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Arch Womens Ment Health. 2019 Oct;22(5):543-556. doi: 10.1007/s00737-018-0930-2. Epub 2018 Dec 6.

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

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Department of Psychiatry, Sunnybrook Health Sciences Centre and the University of Toronto, FG29 - 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
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.
Department of Family and Community Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI, 49008-8017, USA.
Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, F111 - 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
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.
Department of Psychiatry, Women's College Hospital and the University of Toronto, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada.
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.
Department of Psychiatry, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.
Department of Psychiatry, Sunnybrook Health Sciences Centre and the University of Toronto, FG29 - 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
Health Promotion Consultant, Health Nexus, 180 Dundas Street West, Suite 301, Toronto, ON, M5G 1Z8, Canada.
Division of Neurology, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.


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.


Antenatal anxiety; Breastfeeding; Postpartum depression; Postpartum outcomes


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