(228) The Influence of Social Determinants on Antenatal Anxiety and Physical Activity: A Step Forward

Objective: Physical activity is important for physical and mental health, yet most pregnant people do not achieve the recommended 150 minutes of aerobic exercise per week. People from lower socioeconomic backgrounds are even less likely to meet this target, yet it is unclear why. To see if socioeconomic stress is a contributing factor, we evaluated whether socioeconomic status (SES) modified the association between anxiety and physical activity.

Study Design: In 2021 and 2022, this prospective study recruited pregnant outpatients with singleton gestations between 16 and 36 weeks. Clinical anxiety was the mental health exposure, defined as State-Trait Anxiety Inventory [STAI] score > 80 at enrollment. The primary outcome was average daily physical activity (steps, metabolic equivalent tasks [METs], and moderate-to-vigorous-physical-activity bursts [MVPAs]), obtained from accelerometer watches worn for 7 days. Socioeconomic variables were self-reported via surveys: low household income, education ≤ high school, or public insurance were defined as low SES. The relationship between physical activity and anxiety was assessed using linear generalized estimating equations adjusting for maternal age, body mass index and low SES. We assessed effect modification between anxiety and SES using interaction terms.

Results: 40 pregnant people were enrolled. Anxiety was significantly associated with lower steps, METs, and MVPAs per day (p=0.01, p=0.02, p< 0.01, Table 1). Effect modification was detected, such that people with positive anxiety screening scores and low SES had fewer steps [ß coefficient -3619, 95% confidence interval (CI) -6451, -788, p-interaction=0.01, Figure 1].

Conclusion: Positive anxiety screening was associated with lower physical activity over the subsequent 7 days. This was heightened for people with anxiety and lower SES, who had 3619 fewer daily steps than those with higher SES and no anxiety. Improving physical activity among pregnant people with anxiety, especially those from lower SES backgrounds, is warranted.