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

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

doi:10.1007/s00737-018-0930-2

Review Article
Published: 06 December 2018

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

Sophie Grigoriadis^1,2,
Lisa Graves³,
Miki Peer⁴,
Lana Mamisashvili⁴,
George Tomlinson⁵,
Simone N. Vigod⁶,
Cindy-Lee Dennis⁷,
Meir Steiner⁸,
Cara Brown⁹,
Amy Cheung¹,
Hiltrud Dawson¹⁰,
Neil A. Rector¹,
Melanie Guenette¹¹ &
Margaret Richter¹

Archives of Women's Mental Health volume 22, pages 543–556 (2019)Cite this article

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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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Notes

Two studies provided only the total sample size but not the number of women with and without antenatal anxiety (Lee et al. 2007; Soderquist et al. 2009).

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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.

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Affiliations

Department of Psychiatry, Sunnybrook Health Sciences Centre and the University of Toronto, FG29 – 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
Sophie Grigoriadis, Amy Cheung, Neil A. Rector & Margaret Richter
Women’s Mood and Anxiety Clinic: Reproductive Transitions, Department of Psychiatry, FG 29, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
Sophie Grigoriadis
Department of Family and Community Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI, 49008-8017, USA
Lisa Graves
Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, F111 – 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
Miki Peer & Lana Mamisashvili
Biostatistics and Department of Medicine, Toronto General Hospital and the University of Toronto, Eaton North 13th Fl., Rm. 238 – 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
George Tomlinson
Department of Psychiatry, Women’s College Hospital and the University of Toronto, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
Simone N. Vigod
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada
Cindy-Lee Dennis
Departments of Psychiatry and Behavioural Neurosciences, St. Joseph’s Healthcare Hamilton and McMaster University, West 5th Campus, 100 West 5th St., Level 1 – Room G112, Hamilton, ON, L8N 3K7, Canada
Meir Steiner
Department of Psychiatry, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
Cara Brown
Health Promotion Consultant, Health Nexus, 180 Dundas Street West, Suite 301, Toronto, ON, M5G 1Z8, Canada
Hiltrud Dawson
Division of Neurology, St. Michael’s Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
Melanie Guenette

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

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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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Received: 20 June 2018
Accepted: 13 November 2018
Published: 06 December 2018
Issue Date: October 2019
DOI: https://doi.org/10.1007/s00737-018-0930-2

Keywords

Antenatal anxiety
Postpartum outcomes
Postpartum depression
Breastfeeding