The Relationship of Spiritual Well-Being, Antenatal Care Frequency and Sleep Quality with Anxiety: A Cross-Sectional Study

Abstract

Pregnancy is accompanied by physical and psychological changes that may increase anxiety, particularly during the third trimester, with potential consequences for maternal and fetal health. This study aimed to examine the associations between spiritual well-being, antenatal care (ANC) frequency, sleep quality, and anxiety among third-trimester pregnant women at Karawang Health Center, Sukabumi Regency. A cross-sectional study was conducted among 62 pregnant women selected using consecutive sampling. Data were collected using validated instruments, including the Spiritual Well-Being Scale (SWBS), Pittsburgh Sleep Quality Index (PSQI), and Pregnancy-Related Anxiety Questionnaire-Revised 2 (PRAQ-R2). Ethical approval was obtained from the STIKES Sukabumi Research Ethics Committee (No. 317/II.I.AU/KET.ETIK/XI/2025). Associations were analyzed using the Chi-square test, with odds ratios (ORs) and 95% confidence intervals (CIs) reported as measures of association. Low–moderate spiritual well-being was associated with higher odds of anxiety (OR = 7.27; 95% CI: 2.28–23.13; p < 0.001). Non-compliance with ANC visits was also associated with higher odds of anxiety (OR = 4.23; 95% CI: 1.28–14.03; p = 0.032), while poor sleep quality showed the largest magnitude of association (OR = 15.54; 95% CI: 4.27–56.60; p < 0.001). In conclusion, spiritual well-being, ANC frequency, and sleep quality were significantly associated with anxiety among third-trimester pregnant women. Future studies with larger and more diverse samples and longitudinal or prospective designs are recommended to further clarify the direction and strength of these associations.