As a result of a higher-than-expected prevalence of anxiety disorders during pregnancy and the postpartum period, investigators recommended more robust anxiety screening methods for clinicians in obstetrics and gynecology, according to results from a meta-analysis published in the Journal of Clinical Psychiatry.

The investigators conducted a search of PsycINFO and PubMed from inception to 2016 for articles on the prevalence of anxiety disorders in pregnant or postpartum women. Eligible articles reported the prevalence of 1 or more of the following eight common anxiety disorders: panic disorder, agoraphobia, obsessive-compulsive disorder, generalized anxiety disorder, social phobia, specific phobia, posttraumatic stress disorder, and anxiety not otherwise specified. Anxiety disorder prevalence and potential predictive factors were extracted from each study. A Bayesian multivariate model was used to estimate the prevalence of each disorder, the prevalence of having one or more disorder, and the between-study heterogeneity of each disorder. Each study was scored for quality based on methodological criteria outlined in prior literature.

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Of 2613 studies identified in the search, 26 were selected for meta-analysis. These 26 studies presented 28 prevalence estimates, among which 19 applied to pregnant women and 9 applied to the postpartum period. Individual disorder prevalence ranged from 1.1% for posttraumatic stress disorder to 4.8% for specific phobias. The prevalence of having one or more anxiety disorder during pregnancy or postpartum was estimated at 20.7% across studies. A trend toward greater prevalence during pregnancy vs the postpartum period was observed, with a 3.1% increased risk for anxiety observed among pregnant women; however, this difference did not reach statistical significance. Significant between-study heterogeneity was observed, indicating that prevalence rates vary by cohort demographics. Specifically, higher anxiety prevalence was observed in North American samples (26.9%) compared with other samples (18.5%), driven largely by differences in the prevalence of obsessive-compulsive disorder (3.2%), social phobia (1.5%), and posttraumatic stress disorder (2.4%).

Approximately 1 in 5 (20.7%) women met diagnostic criteria for at least one anxiety disorder during pregnancy or postpartum, and 1 in 20 (5.5%) met criteria for at least 2 disorders.

“These findings highlight the need for anxiety screening, education, and referral in obstetrics and gynecology settings,” the investigators concluded.

Reference

Fawcett EJ, Fairbrother N, Cox ML, White IR, Fawcett JM. The prevalence of anxiety disorders during pregnancy and the postpartum period: a multivariate Bayesian meta-analysis. J Clin Psychiatry. 2019;80(4):18r12527.