extent of anxiety during pregnancy. All the authors agree with adverse effects of anxiety on the pregnancy outcome, mother-child interaction and the infant development. According to Capponi et al. [<xref ref-type="bibr" rid="scirp.93533-ref12">12</xref>] , mothering approaches are modified by a high level of anxiety “even non pathological”, and reflect in mother-child relationships quality. In general, the anxiety specific to pregnancy has numerous consequences on both mother and foetus [<xref ref-type="bibr" rid="scirp.93533-ref1">1</xref>] .</p></sec><sec id="s4_2_2"><title>4.2.2. Prevalence of Depression</title><p>Depressive syndrome prevalence in expectant mothers of Parakou was 35.33%. The third trimester of pregnancy was more depressogenic (see <xref ref-type="table" rid="table2">Table 2</xref>). And marriage did not protect against depression (see <xref ref-type="table" rid="table3">Table 3</xref>). In a meta-analysis, Ayano et al. [<xref ref-type="bibr" rid="scirp.93533-ref13">13</xref>] , reported a higher antenatal depression (32.10%) during the third trimester of pregnancy. Although close to the prevalence found in Parakou, that number rather assesses depression particularly at the third trimester (see <xref ref-type="table" rid="table4">Table 4</xref>). By contrast, Duko et al. [<xref ref-type="bibr" rid="scirp.93533-ref14">14</xref>] , reported 21.5% as prevalence after a similar study in Ethiopia. Basing on Life Event Scale for Pregnancy Women (LESPW) to assess stress at 12 - 16 weeks of pregnancy and at 32 - 36 weeks of pregnancy, 11.1% and 10.3% of expectant mothers developed respectively anxiety and depressive mood in Shanghai MCPC District [<xref ref-type="bibr" rid="scirp.93533-ref15">15</xref>] . The fluctuation of depression prevalences reported in expectant mothers is related to the different tools and the threshold values used.</p></sec></sec><sec id="s4_3"><title>4.3. Social Determinants of Anxiety and Depression in Expectant Mothers at Parakou</title><sec id="s4_3_1"><title>4.3.1. Deficit in Education and Economic Resources</title><p>Lack of education (OR 1.85; IC<sub>95%</sub> [1.06 - 3.23]; p = 0.028) and low socioeconomic level (OR 8.643; IC<sub>95%</sub> [09 - 17.18]; p = 0.00), have been identified as risk factors for depression in expectant mothers at Parakou (see <xref ref-type="table" rid="table1">Table 1</xref> and <xref ref-type="table" rid="table5">Table 5</xref>). Unemployed expectant mothers are mostly dependent on their partner/spouse and could suffer from deprivation. Van Heyningen et al. [<xref ref-type="bibr" rid="scirp.93533-ref11">11</xref>] , observed that a high social support seemed to reduce the risk for prenatal anxiety in South African expectant mothers who had a low income (OR 0.95; IC<sub>95%</sub> [0.91 - 0.99]). Therefore, a good socioeconomic level protects from anxiety and depression during pregnancy [<xref ref-type="bibr" rid="scirp.93533-ref16">16</xref>] . Kinser et al. [<xref ref-type="bibr" rid="scirp.93533-ref17">17</xref>] , reported the income and stressful events as the most important predictors of depression during pregnancy.</p><p>Educational levels in the sample varied. The majority had a secondary level (47%). Chan et al. [<xref ref-type="bibr" rid="scirp.93533-ref18">18</xref>] found similar results in China in 2013 (52.4%). Silva et al. [<xref ref-type="bibr" rid="scirp.93533-ref19">19</xref>] , also got the same results (41.1%) in Brazil, in 2017. Whereas Giardinelli et al. [<xref ref-type="bibr" rid="scirp.93533-ref16">16</xref>] reported almost the same frequencies of both secondary (47%) and high level (46.4%) in Italy in 2012. That difference with the observations made at Parakou is due to the fact that this study has been conducted only in public maternities which are not frequented by intellectual expectant mothers.</p></sec><sec id="s4_3_2"><title>4.3.2. Celibacy as Risk of Developing Anxiety and Depression in Pregnancy</title><p>In the multivariate logistic regression, celibacy was a risk factor (celibacy: OR = 2.18; IC<sub>95%</sub> [1.07 - 4.40]; p = 0.026) for depression in expectant mothers (see <xref ref-type="table" rid="table6">Table 6</xref>). R&#228;is&#228;nen et al., [<xref ref-type="bibr" rid="scirp.93533-ref20">20</xref>] in Finland (2014), achieved the same conclusions; (celibacy: OR = 2.86; IC<sub>95%</sub> [2.62 - 3.11]). Besides Weobong et al. in Ghana [<xref ref-type="bibr" rid="scirp.93533-ref21">21</xref>] and Duko et al., [<xref ref-type="bibr" rid="scirp.93533-ref14">14</xref>] , reported the lack of social support as a factor significantly associated with depression in pregnancy. So, single expectant mothers can be considered as vulnerable because of their poor support.</p></sec><sec id="s4_3_3"><title>4.3.3. Gynaecological and Obstetrical Factors</title><p>The risk of developing anxiety during the third trimester of pregnancy is 2.47 times higher (OR = 2.47; IC<sub>95%</sub> [1.68 - 3.64]; p = 0.000) than the one at the 1st trimester (see <xref ref-type="table" rid="table5">Table 5</xref>). The third trimester is for sure very critical for the management of risky pregnancies. Moreover, the third trimester is the period in which the expectant mother intensively lives the problem of “imaginary/real child” before the childbirth.</p><p>A previous spontaneous miscarriage potentiates 3.70 times (OR = 3.70; IC<sub>95%</sub> [2.46 - 5.56]; p = 0.001) the risk of developing depression during pregnancy in expectant mothers at Parakou. Zhu et al. [<xref ref-type="bibr" rid="scirp.93533-ref22">22</xref>] , in Singapore (2018) found a similar result (OR = 2.70; IC<sub>95%</sub> [1.55 - 4.71]; p &lt; 0.001). A previous induced abortion had the same potential risk for the onset of depression in pregnancy (OR = 3.11; IC<sub>95%</sub> [1.81 - 5.32]; p = 0.000). Pregnancy in women is a particular moment for the recurrence of past traumas and bereavements. Here, the underlying psychological constructions for the bereavement are the same [<xref ref-type="bibr" rid="scirp.93533-ref23">23</xref>] . In retrospective and observational study using a large sample including 38,000 pregnancies, Wallwiener et al. [<xref ref-type="bibr" rid="scirp.93533-ref24">24</xref>] , reported 9.3% of depression and 16.9% of anxiety disorders.</p></sec><sec id="s4_3_4"><title>4.3.4. Stressful Life Event and Alcoholism during Pregnancy</title><p>A close one or a perinatal death during pregnancy was a risk factor for anxiety (see <xref ref-type="table" rid="table5">Table 5</xref>). It increases 2.10 times (0R = 2.10; IC<sub>95%</sub> [1.26 - 3.50]; p = 0.003) the risk of developing anxiety during pregnancy. Van Heyningen et al. [<xref ref-type="bibr" rid="scirp.93533-ref11">11</xref>] , in South Africa (2017), made the same observation. All those losses assimilated to stressful events had been identified by Bayrampour et al. [<xref ref-type="bibr" rid="scirp.93533-ref25">25</xref>] as predictive factors of anxiety and depression during pregnancy. Alcohol consumption (see <xref ref-type="table" rid="table6">Table 6</xref>) during pregnancy, was associated with a higher risk of depressive mood (OR = 1.99; IC<sub>95%</sub> [1.15 - 3.44]; p = 0.012). This study doesn’t provide information on the impact of maternal addiction to alcohol on the foetus. Easey et al. [<xref ref-type="bibr" rid="scirp.93533-ref26">26</xref>] , reported through a meta-analysis, a positive association between prenatal exposure to alcohol and children with mental health problems proved by more than half of analysis.</p></sec></sec></sec><sec id="s5"><title>5. Conclusion</title><p>The risk factors found during pregnancy such as: single status, low educational level, low socioeconomic level are to be considered as true social determinants of anxiety and depression during pregnancy. They have harmful consequences on the mother and her child. Past history of spontaneous miscarriage or induced abortion, stressful life events; all those difficulties during pregnancy lead expectant mothers to alcohol consumption without regard for its damage for the unborn child. The implementation of social support seems necessary in order to help and accompany women suffering from anxiety and depression during the perinatal period.</p></sec><sec id="s6"><title>Conflicts of Interest</title><p>The authors declare no conflicts of interest regarding the publication of this paper.</p></sec><sec id="s7"><title>Cite this paper</title><p>Djidonou, A., Tognon Tchegnonsi, F., Ahouandjinou, C.C.M., Houinou Ebo, B., Bokossa, C.M., Degla, J. and Fiossi-Kpadonou, E. (2019) Prevalence and Factors Associated with Anxiety and Depression in Expectant Mothers at Parakou in 2018. Open Journal of Psychiatry, 9, 235-247. https://doi.org/10.4236/ojpsych.2019.93018</p></sec></body><back><ref-list><title>References</title><ref id="scirp.93533-ref1"><label>1</label><mixed-citation publication-type="other" xlink:type="simple">Reymond, C., Derguy, C., Wendland, J. and Loyal, D. (2019) Validation fran&amp;#231;aise d’une échelle d’anxiété spécifique à la grossesse (PRAQ-R2). Pratiques Psychologiques. https://doi.org/10.1016/j.prps.2018.11.008</mixed-citation></ref><ref id="scirp.93533-ref2"><label>2</label><mixed-citation publication-type="other" xlink:type="simple">Mourabbih, M., Serhier, Z., Arazakou, M., Agoub, M. and Bennani, M.O. (2017) Prévalence de la dépression et de l’anxiété en fin de grossesse au Maroc. 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