The Prevalence of Anxiety Disorders During Pregnancy and the Postpartum Period: A Multivariate Bayesian Meta-Analysis

Abstract

Objective: To estimate the prevalence of anxiety disorders in pregnant and postpartum women and identify predictors accounting for variability across estimates.

Data sources: An electronic search of PsycINFO and PubMed was conducted from inception until July 2016, without date or language restrictions, and supplemented by articles referenced in the obtained sources. A Boolean search phrase utilized a combination of keywords related to pregnancy, postpartum, prevalence, and specific anxiety disorders.

Study selection: Articles reporting the prevalence of 1 or more of 8 common anxiety disorders in pregnant or postpartum women were included. A total of 2,613 records were retrieved, with 26 studies ultimately included.

Data extraction: Anxiety disorder prevalence and potential predictor variables (eg, parity) were extracted from each study. A Bayesian multivariate modeling approach estimated the prevalence and between-study heterogeneity of each disorder and the prevalence of having 1 or more anxiety disorder.

Results: Individual disorder prevalence estimates ranged from 1.1% for posttraumatic stress disorder to 4.8% for specific phobia, with the prevalence of having at least 1 or more anxiety disorder estimated to be 20.7% (95% highest density interval [16.7% to 25.4%]). Substantial between-study heterogeneity was observed, suggesting that "true" prevalence varies broadly across samples. There was evidence of a small (3.1%) tendency for pregnant women to be more susceptible to anxiety disorders than postpartum women.

Conclusions: Peripartum anxiety disorders are more prevalent than previously thought, with 1 in 5 women in a typical sample meeting diagnostic criteria for at least 1 disorder. These findings highlight the need for anxiety screening, education, and referral in obstetrics and gynecology settings.

Figure 1

Meta-analysis inclusion flowchart.

Figure 2

Prevalence (%) of panic disorder, agoraphobia, obsessive-compulsive disorder and generalized anxiety disorder. X’s represent the observed prevalence estimate reported by the corresponding study. Circles and numerical prevalence values represent the shrunken estimates (with 95% highest density interval) for each study as estimated from the model including group (pregnant, postpartum) as a predictor; entries without a circle or numerical prevalence value reflect studies for which that disorder was not measured. Diamonds depict the aggregate estimate for each group and overall. Error bars surrounding each diamond represent the 95% prediction interval.

Figure 3

Prevalence (%) of social phobia, specific phobia, posttraumatic stress disorder and anxiety not otherwise specified. X’s represent the observed prevalence estimate reported by the corresponding study. Circles and numerical prevalence values represent the shrunken estimates (with 95% highest density interval) for each study as estimated from the model including group (pregnant, postpartum) as a predictor; entries without a circle or numerical prevalence value reflect studies for which that disorder was not measured. Diamonds depict the aggregate estimate for each group and overall. Error bars surrounding each diamond represent the 95% prediction interval.