A systematic review and meta-analysis of the effects of antenatal anxiety on postpartum outcomes
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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.
KeywordsAntenatal anxiety Postpartum outcomes Postpartum depression Breastfeeding
Role of the sponsor
The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.
This study was funded by The Canadian Institutes of Health Research (CIHR) (Ottawa, ON, Canada), FRN 141002.
Compliance with ethical standards
Conflicts of interest
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.
This article does not contain any studies with human participants performed by any of the authors.
- 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 CrossRefGoogle Scholar
- 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.Google Scholar
- Brouwers, EPM, van Baar, AL, Pop, VJM. (2001) Maternal anxiety during pregnancy and subsequent infant development. Infant Behav Dev 24(1):95-106.Google Scholar
- 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 CrossRefGoogle Scholar
- 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 CrossRefGoogle Scholar
- 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 CrossRefGoogle Scholar
- 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 CrossRefGoogle Scholar
- 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 CrossRefGoogle Scholar
- 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 CrossRefGoogle Scholar
- 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 CrossRefGoogle Scholar
- 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 CrossRefGoogle Scholar
- 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 CrossRefGoogle Scholar
- 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 CrossRefGoogle Scholar
- 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, GenevaGoogle Scholar