PMH-C Anxiety Disorders in Pregnancy 2 — Questions and Answers
Question 1: A pregnant woman in her third trimester reports persistent worry about fetal well-being, difficulty sleeping, and muscle tension lasting 8 months. Which diagnosis best fits?
- Adjustment disorder with anxious mood
- Generalized anxiety disorder (Correct answer)
- Somatic symptom disorder
- Illness anxiety disorder
Correct answer: Generalized anxiety disorder
GAD requires excessive worry about multiple domains, difficulty controlling the worry, and at least 3 somatic symptoms (e.g., sleep disturbance, muscle tension) persisting ≥6 months.
Question 2: Which fetal outcome has been most consistently associated with untreated severe maternal anxiety during pregnancy?
- Congenital cardiac defects
- Preterm birth (Correct answer)
- Macrosomia
- Polyhydramnios
Correct answer: Preterm birth
Robust evidence links severe prenatal anxiety to increased risk of preterm birth, likely mediated by stress hormones and inflammatory pathways.
Question 3: A clinician uses the Generalized Anxiety Disorder 7-item scale (GAD-7) in the first trimester. What score indicates moderate anxiety warranting clinical attention?
- ≥5
- ≥10 (Correct answer)
- ≥15
- ≥20
Correct answer: ≥10
GAD-7 scores of 5, 10, and 15 correspond to mild, moderate, and severe anxiety thresholds; ≥10 indicates moderate severity warranting further evaluation.
Question 4: A woman with pre-existing OCD becomes pregnant and notices contamination obsessions intensifying. What is the recommended first-line pharmacotherapy?
- Buspirone
- Selective serotonin reuptake inhibitor (Correct answer)
- Benzodiazepine
- Tricyclic antidepressant
Correct answer: Selective serotonin reuptake inhibitor
SSRIs remain first-line pharmacotherapy for OCD in pregnancy due to their established safety profile and efficacy.
Question 5: Which cognitive distortion is most characteristic of health anxiety (illness anxiety disorder) in pregnant women?
- All-or-nothing thinking about birth outcomes
- Catastrophic misinterpretation of normal pregnancy symptoms as signs of serious fetal illness (Correct answer)
- Overgeneralization from a prior miscarriage
- Mind reading about clinicians' concerns
Correct answer: Catastrophic misinterpretation of normal pregnancy symptoms as signs of serious fetal illness
Illness anxiety disorder is defined by catastrophic misinterpretation of benign bodily sensations as evidence of serious disease.
Question 6: During a perinatal mental health assessment, a woman describes recurrent intrusive thoughts of accidentally harming her unborn baby that she finds deeply distressing and ego-dystonic. The most appropriate response is to:
- Refer immediately to child protective services
- Recognize this as a common OCD symptom and assess further (Correct answer)
- Diagnose perinatal psychosis and consider hospitalization
- Dismiss the thoughts as normal pregnancy worries
Correct answer: Recognize this as a common OCD symptom and assess further
Ego-dystonic intrusive thoughts about harming a baby are a hallmark OCD symptom and are very different from psychotic command hallucinations; CPS referral is not warranted.
Question 7: Which nonpharmacological intervention has the strongest evidence base for treating anxiety disorders during pregnancy?
- Psychodynamic psychotherapy
- Cognitive-behavioral therapy (Correct answer)
- Supportive counseling
- Mindfulness-based art therapy
Correct answer: Cognitive-behavioral therapy
CBT has the strongest evidence base for anxiety disorders in the perinatal period, with multiple RCTs demonstrating efficacy.
PMH-C Anxiety Disorders in Pregnancy 2
A pregnant woman in her third trimester reports persistent worry about fetal well-being, difficulty sleeping, and muscle tension lasting 8 months.
Which diagnosis best fits?