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Anxiety during pregnancy linked to adverse birth outcomes

Maternal antenatal anxiety was associated with increased risk for multiple negative perinatal outcomes, including preterm birth, lower mean birth weight and earlier gestational age, according to a study published in the Journal of Clinical Psychiatry.

“To date, meta-analyses of the effects of anxiety during pregnancy have been narrowly focused on preterm birth and low birth weight, and while two systematic reviews have addressed a broader range of outcomes, results were inconsistent and, with newer published work, need to be readdressed,” Sophie Grigoriadis, MD, from the department of psychiatry, Sunnybrook Health Sciences Center, and the University of Toronto, and colleagues wrote. “Given the high prevalence of antenatal anxiety and the preliminary recognition of its negative effect on maternal and infant outcomes, it is important to systematically summarize the literature across diverse outcomes.”

According to the researchers, most prior research has focused on perinatal depression; however, in the current systematic review and meta-analysis, researchers evaluated the relationship between maternal antenatal anxiety and perinatal outcomes. They searched clinical databases for relevant studies using controlled vocabulary and keywords and included prospectively collected data on perinatal outcomes of women with and without antenatal anxiety. The investigators also conducted subanalyses to assess the potential effect moderators.

Twenty-nine articles were included in the analysis. The pooled results revealed that antenatal anxiety was tied to higher risk for:

• preterm birth (OR = 1.54; 95% CI, 1.39-1.7);
• spontaneous preterm birth (OR = 1.41; 95% CI, 1.13-1.75);
• lower mean birth weight (mean difference = –55.96 g; 95% CI, –93.62 to –18.31 g);
• low birth weight (OR = 1.8; 95% CI, 1.48-2.18);
• earlier gestational age (mean difference = –0.13 week; 95% CI, –0.22 to –0.04 week);
• being small for gestational age (OR = 1.48; 95% CI, 1.26-1.74); and
• smaller head circumference (mean difference = –0.25 cm; 95% CI, –0.45 to –0.06 cm).

Heterogeneity was not significant for most outcomes, according to the results. After conducting subanalyses for birth weight, Grigoriadis and colleagues found that women with diagnosed anxiety gave birth to infants with lower birth weight (P < .03) compared with those identified with rating scales. However, they observed nonsignificant relationships between anxiety and preeclampsia, cesarean delivery and Apgar scores.

The investigators also observed that most included studies (22 of 29) did not report the psychotropic medication use and that psychotherapy use was equally unknown.

“While psychological therapies are both first-line treatment for mild anxiety and the preferred modality for most women during pregnancy, these treatments are nevertheless also linked with variable rates of adherence/attrition,” Grigoriadis and colleagues wrote.

“The multiple adverse perinatal outcomes associated with antenatal anxiety highlight the need to both identify and manage pregnant women with high levels of anxiety, particularly those with the most severe forms of anxiety,” they continued. “Here, we provide data that will be useful to clinicians and patients in their decision making.” – by Savannah Demko

Disclosure: Grigoriadis reports fees from Allergan, Bristol-Myers Squibb, Pfizer and Sage. Please see the study for all other authors’ relevant financial disclosures.