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A systematic review and meta-analysis of the effects of antenatal anxiety on postpartum outcomes

  • Sophie Grigoriadis
  • Lisa Graves
  • Miki Peer
  • Lana Mamisashvili
  • George Tomlinson
  • Simone N. Vigod
  • Cindy-Lee Dennis
  • Meir Steiner
  • Cara Brown
  • Amy Cheung
  • Hiltrud Dawson
  • Neil A. Rector
  • Melanie Guenette
  • Margaret Richter
Review Article
  • 33 Downloads

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.

Keywords

Antenatal anxiety Postpartum outcomes Postpartum depression Breastfeeding 

Notes

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.

Funding

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.

Ethics

This article does not contain any studies with human participants performed by any of the authors.

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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  • Sophie Grigoriadis
    • 1
    • 2
  • Lisa Graves
    • 3
  • Miki Peer
    • 4
  • Lana Mamisashvili
    • 4
  • George Tomlinson
    • 5
  • Simone N. Vigod
    • 6
  • Cindy-Lee Dennis
    • 7
  • Meir Steiner
    • 8
  • Cara Brown
    • 9
  • Amy Cheung
    • 1
  • Hiltrud Dawson
    • 10
  • Neil A. Rector
    • 1
  • Melanie Guenette
    • 11
  • Margaret Richter
    • 1
  1. 1.Department of PsychiatrySunnybrook Health Sciences Centre and the University of TorontoTorontoCanada
  2. 2.Women’s Mood and Anxiety Clinic: Reproductive Transitions, Department of Psychiatry, FG 29Sunnybrook Health Sciences CentreTorontoCanada
  3. 3.Department of Family and Community MedicineWestern Michigan University Homer Stryker M.D. School of MedicineKalamazooUSA
  4. 4.Evaluative Clinical Sciences, Sunnybrook Research InstituteSunnybrook Health Sciences CentreTorontoCanada
  5. 5.Biostatistics and Department of MedicineToronto General Hospital and the University of TorontoTorontoCanada
  6. 6.Department of PsychiatryWomen’s College Hospital and the University of TorontoTorontoCanada
  7. 7.Lawrence S. Bloomberg Faculty of NursingUniversity of TorontoTorontoCanada
  8. 8.Departments of Psychiatry and Behavioural NeurosciencesSt. Joseph’s Healthcare Hamilton and McMaster UniversityHamiltonCanada
  9. 9.Department of PsychiatryUniversity of TorontoTorontoCanada
  10. 10.Health Promotion Consultant, Health NexusTorontoCanada
  11. 11.Division of NeurologySt. Michael’s HospitalTorontoCanada

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