Anxiety disorders during pregnancy: a systematic review.
OBJECTIVE
To systematically evaluate the literature on anxiety disorders during pregnancy.


METHODS
MEDLINE, PsycINFO, and CINAHL were searched through October 2013 for original research studies published in English using combinations of the terms pregnancy, prenatal, or pregnancy outcomes; anxiety disorder; and generalized anxiety. Reference lists of included studies were hand-searched and a PubMed search for in-process reports was conducted.


METHODS
Relevant studies of anxiety disorders during pregnancy as determined by diagnostic interview were included if they reported on prevalence; course, onset, and/or risk factors; maternal, obstetric, or fetal/child outcomes; and/or treatment trial results.


METHODS
Two reviewers independently extracted relevant data and assessed methodological quality of each study.


RESULTS
Fifty-seven reports were included. Reports provided information on panic disorder (25 reports), generalized anxiety disorder (17 reports), obsessive-compulsive disorder (OCD) (23 reports), agoraphobia (6 reports), specific phobia (10 reports), social phobia (14 reports), posttraumatic stress disorder (14 reports), and any anxiety disorder (18 reports). Twenty reports provided information on prevalence, 16 on course, 10 on risk factors, and 22 on outcomes. Only 1 treatment study was identified. High anxiety disorder prevalence in pregnancy was found; however, estimates vary considerably, and evidence is inconclusive as to whether prevalence among pregnant women differs from that of nonpregnant populations. Considerable variation in prenatal course of OCD and panic disorder was found. Substantial heterogeneity limits conclusions regarding risk factors or outcomes.


CONCLUSIONS
Additional research of higher methodological quality is required to more accurately determine prevalence, understand course, identify risk factors and outcomes, and determine effective treatments for anxiety disorders in pregnancy.
MGH Institute of Health Professions, School of Nursing, 36 1st Ave, Boston, MA 02129 jgoodman@mghihp.edu.
Janice H
JH
Goodman
Kerry L
KL
Chenausky
Marlene P
MP
Freeman
D001008:Anxiety Disorders / Q000453:epidemiology*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*