Prenatal Maternal Anxiety as a Risk Factor for Preterm Birth and the Effects of Heterogeneity on This Relationship: A Systematic Review and Meta-Analysis

Abstract

Background. Systematic reviews (SR) and meta-analyses (MA) that previously explored the relationship between prenatal maternal anxiety (PMA) and preterm birth (PTB) have not been comprehensive in study inclusion, failing to account for effects of heterogeneity and disagree in their conclusions. Objectives. This SRMA provides a summary of the published evidence of the relationship between PMA and PTB while examining methodological and statistical sources of heterogeneity. Methods. Published studies from MEDLINE, CINAHL, PsycINFO, and EMBASE, until June 2015, were extracted and reviewed. Results. Of the 37 eligible studies, 31 were used in this MA; six more were subsequently excluded due to statistical issues, substantially reducing the heterogeneity. The odds ratio for PMA was 1.70 (95% CI 1.33, 2.18) for PTB and 1.67 (95% CI 1.35, 2.07) for spontaneous PTB comparing higher levels of anxiety to lower levels. Conclusions. Consistent findings indicate a significant association between PMA and PTB. Due to the statistical problem of including collinear variables in a single regression model, it is hard to distinguish the effect of the various types of psychosocial distress on PTB. However, a prenatal program aimed at addressing mental health issues could be designed and evaluated using a randomised controlled trial to assess the causal nature of different aspects of mental health on PTB.

Effect of antenatal maternal anxiety on the reactivity of fetal cerebral circulation to auditory stimulation, and early child development

“…Studies have shown that negative maternal emotions during pregnancy are associated with an adverse pregnancy outcome. The effect of high antenatal anxiety on both low birth weight for gestational age and preterm delivery are the most reported results [1,3,9,19]. On the contrary, no significant correlation between antenatal maternal anxiety and gestational age at birth was reported [20].…”

The Role of Body, Mind, and Environment in Preterm Birth: Mind the Gap

“…40 Systematic reviews including meta-analyses have demonstrated an association between anxiety and preterm birth. [43][44][45] A substantial reduction in heterogeneity between the studies was noted when analyses were restricted to state anxiety and pregnancy-specific anxiety, with odds ratios similar for both (OR, 1.70; 95% CI, 1.33-2.18; OR, 1.67; 95% CI, 1.35-2.07, respectively). 43 Antenatal depression is also thought to be associated with preterm birth, though the effect size is typically smaller, and fewer studies demonstrate statistically significant associations.…”

“…[43][44][45] A substantial reduction in heterogeneity between the studies was noted when analyses were restricted to state anxiety and pregnancy-specific anxiety, with odds ratios similar for both (OR, 1.70; 95% CI, 1.33-2.18; OR, 1.67; 95% CI, 1.35-2.07, respectively). 43 Antenatal depression is also thought to be associated with preterm birth, though the effect size is typically smaller, and fewer studies demonstrate statistically significant associations. 40 Although a meta-analysis reported an association between antenatal depression and preterm birth (RR, 1.39; 95% CI, 1.17-1.61), Grote et al noted significant heterogeneity (I 2 , 61%; P Ͻ .001) and publication bias suggesting the association may not in fact be present.…”

“…Pregnancy‐specific anxiety, a unique construct, describes fears and worries surrounding the perinatal period, including birth, maternal and fetal/newborn health, and child‐care abilities . Systematic reviews including meta‐analyses have demonstrated an association between anxiety and preterm birth . A substantial reduction in heterogeneity between the studies was noted when analyses were restricted to state anxiety and pregnancy‐specific anxiety, with odds ratios similar for both (OR, 1.70; 95% CI, 1.33‐2.18; OR, 1.67; 95% CI, 1.35‐2.07, respectively) …”

Midwives’ perspectives of maternal mental health assessment and screening for risk during pregnancy

“…Anxiety and depression during pregnancy often coexist (O'Hara, Wisner, & Asher, 2014;Schmeid et al, 2013) and are associated with postnatal depression (Koutra et al, 2014;Obgo et al, 2018). Antenatal stress, anxiety and depression represent key risk factors in the aetiology of preterm birth (Eastwood, Obgo, Hendry, Noble, & Page, 2017;Rose, Pana, & Premji, 2016;Staneva, Bogossian, Pritchard, & Wittkowski, 2015). An association has also been identified between antenatal stress, anxiety and depression and low birthweight infants (Khashan et al, 2014;Saeed, Rashid, Ahmed, Naqvi, & Tabassum, 2016).…”