title: The effects of maternal depression, anxiety, and perceived stress during pregnancy on preterm birth: A systematic review.
abstract: BACKGROUND
  Experiencing psychological distress such as depression, anxiety, and/or perceived stress during pregnancy may increase the risk for adverse birth outcomes, including preterm birth. Clarifying the association between exposure and outcome may improve the understanding of risk factors for prematurity and guide future clinical and research practices.
  
  
  OBJECTIVE
  The aims of the present review were to outline the evidence on the risk of preterm associated with antenatal depression, anxiety, and stress.
  
  
  METHODS
  Four electronic database searches were conducted to identify quantitative population-based, multi-centre, cohort studies and randomised-controlled trial studies focusing on the association between antenatal depression, anxiety, and stress, and preterm birth published in English between 1980 and 2013.
  
  
  RESULTS
  Of 1469 electronically retrieved articles, 39 peer-reviewed studies met the final selection criteria and were included in this review following the PRISMA and MOOSE review guidelines. Information was extracted on study characteristics; depression, anxiety and perceived stress were examined as separate and combined exposures. There is strong evidence that antenatal distress during the pregnancy increases the likelihood of preterm birth.
  
  
  CONCLUSIONS
  Complex paths of significant interactions between depression, anxiety and stress, risk factors and preterm birth were indicated in both direct and indirect ways. The effects of pregnancy distress were associated with spontaneous but not with medically indicated preterm birth. Health practitioners engaged in providing perinatal care to women, such as obstetricians, midwives, nurses, and mental health specialists need to provide appropriate support to women experiencing psychological distress in order to improve outcomes for both mothers and infants.
authors.affiliation: The School of Psychology, The University of Queensland, St Lucia Campus, McElwain Building, Brisbane, QLD 4072, Australia. Electronic address: a.staneva@uq.edu.au.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Staneva
authors.affiliation: School of Nursing, Midwifery, and Social Work, The University of Queensland, Level 3, Chamberlain Building, St Lucia QLD 4072 Australia.
authors.forename: Fiona
authors.initials: F
authors.lastname: Bogossian
authors.affiliation: Perinatal Research, Women's and Newborn Services Royal Brisbane Women's Hospital, The University of Queensland Centre for Clinical Research, Level 6 NHB, Herston 4029, Australia.
authors.forename: Margo
authors.initials: M
authors.lastname: Pritchard
authors.affiliation: School of Psychological Sciences, Clinical Psychology, University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester M13 9PL, UK.
authors.forename: Anja
authors.initials: A
authors.lastname: Wittkowski
mesh_terms: D001007:Anxiety / Q000453:epidemiology*; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008425:Maternal Behavior; D000068097:Maternal Health / Q000706:statistics & numerical data*; D009035:Mothers / Q000523:psychology; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D047928:Premature Birth / Q000453:epidemiology*; D012307:Risk Factors; D013315:Stress, Psychological / Q000453:epidemiology*
keywords: Anxiety; Depression; Pregnancy; Preterm birth; Stress