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Objective: To assess the association between trajectories of comorbid anxiety and depressive (CAD) symptoms assessed in each pregnancy trimester and physiological birth. Design: Large longitudinal prospective cohort study with recruitment between January 2013 and September 2014. Setting: Primary care, in the Netherlands. Population: Dutch‐speaking pregnant women with gestational age at birth ≥37 weeks, and without multiple pregnancy, severe psychiatric disorder or chronic disease history. Methods: Pregnancy‐specific anxiety and depressive symptoms were measured prospectively in each trimester of pregnancy using the negative affect subscale of the Tilburg Pregnancy Distress Scale and Edinburgh (Postnatal) Depression Scale. Data on physiological birth were obtained from obstetric records. Multivariate growth mixture modelling was performed in MPLUS to determine longitudinal trajectories of CAD symptoms. Multiple logistic regression analysis was used to examine the association between trajectories and physiological birth. Main outcome measures: Trajectories of CAD symptoms and physiological birth. Results: Seven trajectories (classes) of CAD symptoms were identified in 1682 women and subsequently merged into three groups: group 1—persistently low levels of symptoms (reference class 1; 79.0%), group 2—intermittently high levels of symptoms (classes 3, 6 and 7; 11.2%), and group 3—persistently high levels of symptoms (classes 2, 4 and 5; 9.8%). Persistently high levels of CAD symptoms (group 3) were associated with a lower likelihood of physiological birth (odds ratio 0.67, 95% confidence interval 0.47–0.95, P = 0.027) compared with the reference group (persistently low levels of symptoms), after adjusting for confounders. Conclusions: This study is the first showing evidence that persistently high CAD levels, assessed in each pregnancy trimester, are associated with a lower likelihood of physiological birth. Linked article: This article is commented on by Gustaf Rejnö, pp.506 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471‐0528.17389 This article includes Author Insights, a video abstract available at: https://vimeo.com/732411350 [ABSTRACT FROM AUTHOR]

We thank Grogan and Srinivasan[1] for writing a letter with interesting comments on our previously published article by Hulsbosch et al.[2] In this paper we investigated the association between comorbid anxiety and depressive (CAD) symptoms during pregnancy, and the likelihood of a physiological birth (defined as birth at term, free from intervention during labour, with a healthy mother and baby). Grogan and Srinivasan[1] suggest investigation of whether there is an association in our cohort between traumatic birth and persistent anxiety during pregnancy. GRAPH: ICMJE GRAPH: ICMJE GRAPH: ICMJE GRAPH: ICMJE GRAPH: ICMJE GRAPH: ICMJE GRAPH: ICMJE GRAPH: ICMJE GRAPH: ICMJE Footnotes 1 A comment on the recently published letter by Grogan and Srinivasan: The effect of antenatal depressive and anxious symptoms on the rate of physiological births. [Extracted from the article]