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Anxiety Disorders

  • Giampaolo Perna
  • Ylenia Barone
  • Alessandra Alciati
Chapter

Abstract

Pregnancy and the puerperium are associated with high vulnerability to mental illnesses. Anxiety disorders, which have not been extensively studied, are common during the perinatal period, and their actual prevalence is probably underestimated. Studies on the pharmacological effects of drugs during pregnancy are inconclusive, and further research is needed to devise clear guidance. Overall, psychotherapeutic treatment should be the first choice for mild anxious symptoms, whereas drugs should be considered for moderate-to-severe anxiety. “No treatment” is not a valid alternative because of the well-documented medical and psychological consequences of untreated maternal anxiety on newborns. Therefore, identifying perinatal anxiety disorders is crucial for providing valid treatment options to the future mother and preventing any consequences for the child.

Keywords

Perinatal period Pregnancy Postpartum Anxiety disorders Panic disorder Generalized anxiety Social phobia Specific phobia Benzodiazepines Antidepressants 

References

  1. 1.
    O’Hara MW, Wisner KL. Perinatal mental illness: definition, description and aetiology. Best Pract Res Clin Obstet Gynaecol. 2014;28:3–12.CrossRefGoogle Scholar
  2. 2.
    Vesga-López O, Blanco C, Keyes K, Olfson M, Grant BF, Hasin DS. Psychiatric disorders in pregnant and postpartum women in the United States. Arch Gen Psychiatry. 2008;65:805–15.CrossRefGoogle Scholar
  3. 3.
    Huizink AC, Menting B, Oosterman M, Verhage ML, Kunseler FC, Schuengel C. The interrelationship between pregnancy-specific anxiety and general anxiety across pregnancy: a longitudinal study. J Psychosom Obstet Gynaecol. 2014;35:92–100.CrossRefGoogle Scholar
  4. 4.
    Austin MP, Tully L, Parker G. Examining the relationship between antenatal anxiety and postnatal depression. J Affect Disord. 2007;101:169–74.CrossRefGoogle Scholar
  5. 5.
    Heron J, O’Connor TG, Evans J, Golding J, Glover V, Study Team ALSPAC. The course of anxiety and depression through pregnancy and the postpartum in a community sample. J Affect Disord. 2004;80:65–73.CrossRefGoogle Scholar
  6. 6.
    Dennis CL, Falah-Hassani K, Shiri R. Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis. Br J Psychiatry. 2017;210:315–23.CrossRefGoogle Scholar
  7. 7.
    Goodman JH, Chenausky KL, Freeman MP. Anxiety disorders during pregnancy: a systematic review. J Clin Psychiatry. 2014;75:1153–84.CrossRefGoogle Scholar
  8. 8.
    Marchesi C, Ossola P, Amerio A, Daniel BD, Tonna M, De Panfilis C. Clinical management of perinatal anxiety disorders: a systematic review. J Affect Disord. 2016;190:543–50.CrossRefGoogle Scholar
  9. 9.
    Adewuya AO, Ola BA, Aloba OO, Mapayi BM. Anxiety disorders among Nigerian women in late pregnancy: a controlled study. Arch Womens Ment Health. 2006;9:325–8.CrossRefGoogle Scholar
  10. 10.
    Bar-Shai M, Gott D, Kreinin I, Marmor S. Atypical presentations of pregnancy-specific generalized anxiety disorders in women without a previous psychiatric background. Psychosomatics. 2015;56:286–91.CrossRefGoogle Scholar
  11. 11.
    Fairbrother N, Young AH, Zhang A, Janssen P, Antony MM. The prevalence and incidence of perinatal anxiety disorders among women experiencing a medically complicated pregnancy. Arch Womens Ment Health. 2017;20:311–9.CrossRefGoogle Scholar
  12. 12.
    Guler O, Sahin FK, Emul HM, Ozbulut O, Gecici O, Uguz F, Gezginc K, Zeytinci IE, Karatayli S, Askin R. The prevalence of panic disorder in pregnant women during the third trimester of pregnancy. Compr Psychiatry. 2008;49:154–8.CrossRefGoogle Scholar
  13. 13.
    Alder J, Fink N, Bitzer J, Hösli I, Holzgreve W. 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. 2007;20:189–209.CrossRefGoogle Scholar
  14. 14.
    O’Connor TG, Heron J, Golding J, Beveridge M, Glover V. Maternal antenatal anxiety and children’s behavioural/emotional problems at 4 years. Report from the Avon Longitudinal Study of Parents and Children. Br J Psychiatry. 2002;180:502–8.CrossRefGoogle Scholar
  15. 15.
    Dunkel Schetter C, Tanner L. Anxiety, depression and stress in pregnancy: implications for mothers, children, research, and practice. Curr Opin Psychiatry. 2012;25:141–8.CrossRefGoogle Scholar
  16. 16.
    O’Donnell KJ, Bugge Jensen A, Freeman L, Khalife N, O’Connor TG, Glover V. Maternal prenatal anxiety and downregulation of placental 11β HSD2. Psychoneuroendocrinology. 2012;37:818–26.CrossRefGoogle Scholar
  17. 17.
    Winkel S, Einsle F, Pieper L, Höfler M, Wittchen HU, Martini J. Associations of anxiety disorders, depressive disorders and body weight with hypertension during pregnancy. Arch Womens Ment Health. 2015;18:473–83.CrossRefGoogle Scholar
  18. 18.
    Rubertsson C, Hellström J, Cross M, Sydsjö G. Anxiety in early pregnancy: prevalence and contributing factors. Arch Womens Ment Health. 2014;17:221–8.CrossRefGoogle Scholar
  19. 19.
    Farias DR, Pinto Tde J, Teofilo MM, Vilela AA, Vaz Jdos S, Nardi AE, Kac G. Prevalence of psychiatric disorders in the first trimester of pregnancy and factors associated with current suicide risk. Psychiatry Res. 2013;210:962–8.CrossRefGoogle Scholar
  20. 20.
    George A, Luz RF, De Tychey C, Thilly N, Spitz E. Anxiety symptoms and coping strategies in the perinatal period. BMC Pregnancy Childbirth. 2013;13:233.CrossRefGoogle Scholar
  21. 21.
    Arch JJ. Pregnancy-specific anxiety: which women are highest and what are the alcohol-related risks? Compr Psychiatry. 2013;54:217–28.CrossRefGoogle Scholar
  22. 22.
    Sanchez SE, Puente GC, Atencio G, Qiu C, Yanez D, Gelaye B, Williams MA. Risk of spontaneous preterm birth in relation to maternal depressive, anxiety, and stress symptoms. J Reprod Med. 2013;58:25–33.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Uguz F, Sonmez EO, Sahingoz M, Gokmen Z, Basaran M, Gezginc K, Sonmez G, Kaya N, Erdem SS, Cicekler H, Tasyurek E. Maternal generalized anxiety disorder during pregnancy and fetal brain development: a comparative study on cord blood brain-derived neurotrophic factor levels. J Psychosom Res. 2013;75:346–50.CrossRefGoogle Scholar
  24. 24.
    Teixeira JM, Fisk NM, Glover V. Association between maternal anxiety in pregnancy and increased uterine artery resistance index: cohort based study. BMJ. 1999;318:153–7.CrossRefGoogle Scholar
  25. 25.
    Martini J, Knappe S, Beesdo-Baum K, Lieb R, Wittchen HU. Anxiety disorders before birth and self-perceived distress during pregnancy: associations with maternal depression and obstetric, neonatal and early childhood outcomes. Early Hum Dev. 2010;86:305–10.CrossRefGoogle Scholar
  26. 26.
    Van den Bergh BR, Marcoen A. High antenatal maternal anxiety is related to ADHD symptoms, externalizing problems, and anxiety in 8- and 9-year-olds. Child Dev. 2004;75:1085–97.CrossRefGoogle Scholar
  27. 27.
    Hunter SK, Mendoza JH, D’Anna K, Zerbe GO, McCarthy L, Hoffman C, Freedman R, Ross RG. Antidepressants may mitigate the effects of prenatal maternal anxiety on infant auditory sensory gating. Am J Psychiatry. 2012;169:616–24.CrossRefGoogle Scholar
  28. 28.
    Clavarino AM, Mamun AA, O’Callaghan M, Aird R, Bor W, O’Callaghan F, Williams GM, Marrington S, Najman JM, Alati R. Maternal anxiety and attention problems in children at 5 and 14 years. J Atten Disord. 2010;13:658–67.CrossRefGoogle Scholar
  29. 29.
    Meltzer-Brody S. New insights into perinatal depression: pathogenesis and treatment during pregnancy and postpartum. Dialogues Clin Neurosci. 2011;13:89–100.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Ornoy A, Koren G. Selective serotonin reuptake inhibitors in human pregnancy: on the way to resolving the controversy. Semin Fetal Neonatal Med. 2014;19:188–94.CrossRefGoogle Scholar
  31. 31.
    Hanley GE, Oberlander TF. The effect of perinatal exposures on the infant: antidepressants and depression. Best Pract Res Clin Obstet Gynaecol. 2014;28:37–48.CrossRefGoogle Scholar
  32. 32.
    Huybrechts KF, Hernández-Díaz S, Avorn J. Antidepressant use in pregnancy and the risk of cardiac defects. N Engl J Med. 2014;371:1168–9.PubMedGoogle Scholar
  33. 33.
    Alehan F, Saygi S, Tarcan A, Gürakan B. Prolonged neonatal complications after in utero exposure to fluoxetine. J Matern Fetal Neonatal Med. 2008;21:921–3.CrossRefGoogle Scholar
  34. 34.
    Laine K, Heikkinen T, Ekblad U, Kero P. Effects of exposure to selective serotonin reuptake inhibitors during pregnancy on serotonergic symptoms in newborns and cord blood monoamine and prolactin concentrations. Arch Gen Psychiatry. 2003;60:720–6.CrossRefGoogle Scholar
  35. 35.
    Bérard A, Sheehy O, Zhao JP, Vinet É, Bernatsky S, Abrahamowicz M. SSRI and SNRI use during pregnancy and the risk of persistent pulmonary hypertension of the newborn. Br J Clin Pharmacol. 2017;83:1126–33.CrossRefGoogle Scholar
  36. 36.
    Westin AA, Brekke M, Molden E, Skogvoll E, Spigset O. Selective serotonin reuptake inhibitors and venlafaxine in pregnancy: changes in drug disposition. PLoS One. 2017;12:e0181082.CrossRefGoogle Scholar
  37. 37.
    Iqbal MM, Sobhan T, Ryals T. Effects of commonly used benzodiazepines on the fetus, the neonate, and the nursing infant. Psychiatr Serv. 2002;53:39–49.CrossRefGoogle Scholar
  38. 38.
    McElhatton PR. The effects of benzodiazepine use during pregnancy and lactation. Reprod Toxicol. 1994;8:461–75.CrossRefGoogle Scholar
  39. 39.
    Wikner BN, Stiller CO, Bergman U, Asker C, Källén B. Use of benzodiazepines and benzodiazepine receptor agonists during pregnancy: neonatal outcome and congenital malformations. Pharmacoepidemiol Drug Saf. 2007;16:1203–10.CrossRefGoogle Scholar
  40. 40.
    National Institute for Health and Care Excellence. Antenatal and postnatal mental health: clinical management and service guidance. NICE clinical guideline 192. 2014.Google Scholar
  41. 41.
    Taylor D, Paton C, Kapur S. The Maudsley prescribing guidelines in psychiatry. 11th ed. Wiley-Blackwell: Hoboken, NJ; 2012.Google Scholar
  42. 42.
    Andrisano C, Chiesa A, Serretti A. Newer antidepressants and panic disorder: a meta-analysis. Int Clin Psychopharmacol. 2013;28:33–45.CrossRefGoogle Scholar
  43. 43.
    Uguz F, Sahingoz M, Gungor B, Askin R. Low-dose imipramine for treatment of panic disorder during pregnancy: a retrospective chart review. J Clin Psychopharmacol. 2014;34:513–5.CrossRefGoogle Scholar
  44. 44.
    Uguz F. A pharmacological approach to panic disorder during pregnancy. J Matern Fetal Neonatal Med. 2016;29:1468–75.CrossRefGoogle Scholar
  45. 45.
    Marchesi C. Pharmacological management of panic disorder. Neuropsychiatr Dis Treat. 2008;4:93–106.CrossRefGoogle Scholar
  46. 46.
    Reinhold JA, Rickels K. Pharmacological treatment for generalized anxiety disorder in adults: an update. Expert Opin Pharmacother. 2015;16:1669–81.CrossRefGoogle Scholar
  47. 47.
    Stein MB, Sareen J. Clinical practice. Generalized anxiety disorder. N Engl J Med. 2015;373:2059–68.CrossRefGoogle Scholar
  48. 48.
    Misri S, Abizadeh J, Sanders S, Swift E. Perinatal generalized anxiety disorder: assessment and treatment. J Women’s Health. 2015;24:762–70.CrossRefGoogle Scholar
  49. 49.
    Bérard A, Iessa N, Chaabane S, Muanda FT, Boukhris T, Zhao JP. The risk of major cardiac malformations associated with paroxetine use during the first trimester of pregnancy: a systematic review and meta-analysis. Br J Clin Pharmacol. 2016;81:589–604.CrossRefGoogle Scholar
  50. 50.
    Gentile S. SSRIs in pregnancy and lactation: emphasis on neurodevelopmental outcome. CNS Drugs. 2005;19:623–33.CrossRefGoogle Scholar
  51. 51.
    Orsolini L, Bellantuono C. Serotonin reuptake inhibitors and breastfeeding: a systematic review. Hum Psychopharmacol. 2015;30:4–20.CrossRefGoogle Scholar
  52. 52.
    Bellantuono C, Vargas M, Mandarelli G, Nardi B, Martini MG. The safety of serotonin-noradrenaline reuptake inhibitors (SNRIs) in pregnancy and breastfeeding: a comprehensive review. Hum Psychopharmacol. 2015;30:143–51.CrossRefGoogle Scholar
  53. 53.
    Goodman JH, Watson GR, Stubbs B. Anxiety disorders in postpartum women: A systematic review and meta-analysis. J Affect Disord. 2016;203:292–331.CrossRefGoogle Scholar
  54. 54.
    Demšar K, Svetina M, Verdenik I, Tul N, Blickstein I, Globevnik Velikonja V. Tokophobia (fear of childbirth): prevalence and risk factors. J Perinat Med. 2018;46:151–4.CrossRefGoogle Scholar
  55. 55.
    Weaver J, Browne J, Aras-Payne A, Magill-Cuerden J. A comprehensive systematic review of the impact of planned interventions offered to pregnant women who have requested a caesarean section as a result of tokophobia (fear of childbirth). JBI Libr Syst Rev. 2012;10:1–20.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Giampaolo Perna
    • 1
    • 2
    • 3
    • 4
  • Ylenia Barone
    • 1
  • Alessandra Alciati
    • 1
    • 5
  1. 1.Department of Clinical NeurosciencesVilla San Benedetto Menni – Hermanas HospitalariasComo LakeItaly
  2. 2.Humanitas UniversityRozzanoItaly
  3. 3.Department of Psychiatry and NeuropsychologyUniversity of MaastrichtMaastrichtThe Netherlands
  4. 4.Department of Psychiatry and Behavioral Sciences, Leonard Miller School of MedicineUniversity of MiamiCoral GablesUSA
  5. 5.Humanitas Clinical and Research CenterRozzanoItaly

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