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.
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