Prevalence, onset and course of anxiety disorders during pregnancy: A systematic review and meta analysis

Background: Anxiety disorders during pregnancy are associated with various adverse outcomes. Previous reviews of anxiety disorders during pregnancy have methodological limitations and were conducted without a meta-analysis. The present study is a systematic review and meta-analysis of the published research on the prevalence, onset and course of all anxiety disorders during pregnancy plus obsessive-compulsive disorder (OCD) and posttraumatic stress disorder.

Methods: A comprehensive literature search was performed on a wide range of databases. A random effects model was used for the meta-analysis.

Results: Thirty-six studies were included. Prevalence rates of anxiety disorders during pregnancy varied considerably. The pooled prevalence rate of each disorder during pregnancy was 3%, except for specific phobia, where it was 6%. Between 13% and 39% of pregnant OCD women had the onset of OCD during pregnancy, and this occurred mainly in the 2nd trimester. The onset of panic disorder (PD) was more common in the 1st and 2nd trimesters of pregnancy.

Limitations: Different designs of the included studies, as well as different assessment tools and assessment times during pregnancy and the paucity of studies of the onset and course, preclude definitive conclusions.

Conclusions: Anxiety disorders are common during pregnancy. Unlike prevalence rates of other anxiety disorders during pregnancy, prevalence rates of PD and OCD during pregnancy were higher than their lifetime prevalence rates in women in the general population. The onset of OCD during pregnancy is not rare and the course of PD and OCD during pregnancy is highly variable. These findings suggest that pregnancy may be a specific risk factor for the occurrence and/or exacerbation of PD and OCD and underscore the importance of their early diagnosis and management.