PMH-C Anxiety Disorders in Pregnancy 4 — Questions and Answers
Question 1: A pregnant woman describes intense fear of childbirth, avoidance of childbirth education classes, and requests an elective cesarean section solely due to fear. This presentation is most consistent with:
- Adjustment disorder
- Tokophobia (Correct answer)
- Specific phobia, blood-injection-injury type
- Agoraphobia
Correct answer: Tokophobia
Tokophobia is a specific, debilitating fear of childbirth that can lead to requests for cesarean delivery and avoidance of childbirth-related information.
Question 2: Which benzodiazepine characteristic is most important when considering short-term use for acute anxiety in a pregnant patient near term?
- Half-life, because long-acting agents accumulate in the neonate (Correct answer)
- Receptor selectivity, because GABA-A selectivity reduces teratogenicity
- Protein binding, because high binding prevents placental transfer
- Route of administration, as oral forms do not cross the placenta
Correct answer: Half-life, because long-acting agents accumulate in the neonate
Long-acting benzodiazepines (e.g., diazepam) accumulate in the neonate due to immature hepatic metabolism, causing neonatal sedation and hypotonia; short-acting agents are preferred if use is necessary near term.
Question 3: A woman with social anxiety disorder is pregnant and relies on avoidance of prenatal group classes, pushing them to see only one provider. What complication of untreated social anxiety is most relevant in the perinatal context?
- Increased risk of gestational diabetes
- Social isolation and reduced social support, increasing postpartum depression risk (Correct answer)
- Elevated systolic blood pressure from social stress
- Preterm labor triggered by interpersonal conflict
Correct answer: Social isolation and reduced social support, increasing postpartum depression risk
Social anxiety often leads to isolation and poor social support, which are key risk factors for postpartum depression.
Question 4: Which statement best describes the relationship between prenatal anxiety and postpartum depression?
- They are unrelated conditions with distinct risk factor profiles
- Prenatal anxiety is one of the strongest predictors of postpartum depression (Correct answer)
- Postpartum depression always precedes prenatal anxiety in the same pregnancy
- Prenatal anxiety only predicts postpartum anxiety, not depression
Correct answer: Prenatal anxiety is one of the strongest predictors of postpartum depression
Prenatal anxiety is consistently identified as one of the strongest independent predictors of postpartum depression across multiple longitudinal studies.
Question 5: A PMH-C clinician recommends mindfulness-based cognitive therapy (MBCT) to a pregnant patient with recurrent anxiety. What is the primary mechanism of action of MBCT?
- Exposure and response prevention to feared stimuli
- Developing non-judgmental awareness of thoughts to break the anxiety rumination cycle (Correct answer)
- Behavioral activation to counter anxiety-driven withdrawal
- Systematic desensitization through progressive muscle relaxation
Correct answer: Developing non-judgmental awareness of thoughts to break the anxiety rumination cycle
MBCT teaches patients to observe thoughts non-judgmentally rather than automatically reacting, interrupting the ruminative cycles that sustain anxiety.
Question 6: When assessing a pregnant immigrant woman for anxiety, which culturally sensitive consideration is most critical?
- Assuming anxiety is less prevalent in non-Western cultures
- Recognizing that somatic presentations of anxiety may predominate in some cultural contexts (Correct answer)
- Applying Western diagnostic criteria without cultural adaptation
- Avoiding discussion of anxiety to respect cultural norms about mental health
Correct answer: Recognizing that somatic presentations of anxiety may predominate in some cultural contexts
In many cultures, anxiety presents primarily through somatic complaints (e.g., headaches, chest pain) rather than psychological language; culturally responsive assessment recognizes this.
Question 7: A pregnant woman with PTSD from a prior traumatic birth reports that her current pregnancy has triggered severe intrusive re-experiencing. Which specific CBT technique is most evidence-based for trauma-related intrusive symptoms?
- Behavioral activation
- Trauma-focused cognitive restructuring and prolonged exposure (Correct answer)
- Worry time scheduling
- Interoceptive exposure
Correct answer: Trauma-focused cognitive restructuring and prolonged exposure
Trauma-focused CBT incorporating cognitive restructuring and prolonged exposure (or its variants like CPT) has the strongest evidence base for PTSD intrusive symptoms.
PMH-C Anxiety Disorders in Pregnancy 4
A pregnant woman describes intense fear of childbirth, avoidance of childbirth education classes, and requests an elective cesarean section solely due to fear.
This presentation is most consistent with: