Maternal Anxiety During Pregnancy and the Association With Adverse Perinatal Outcomes: Systematic Review and Meta-Analysis
Abstract
OBJECTIVE: This systematic review and meta-analysis examined the association between maternal antenatal anxiety (AA) and a range of perinatal outcomes. DATA SOURCES: Ovid MEDLINE, MEDLINE In-Process and Other Non-Indexed Citations, PsycINFO, CINAHL, Embase, and the Cochrane Library were searched to May 31, 2016, using controlled vocabulary and keywords (eg, prenatal, anxiety, preterm). STUDY SELECTION: Perinatal outcomes of women with and without AA (diagnosed or self-reported using validated scale) derived from English language, prospectively collected data were included. 1,458 abstracts were reviewed, 306 articles were retrieved, and 29 articles were included. DATA EXTRACTION: Two independent reviewers extracted data and assessed quality. Random-effects models were utilized for outcomes (≥ 3 studies). Subanalyses examined potential effect moderators including study quality and diagnostic versus self-reported anxiety among others. RESULTS: Antenatal anxiety was associated with increased odds for preterm birth (pooled odds ratio [OR] = 1.54; 95% confidence interval [CI], 1.39 to 1.70, 16 studies) and spontaneous preterm birth (OR = 1.41; 95% CI, 1.13 to 1.75), lower mean birth weight (mean difference = -55.96 g; 95% CI, -93.62 to -18.31 g), increased odds for low birth weight (OR = 1.80; 95% CI, 1.48 to 2.18), earlier gestational age (mean difference = -0.13 wk; 95% CI, -0.22 to -0.04 wk), increased odds for being small for gestational age (OR = 1.48; 95% CI, 1.26 to 1.74), and smaller head circumference (mean difference = -0.25 cm; 95% CI, -0.45 to -0.06 cm). Heterogeneity between studies was not significant for most outcomes. Subanalyses for birth weight found women with diagnosed anxiety had infants with significantly lower birth weight (P < .03) compared to those identified with rating scales (although both subanalyses were significant [P < .01]). Associations between anxiety and preeclampsia, cesarean delivery, and Apgar scores were nonsignificant. CONCLUSIONS: Antenatal anxiety is associated with multiple adverse perinatal outcomes and is not benign. The impact of treating anxiety on these associations is unknown.
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Depression and anxiety during pregnancy are associated with negative outcomes for both mother and child.
“Depression and anxiety during pregnancy are associated with negative outcomes for both mother and child (16–18).”
From Acceptance, experiences, and needs of hospitalized pregnant women toward an electronic mindfulness-based intervention: A pilot mixed-methods study (2022) · cites this paper as [18]
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Mahini, E., Hakimi, S., Shahrokhi, H., Salahi, B., Baniadam, K. O., & Ranjbar, F. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-04823-8 · Cited by 20 · see citing works
Jalal, S. M., Alsebeiy, S. H., & Alshealah, N. M. J. (2024) · Healthcare · doi:10.3390/healthcare12222227 · Cited by 20 · see citing works
“Several studies have highlighted that increased gravidity and parity are often associated with higher psychological stress and anxiety, likely due to past experiences with childbirth or complications in previous pregnancies [36–38].”
Chandra, P. S., Bajaj, A., Desai, G., Satyanarayana, V. A., Sharp, H. M., Ganjekar, S., Supraja, T. A., Jangam, K. V., Venkatram, L., & Thennarasu, K. (2021) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-021-02106-9 · Cited by 18 · see citing works
Preconception Mental Health, Socioeconomic Status, and Pregnancy Outcomes in Primiparous Women
Björkstedt, S.-M., Koponen, H., Kautiainen, H., Gissler, M., Pennanen, P., Eriksson, J. G., & Laine, M. K. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.880339 · Cited by 18 · see citing works
The approach to managing perinatal anxiety: A mini-review
Silverwood, V., Bullock, L., Turner, K. M., Chew-Graham, C. A., & Kingstone, T. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.1022459 · Cited by 18 · see citing works
Tsakiridis, I. G., Dagklis, T., Mamopoulos, A. M., Athanasiadis, A. P., Pearson, R. M., & Papazisis, G. (2021) · Journal of Perinatal Medicine · doi:10.1515/jpm-2020-0473 · Cited by 18 · see citing works
Pregnancy outcomes and anxiety in nulliparous women
Gimbel, L. A., Blue, N., Allshouse, A., Silver, R., Gimbel, B., Grobman, W., Haas, D., Simhan, H., Mercer, B., & Hatfield, T. J. (2021) · Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2021.1998441 · Cited by 13 · see citing works
“In a meta-analysis of 16 studies of pregnancy outcomes in women with anxiety, Grigoriadis and colleagues (2018) found that antenatal anxiety was associated with preterm birth, small for gestational age neonate and low birth weight [10].”
BackgroundMethodKallas, K.-A., Marr, K., Moirangthem, S., Heude, B., Koehl, M., van der Waerden, J. E. B., & Downes, N. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12031120 · Cited by 16 · see citing works
“, preterm birth, low birth weight, and intrauterine growth restriction) and short-term neonatal effects, such as increased distress after delivery and disrupted sleep patterns [6,7].”
BackgroundPrenatal Maternal Psychological Distress During the COVID-19 Pandemic and Newborn Brain Development
Weiner, S. L., Wu, Y., Kapse, K. J., Vozar, T. M., Cheng, J. J., Murnick, J. G., Henderson, D., Teramoto, H., Limperopoulos, C., & Andescavage, N. N. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.17924 · Cited by 20 · see citing works
Tibebu, N. S., Kassie, B. A., Anteneh, T. A., & Rade, B. K. (2022) · Transactions of the Royal Society of Tropical Medicine and Hygiene · doi:10.1093/trstmh/trac126 · Cited by 17 · see citing works
Perinatal Behavioral Health, the COVID-19 Pandemic, and a Social Determinants of Health Framework
Ruyak, S. L., & Kivlighan, K. T. (2021) · Journal of Obstetric, Gynecologic & Neonatal Nursing · doi:10.1016/j.jogn.2021.04.012 · Cited by 16 · see citing works
“After birth, women affected by perinatal mood and anxiety disorders were at risk for postpartum depression (Aris-Meijer et al., 2019; Grigoriadis et al., 2018), anxiety (Aris-Meijer et al.”
BackgroundBrantsæter, A. L., Garthus‐Niegel, S., Brandlistuen, R. E., Caspersen, I. H., Meltzer, H. M., & Abel, M. H. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.09.009 · Cited by 15 · see citing works
Avraham, L., Wainstock, T., Eyal, S., & Pariente, G. (2020) · Archives of Women s Mental Health · doi:10.1007/s00737-020-01018-y · Cited by 15 · see citing works
Mohammadi, F., Kohan, S., Farzi, S., Khosravi, M., & Heidari, Z. (2021) · Journal of Education and Health Promotion · doi:10.4103/jehp.jehp_105_21 · Cited by 14 · see citing works
“A lot of evidence show mental health problems, such as anxiety, during pregnancy and postpartum affect the outcomes of pregnancy like recovery, mental balance, mother attitude toward her baby, and adaptation to new role.[5,6]”
BackgroundNazir, H., Rowther, A. A., Rauf, N., Atiq, M., Kazi, A. K., Malik, A., Atif, N., & Surkan, P. J. (2022) · Health & Social Care in the Community · doi:10.1111/hsc.14019 · Cited by 14 · see citing works
Biete, C., Biete, A., Patriota, É. S. O., Gonçalves, V. S. S., Buccini, G., & Pizato, N. (2024) · Maternal and Child Nutrition · doi:10.1111/mcn.13714 · Cited by 21 · see citing works
“The occurrence of maternal mental disorders, such as anxiety and depression, during pregnancy, should be better investigated by health professionals since it is related to adverse outcomes in maternal and child health (Grigoriadis et al., 2018; Szegda et al., 2014).”
Uğuz, F., & Ak, M. (2020) · Revista Brasileira de Psiquiatria · doi:10.1590/1516-4446-2019-0792 · Cited by 13 · see citing works
Problem gambling during Covid-19
Frisone, F., Alibrandi, A., & Settineri, S. (2020) · Mediterranean Journal of Clinical Psychology · doi:10.6092/2282-1619/mjcp-2457 · Cited by 15 · see citing works
Aydin, E., Glasgow, K. A., Weiss, S. M., Austin, T., Johnson, M. H., Barlow, J., & Lloyd‐Fox, S. (2022) · Journal of Reproductive and Infant Psychology · doi:10.1080/02646838.2022.2075542 · Cited by 15 · see citing works
“, premature delivery; low birthweight) (Grigoriadis et al., 2018) in addition to a range of negative child outcomes that can persist into late adolescence including an increased risk of child behaviour problems (Stein et al.”
BackgroundMaghalian, M., Nikanfar, R., Nabighadim, M., et al. (2024) · BMC Psychology · doi:10.1186/s40359-024-01847-x · Cited by 13 · see citing works
“Maternal anxiety during pregnancy is associated with negative outcomes for both the mother and the baby, including preterm birth, low birth weight, small-for-gestational-age infants, and reduced fetal head circumference [19].”
BackgroundEstinfort, W., Huang, J., Au, H., Lin, C.-L., Chen, Y., Chao, H. J., Chien, L., Lo, Y., & Chen, Y.-H. (2022) · European Psychiatry · doi:10.1192/j.eurpsy.2022.2338 · Cited by 15 · see citing works
“Anxiety has been linked to premature birth and low birth weight [35].”
BackgroundSilverwood, V., Bullock, L., Jordan, J. L., Turner, K. M., Chew-Graham, C. A., Kingstone, T., & Dawson, S. (2023) · BJGP Open · doi:10.3399/bjgpo.2023.0022 · Cited by 16 · see citing works
Mahoney, A., Shiner, C. T., Grierson, A. B., Sharrock, M. J., Loughnan, S. A., Harrison, V., & Millard, M. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.06.008 · Cited by 13 · see citing works
Park, S., Cho, H. Y., Park, J. Y., Chung, K., & Jhung, K. (2024) · Journal of Medical Internet Research · doi:10.2196/56601 · Cited by 15 · see citing works
“Antenatal depression and anxiety increase the risk of pregnancy complications and obstetric outcomes such as preeclampsia, edema, hemorrhage, preterm birth, and low birth weight [8].”
Schiele, C., Goetz, M., Hassdenteufel, K., Müller, M., Graf, J., Zipfel, S., & Wallwiener, S. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.939577 · Cited by 12 · see citing works
Abate, H. K., Mekonnen, C. K., & Ferede, Y. M. (2021) · Risk Management and Healthcare Policy · doi:10.2147/rmhp.s320311 · Cited by 12 · see citing works
“Untreated depression can increase the risk of miscarriage, preterm labour, low Apgar score at birth, and low birth weight.(14) It also induces mental and behavioural difficulties due to changes in brain function.”
Background
- Authors
- Grigoriadis, S., Graves, L., Peer, M., Mamisashvili, L., Tomlinson, G., Vigod, S. N., Dennis, C.-L., Steiner, M., Brown, C., Cheung, A., Dawson, H., Rector, N. A., Guenette, M., & Richter, M.
- Affiliations
- Sunnybrook Health Science Centre (CA)
- Western Michigan University (US)
- University of Toronto (CA)
- St. Joseph’s Healthcare Hamilton (CA)
- St. Michael's Hospital (CA)
- Corresponding author
- Grigoriadis, Sophie
- ORCID
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2018-09-04
- Volume
- 79
- Issue
- 5
- ISSN
- 0160-6689 (ISSN-L)
- 1555-2101
- OpenAlex
- W2889131270
- Cited by
- 404
- References
- 0
- Citations by year
- 2026: 50 · 2025: 54 · 2024: 70 · 2023: 64 · 2022: 69 · 2021: 61 · 2020: 24 · 2019: 11
- FWCI
- 22.85
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research (141002_1)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Keywords
- prenatal anxiety, perinatal outcomes, preterm birth, low birth weight, small for gestational age, head circumference, preeclampsia, gestational diabetes mellitus, fetal growth restriction, macrosomia, neonatal intensive care admission, neonatal mortality, neonatal morbidity, birth weight prediction, gestational age at delivery
- MeSH terms
- Anxiety, Female, Humans, Pregnancy, Pregnancy Complications, Pregnancy Outcome
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