Cited by 406Maternal Mental Health During Pregnancy and PostpartumMaternal and Neonatal HealthcareMaternal and Perinatal Health Interventions

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Maternal Anxiety During Pregnancy and the Association With Adverse Perinatal Outcomes: Systematic Review and Meta-Analysis

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·2018·The Journal of Clinical Psychiatry

DOI 10.4088/jcp.17r12011

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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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Psychometric properties of the Greek versions of the Pandemic-Related Pregnancy Stress Scale and the Pandemic-Related Postpartum Stress Scale and associated risk factors during the second year of the COVID-19 pandemic
Siafaka, V., Tsonis, O., Christogiannis, C., Kontouli, K., Margariti, K., Barbalia, Z., Flindris, S., Manifava, E., Paschopoulou, K. I., Tzioras, S., et al. (2023) · BJPsych Open · doi:10.1192/bjo.2022.635 · Cited by 6
A Clinical Review of the Use of Common Psychiatric Medications in Pregnancy
Lubotzky‐Gete, S., Barker, L. C., & Vigod, S. N. (2023) · Obstetrics and Gynecology Clinics of North America · doi:10.1016/j.ogc.2022.10.009 · Cited by 6
Self-citation
Postpartum experiences among individuals with suspected and confirmed prenatal generalized anxiety disorder during the COVID-19 pandemic: Implications for help-seeking
Koire, A. M., Feldman, N., Erdei, C., Mittal, L. P., & Liu, C. H. (2023) · Psychiatry Research · doi:10.1016/j.psychres.2023.115169 · Cited by 7
“, 2017), meta-analysis supports a consistent association indicating that anxiety symptoms during pregnancy have negative consequences for child health (Grigoriadis et al., 2018).”
Result
Perinatal outcomes of Aboriginal women with mental health disorders
Adane, A. A., Shepherd, C., Walker, R., Bailey, H. D., Galbally, M., & Marriott, R. (2023) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/00048674231160986 · Cited by 8
“Our effect estimates for the associations between common mental disorders (including depression and anxiety) and low birthweight and preterm birth are comparable with the extant findings among studies of mainstream populations (Ding et al., 2014; Ghimire et al., 2021; Grigoriadis et al., 2018).”
Result
Regulatory T-cell phenotypes in prenatal psychological distress
Wiley, K. S., Kwon, D., Knorr, D. A., & Fox, M. M. (2023) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2023.11.033 · Cited by 6
“…anxiety are associated with an increased risk of pregnancy complications and adverse birth outcomes (Accortt et al., 2021; Cole-Lewis et al., 2014; Grigoriadis et al., 2018; Ramos et al., 2019), as well as risk of developmental and health problems for offspring (Dunkel Schetter and Tanner, 2012;…”
The role of benzodiazepines in common conditions: a narrative review focusing on lormetazepam
Pallanti, S. (2024) · International Clinical Psychopharmacology · doi:10.1097/yic.0000000000000529 · Cited by 7
“…meta-analysis indicated that, like insomnia, anxiety during pregnancy was associated with an increased risk of low birth weight and preterm birth (Grigoriadis et al. , 2018), consistent with an etiological relationship between anxiety and insomnia mediated by inflammatory and endocrine…”
Background
Partner delivered relaxation massage to support mild antenatal anxiety; views of participants
Hall, H. G., Lauche, R., Fogarty, S., Kloester, J., Carr, B. L., & Munk, N. (2021) · Midwifery · doi:10.1016/j.midw.2021.103229 · Cited by 6
Validation of the anxiety subscale of the Spanish version of the Edinburgh Postnatal Depression Scale (EPDS-A)
Gomà, M., Gordo, L., Cozodoy, E., Iriarte, L., Prims, E., Ferrer, J., Sánchez, C., Llairó, A., & Arias-Pujol, E. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1294206 · Cited by 5
“…anxiety correlates with a high likelihood of experiencing preterm birth, spontaneous preterm birth, reduced mean birth weight, an increased likelihood of low birth weight, a shorter gestational age, the baby’s elevated risk of being small for gestational age, and a smaller head circumference (11).”
Background
A Supported Online Resilience-Enhancing Intervention for Pregnant Women: A Non-Randomized Pilot Study
Haeken, S. V., Braeken, M., Groenen, A., & Bogaerts, A. (2024) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph21020209 · Cited by 6
“Prevalence rates of maternal mental health problems (MMHPs) are around 20% [3,4], and are associated with adverse obstetric outcomes (e.g., preterm birth) [5–7].”
Background
Mental health concerns during pregnancy associated with the risk of preterm birth: A retrospective cohort study
Zhang, M., Zhou, N., Chen, X., Li, Q., Zhang, C., Tang, Y., Ming, X., Zhou, W., Qi, H., & Zhou, W. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.09.044 · Cited by 6
The complex interaction between oestrogen receptor genes, oestradiol, and perinatal mood
Zorzini, G., Johann, A., Đukić, J., & Ehlert, U. (2025) · Dialogues in Clinical Neuroscience · doi:10.1080/19585969.2025.2482126 · Cited by 5
“…to suicide (Orsolini et al. 2016). associated negative outcomes have also been observed in children, such as a lower likelihood of being breastfed (Grigoriadis et al. 2018) and potential impairments in cognitive development (slomian et al. 2019). so far, various psychosocial and biological…”
Poor neonatal adaptation syndrome: Toward a clinical consensus to guide research and counseling
Carlini, S. V., & Deligiannidis, K. M. (2021) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13386 · Cited by 5
The Effect of Reflexology on the Anxiety of Pregnant Women During Labor: A Systematic Review and Meta-Analysis
Abbaszadeh, Z., Malakouti, J., Maghalian, M., & Mirghafourvand‬‬‬‬‬‬‬‬‬‬‬‬‬‬, M. (2022) · Current Women s Health Reviews · doi:10.2174/1573404818666220527095739 · Cited by 5
Pregnant at the start of the pandemic: a content analysis of COVID-19-related posts on online pregnancy discussion boards
Choi, R. J., Nagappan, A., Kopyto, D., & Wexler, A. (2022) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-022-04802-z · Cited by 5
Early predictors of short duration of exclusive breastfeeding among Havana women
Esquivel, M., Vera, Y. F., Dennis, C., Lye, S. J., Quesada, M. R., González, C. F., Valdés, G. Á., Pérez, V. I. T., & Rancel, M. H. (2022) · Clinical Epidemiology and Global Health · doi:10.1016/j.cegh.2022.101098 · Cited by 6
Self-citation
Relationship between Depression and Anxiety during Pregnancy, Delivery-Related Outcomes, and Healthcare Utilization in Michigan Medicaid, 2012–2021
Zivin, K., Zhang, X., Tilea, A. M., Clark, S. J., & Hall, S. V. (2023) · Healthcare · doi:10.3390/healthcare11222921 · Cited by 5
An investigation into the correlation between early‐to‐mid pregnancy exercise combined with cognitive behavioral therapy and anxiety levels and quality of life in patients
Mei, Q., Chen, X., Liu, L., & Xiao, G. (2024) · Journal of obstetrics and gynaecology research · doi:10.1111/jog.15858 · Cited by 8
“35 Additionally, high levels of anxiety during pregnancy are also associated with emotional and behavioral problems in children, such as inattention and hyperactivity.”
Background
Diagnosis of Perinatal Mental Health Conditions Following Medicaid Expansion to Include Low-Income Immigrants
Rodriguez, M. I., Acevedo, A. C. M., Kaufman, M. R., Nacev, E. C., Seghete, K. L. M., & McConnell, K. J. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.0062 · Cited by 5
Effect of maternal obsessive‐compulsive disorder ( OCD ) on feto‐maternal outcomes: A systematic review and meta‐analysis
Aujla, S., Sandeep, M., Aparnavi, P., Padhi, B. K., Shamim, M. A., Sahoo, S., Gangane, N., & Gandhi, A. P. (2024) · International Journal of Gynecology & Obstetrics · doi:10.1002/ijgo.15792 · Cited by 8
“33,34 Holingue et al. 8 reported that the rate of pre-eclampsia did not differ among OCD-affected pregnant women with or without exacerbations.”
Influential
Impact of maternal depression and anxiety-related disorders on live birth rate in women with recurrent pregnancy loss
Shigemi, D., Hashimoto, Y., Michihata, N., & Yasunaga, H. (2021) · Human Fertility · doi:10.1080/14647273.2021.1953710 · Cited by 5
“…a relationship between antenatal depression and pregnancy outcomes, there are few published data regarding the effect of depressive disorders by different maternal age groups on pregnancy outcomes, including live birth (Grigoriadis et al., 2013; Grigoriadis et al., 2018; Hermon et al., 2019).”
Background
Benzodiazepine exposures among women of reproductive age in the US, 2004–2018
Michaels, N. L., Spiller, H., Badeti, J., Sheftall, A., Funk, A., & Smith, G. A. (2021) · Human & Experimental Toxicology · doi:10.1177/09603271211013431 · Cited by 6
The COVID in the Context of Pregnancy, Infancy and Parenting (CoCoPIP) Study: protocol for a longitudinal study of parental mental health, social interactions, physical growth, and cognitive development of infants during the pandemicPreprint
Aydin, E., Weiss, S. M., Glasgow, K. A., et al. (2021) · medRxiv · doi:10.1101/2021.05.22.21257649 · Cited by 5
Patterns of peripartum depression and anxiety during the pre-vaccine COVID-19 pandemic
Altendahl, M., Xu, L., Asiodu, I. V., Boscardin, W. J., Gaw, S. L., Flaherman, V. J., Jacoby, V. L., Richards, M., Krakow, D., & Afshar, Y. (2024) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-024-06518-8 · Cited by 5
“Untreated antenatal depression and anxiety have both been associated with adverse perinatal outcomes such as preterm delivery and low birth weight [10, 11], as well as impaired mother-infant bonding and delayed childhood cognitive/emotional development [12–14].”
Psychometric Properties of the Online Version of the General Anxiety Disorder-7 (GAD-7): A Longitudinal Study in Pregnant and Postpartum Spanish Women.
Gómez-Gómez, I., Domínguez-Salas, S., Rodríguez-Muñoz, M. F., Rodríguez-Domínguez, C., Gómez-Baya, D., & Motrico, E. (2024) · Psicothema · doi:10.7334/psicothema2023.293 · Cited by 5
Parental Mental Health Conditions and Infant Health Outcomes Among Military Families
Bukowinski, A. T., Gumbs, G. R., Hall, C. B., Khodr, Z. G., Richardson, S. M., & Conlin, A. M. S. (2025) · Military Medicine · doi:10.1093/milmed/usaf069 · Cited by 5
Effectiveness of an online Japanese version of the mindfulness-based childbirth and parenting programme on prenatal mental health: A single group clinical trial
Tanke, A., Tobe, H., Usui, Y., Yonezawa, K., Tahara‐Sasagawa, E., & Haruna, M. (2025) · Midwifery · doi:10.1016/j.midw.2025.104379 · Cited by 4
Effectiveness of aromatherapy for intrapartum and postpartum emotional problems among parturient women: A meta‐analysis of randomized controlled trials
Hu, T., Lee, S., & Loh, E. (2022) · Japan Journal of Nursing Science · doi:10.1111/jjns.12471 · Cited by 4
Romantic Relationship Quality and Mental Health in Pregnancy During the Covid-19 Pandemic
Xie, E. B., Rioux, C., Madsen, J. W., Lebel, C. A., Giesbrecht, G. F., & Tomfohr‐Madsen, L. M. (2022) · Journal of Social and Clinical Psychology · doi:10.1521/jscp.2022.41.5.463 · Cited by 4
Mental health of pregnant women during the SARS-CoV-2 pandemic in France: Evolution of self-perceived psychological state during the first lockdown, and anxiety frequency two months after the lockdown ended
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Does telecounseling reduce anxiety and depression during pregnancy? A randomized controlled trial
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The effect of watching an informational video prior amniocentesis on maternal anxiety: a randomized controlled trail
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Comprehensive Review of the Psychosocial Impact on Parents of Newborns With Congenital Heart Disease: A Significant Problem in Low- and Middle-Income Countries
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“Unfortunately, high levels of anxiety and distress during pregnancy are correlated with preterm birth and intrauterine growth restriction [27].”
Background
Socioeconomic deprivation and perinatal anxiety: an observational cohort study
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“Perinatal anxiety is associated with multiple adverse perinatal outcomes for the infant [10].”

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: Grigoriadis, Sophie
Graves, Lisa
Peer, Miki
Tomlinson, George
Vigod, Simone N.
Dennis, Cindy-Lee
Steiner, Meir
Cheung, Amy
Rector, Neil A.
Guenette, Melanie
Richter, Margaret
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
DOI: 10.4088/jcp.17r12011
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 › Medicine › Pediatrics, Perinatology and Child Health › 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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Maternal Anxiety During Pregnancy and the Association With Adverse Perinatal Outcomes: Systematic Review and Meta-Analysis

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