Abstract
To systematically review and meta-analyze research investigating the association between maternal anxiety during pregnancy and outcomes for mother and baby following the immediate delivery period. MEDLINE, Medline In-Process & Other Non-Indexed Citations, PsycINFO, Embase, CINAHL, and the Cochrane library were searched. English-language, prospective studies providing data on outcomes following delivery in women with and without antenatal anxiety (defined by clinical diagnosis or score on validated scale) were included. Three-hundred-fifty-eight articles were retrieved and 13 were included. Titles and abstracts were screened; two reviewers independently reviewed full text articles, conducted quality assessments, extracted, and checked the data. Where available for > 2 studies, random effect meta-analysis was conducted and heterogeneity was quantified. Subanalyses explored moderators, regardless of heterogeneity, including type of anxiety assessment and timing, among others. There were two outcomes that were amenable to meta-analysis. Antenatal anxiety was significantly associated with postpartum depression (PPD) measured within 6 months postpartum (pooled odds ratio [OR] = 2.64, 95% CI 2.02–3.46; 8 studies), regardless of restricting analyses to those studies controlling for prenatal depression (2.45, 1.77–3.39; 6 studies). Associations were also significant when PPD was measured at 1–3 months (2.57, 1.94–3.40; 7 studies) and 6–10 months (4.42, 1.45–13.49; 3 studies). Maternal anxiety was also associated with reduced odds of breastfeeding (0.63, 0.53–0.74; 5 studies). Antenatal anxiety is associated with PPD up to the first 10 months, independent of prenatal depression, and with lower odds of breastfeeding.
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References
ACOG (2008) ACOG Practice Bulletin: Clinical management guidelines for obstetrician-gynecologists number 92, April 2008 (replaces practice bulletin number 87, November 2007). Use of psychiatric medications during pregnancy and lactation. Obstet Gynecol 111(4):1001–1020. https://doi.org/10.1097/AOG.0b013e31816fd910
Alder J, Fink N, Bitzer J, Hosli I, Holzgreve W (2007) Depression and anxiety during pregnancy: a risk factor for obstetric, fetal and neonatal outcome? A critical review of the literature. J Matern Fetal Neonatal Med 20(3):189–209. https://doi.org/10.1080/14767050701209560
Austin, MP, Hadzi-Pavlovic D, Leader L, Saint K, Parker G (2005) Maternal trait anxiety, depression and life event stress in pregnancy: relationships with infant temperament. Early Hum Dev 81(2):183–190.
Austin MP, Tully L, Parker G (2007) Examining the relationship between antenatal anxiety and postnatal depression. J Affect Disord 101(1–3):169–174. https://doi.org/10.1016/j.jad.2006.11.015
Bayrampour H, Ali E, McNeil DA, Benzies K, MacQueen G, Tough S (2016) Pregnancy-related anxiety: a concept analysis. Int J Nurs Stud 55:115–130. https://doi.org/10.1016/j.ijnurstu.2015.10.023
Biaggi A, Conroy S, Pawlby S, Pariante CM (2016) Identifying the women at risk of antenatal anxiety and depression: a systematic review. J Affect Disord 191:62–77. https://doi.org/10.1016/j.jad.2015.11.014
Brouwers, EPM, van Baar, AL, Pop, VJM. (2001) Maternal anxiety during pregnancy and subsequent infant development. Infant Behav Dev 24(1):95-106.
Clavarino AM, Mamun AA, O’Callaghan M, Aird R, Bor W, O’Callaghan F et al (2010) Maternal anxiety and attention problems in children at 5 and 14 years. J Atten Disord 13(6):658–667. https://doi.org/10.1177/1087054709347203
Coelho HF, Murray L, Royal-Lawson M, Cooper PJ (2011) Antenatal anxiety disorder as a predictor of postnatal depression: a longitudinal study. J Affect Disord 129(1–3):348–353. https://doi.org/10.1016/j.jad.2010.08.002
Davey HL, Tough SC, Adair CE, Benzies KM (2011) Risk factors for sub-clinical and major postpartum depression among a community cohort of Canadian women. Matern Child Health J 15(7):866–875. https://doi.org/10.1007/s10995-008-0314-8
Dennis CL, McQueen K (2009) The relationship between infant-feeding outcomes and postpartum depression: a qualitative systematic review. Pediatrics 123(4):e736–e751. https://doi.org/10.1542/peds.2008-1629
Dennis CL, Heaman M, Vigod S (2012) Epidemiology of postpartum depressive symptoms among Canadian women: regional and national results from a cross-sectional survey. Can J Psychiatr 57(9):537–546. https://doi.org/10.1177/070674371205700904
Dennis CL, Falah-Hassani K, Shiri R (2017) Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis. Br J Psychiatry 210(5):315–323. https://doi.org/10.1192/bjp.bp.116.187179
DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188
Dias CC, Figueiredo B (2015) Breastfeeding and depression: a systematic review of the literature. J Affect Disord 171:142–154. https://doi.org/10.1016/j.jad.2014.09.022
Ding XX, Wu YL, Xu SJ, Zhu RP, Jia XM, Zhang SF et al (2014) Maternal anxiety during pregnancy and adverse birth outcomes: a systematic review and meta-analysis of prospective cohort studies. J Affect Disord 159:103–110. https://doi.org/10.1016/j.jad.2014.02.027
Downs SH, Black N (1998) The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 52(6):377–384
Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. Bmj 315(7109):629–634
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, Initiative S (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370(9596):1453–1457. https://doi.org/10.1016/S0140-6736(07)61602-X
Fairbrother N, Janssen P, Antony MM, Tucker E, Young AH (2016) Perinatal anxiety disorder prevalence and incidence. J Affect Disord 200:148–155. https://doi.org/10.1016/j.jad.2015.12.082
Fallon V, Bennett KM, Harrold JA (2016) Prenatal anxiety and infant feeding outcomes: a systematic review. J Hum Lact 32(1):53–66. https://doi.org/10.1177/0890334415604129
Goodman JH, Chenausky KL, Freeman MP (2014) Anxiety disorders during pregnancy: a systematic review. J Clin Psychiatry 75(10):e1153–e1184. https://doi.org/10.4088/JCP.14r09035
Grigoriadis S, VonderPorten EH, Mamisashvili L, Tomlinson G, Dennis CL, Koren G et al (2013) The impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta-analysis. J Clin Psychiatry 74(4):e321–e341. https://doi.org/10.4088/JCP.12r07968
Grigoriadis S, Wilton AS, Kurdyak PA, Rhodes AE, VonderPorten EH, Levitt A et al (2017) Perinatal suicide in Ontario, Canada: a 15-year population-based study. CMAJ 189(34):E1085–E1092. https://doi.org/10.1503/cmaj.170088
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P et al (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336(7650):924–926. https://doi.org/10.1136/bmj.39489.470347.AD
Heron J, O’Connor TG, Evans J, Golding J, Glover V (2004) The course of anxiety and depression through pregnancy and the postpartum in a community sample. J Affect Disord 80(1):65–73. https://doi.org/10.1016/j.jad.2003.08.004
Huedo-Medina TB, Sanchez-Meca J, Marin-Martinez F, Botella J (2006) Assessing heterogeneity in meta-analysis: Q statistic or I2 index? Psychol Methods 11(2):193–206. https://doi.org/10.1037/1082-989x.11.2.193
Ibanez G, Bernard JY, Rondet C, Peyre H, Forhan A, Kaminski M, Saurel-Cubizolles MJ (2015) Effects of antenatal maternal depression and anxiety on children’s early cognitive development: a prospective cohort study. PLoS One 10(8):e0135849. https://doi.org/10.1371/journal.pone.0135849
Khalifeh H, Hunt IM, Appleby L, Howard LM (2016) Suicide in perinatal and non-perinatal women in contact with psychiatric services: 15 year findings from a UK national inquiry. Lancet Psychiatry 3(3):233–242. https://doi.org/10.1016/s2215-0366(16)00003-1
Lee AM, Lam SK, Sze Mun Lau SM, Chong CS, Chui HW, Fong DY (2007) Prevalence, course, and risk factors for antenatal anxiety and depression. Obstet Gynecol 110(5):1102–1112. https://doi.org/10.1097/01.aog.0000287065.59491.70
Lilliecreutz C, Sydsjo G, Josefsson A (2011) Obstetric and perinatal outcomes among women with blood- and injection phobia during pregnancy. J Affect Disord 129(1–3):289–295. https://doi.org/10.1016/j.jad.2010.08.013
Littleton HL, Breitkopf CR, Berenson AB (2007) Correlates of anxiety symptoms during pregnancy and association with perinatal outcomes: a meta-analysis. Am J Obstet Gynecol 196(5):424–432. https://doi.org/10.1016/j.ajog.2007.03.042
MacQueen GM, Frey BN, Ismail Z, Jaworska N, Steiner M, Lieshout RJ et al (2016) Canadian network for mood and anxiety treatments (CANMAT) 2016 clinical guidelines for the Management of Adults with major depressive disorder: section 6. Special populations: youth, women, and the elderly. Can J Psychiatr 61(9):588–603. https://doi.org/10.1177/0706743716659276
Martini J, Petzoldt J, Einsle F, Beesdo-Baum K, Hofler M, Wittchen HU (2015) Risk factors and course patterns of anxiety and depressive disorders during pregnancy and after delivery: a prospective-longitudinal study. J Affect Disord 175:385–395. https://doi.org/10.1016/j.jad.2015.01.012
McGowan J, Sampson M, Lefebvre C (2016) An evidence based checklist for the peer review of electronic search strategies (PRESS EBC). Evid Based Libr Inf Pract 5(1):149–154
Mehta UJ, Siega-Riz AM, Herring AH, Adair LS, Bentley ME (2011) Maternal obesity, psychological factors, and breastfeeding initiation. Breastfeed Med 6(6):369–376. https://doi.org/10.1089/bfm.2010.0052
Moher D, Liberati A, Tetzlaff J, Altman DG, Group, P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62(10):1006–1012. https://doi.org/10.1016/j.jclinepi.2009.06.005
Norhayati MN, Hazlina NH, Asrenee AR, Emilin WM (2015) Magnitude and risk factors for postpartum symptoms: a literature review. J Affect Disord 175:34–52. https://doi.org/10.1016/j.jad.2014.12.041
O’Hara MW, McCabe JE (2013) Postpartum depression: current status and future directions. Annu Rev Clin Psychol 9:379–407. https://doi.org/10.1146/annurev-clinpsy-050212-185612
O’Hara MW, Swain AM (1996) Rates and risk of postpartum depression—a meta-analysis. Int Rev Psychiatry 8(1):37–54. https://doi.org/10.3109/09540269609037816
Pavlov M, Steiner N, Kessous R, Weintraub AY, Sheiner E (2014) Obstetric and neonatal outcome in patients with anxiety disorders. J Matern Fetal Neonatal Med 27(13):1339–1342. https://doi.org/10.3109/14767058.2013.858242
Pope CJ, Mazmanian D (2016) Breastfeeding and postpartum depression: an overview and methodological recommendations for future research. Depress Res Treat 2016:4765310–4765319. https://doi.org/10.1155/2016/4765310
Rambelli C, Montagnani MS, Oppo A, Banti S, Borri C, Cortopassi C et al (2010) Panic disorder as a risk factor for post-partum depression: results from the Perinatal Depression-Research & Screening Unit (PND-ReScU) study. J Affect Disord 122(1–2):139–143. https://doi.org/10.1016/j.jad.2009.07.002
Robertson E, Grace S, Wallington T, Stewart DE (2004) Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen Hosp Psychiatry 26(4):289–295. https://doi.org/10.1016/j.genhosppsych.2004.02.006
Rose MS, Pana G, Premji S (2016) Prenatal maternal anxiety as a risk factor for preterm birth and the effects of heterogeneity on this relationship: a systematic review and meta-analysis. Biomed Res Int 2016:8312158–8312118. https://doi.org/10.1155/2016/8312158
Ross LE, Grigoriadis S, Mamisashvili L, Koren G, Steiner M, Dennis CL et al (2011) Quality assessment of observational studies in psychiatry: an example from perinatal psychiatric research. Int J Methods Psychiatr Res 20(4):224–234. https://doi.org/10.1002/mpr.356
Sharma V, Mazmanian D (2014) The DSM-5 peripartum specifier: prospects and pitfalls. Arch Womens Ment Health 17(2):171–173. https://doi.org/10.1007/s00737-013-0406-3
Soderquist J, Wijma B, Thorbert G, Wijma K (2009) Risk factors in pregnancy for post-traumatic stress and depression after childbirth. Bjog 116(5):672–680. https://doi.org/10.1111/j.1471-0528.2008.02083.x
Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D et al (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 283(15):2008–2012
Sutter-Dallay AL, Giaconne-Marcesche V, Glatigny-Dallay E, Verdoux H (2004) Women with anxiety disorders during pregnancy are at increased risk of intense postnatal depressive symptoms: a prospective survey of the MATQUID cohort. Eur Psychiatry 19(8):459–463. https://doi.org/10.1016/j.eurpsy.2004.09.025
Wells GA, Shea B, O'Connell D, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Ottawa, Canada: Department of Epidemiology and Community Medicine, University of Ottawa. Ottawa Hospital Research Institute Web site. http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm. Accessed January 2, 2016
WHO (2003) Global strategy for infant and young child feeding. World Health Organization, Geneva
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This study was funded by The Canadian Institutes of Health Research (CIHR) (Ottawa, ON, Canada), FRN 141002.
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SG has received other fees from Allergan, personal fees from Pfizer, other fees from Sage, and personal fees from Bristol Myers Squibb, outside the submitted work; no other relationships or activities that could appear to have influenced the submitted work. LG, MP, LM, GT, SNV, CLD, MS, CB, AC, HD, NR, MG, and MR report no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years and no other relationships or activities that could appear to have influenced the submitted work.
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Grigoriadis, S., Graves, L., Peer, M. et al. A systematic review and meta-analysis of the effects of antenatal anxiety on postpartum outcomes. Arch Womens Ment Health 22, 543–556 (2019). https://doi.org/10.1007/s00737-018-0930-2
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DOI: https://doi.org/10.1007/s00737-018-0930-2