References were misinterpreted

EDITOR—Hughes et al state that “maternal anxiety in pregnancy is associated with earlier births and lower birthweight”1 and then cite two papers, one of which found no relation between anxiety and prematurity or low birth weight2; the other found no relation between anxiety and low birth weight but did find a relation between anxiety and preterm birth.3 This second study was, however, fundamentally flawed: it consisted of a highly selected group of only 90 women, less than 3% of whom had smoked, drunk alcohol in pregnancy, or taken illicit drugs.3 Assessment of the women was confined to the third trimester. The association found between anxiety and prematurity was based on 12 infants being born prematurely. No confidence intervals were given throughout the paper.

Of course researchers will always cite papers that support their observations or hypotheses. However, it is interesting that apart from misinterpreting the above papers, the authors, two based at St George's Hospital, failed to cite the St George's birthweight study of 1515 women, which measured anxiety and depression throughout pregnancy and found no association with either prematurity4 or low birth weight.5

Depression after stillbirth may simply reflect normal process of grieving

EDITOR—I was pleased …