Prenatal Maternal Anxiety as a Risk Factor for Preterm Birth and the Effects of Heterogeneity on This Relationship: A Systematic Review and Meta-Analysis.
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.
Research Facilitation, Alberta Health Services, Calgary, AB, Canada T2N 2T9.
M Sarah
MS
Rose
Faculty of Medicine, University of Calgary, AB, Canada T2N 1N4.
Gianella
G
Pana
Faculty of Nursing and Cumming School of Medicine, Department of Community Health Sciences, University of Calgary, AB, Canada T2N 1N4.
Shahirose
S
Premji
D001007:Anxiety / Q000150:complications* / Q000175:diagnosis* / Q000208:ethnology*; D005006:Ethnicity; D005260:Female; D006801:Humans; D015233:Models, Statistical; D016017:Odds Ratio; D011247:Pregnancy; D011248:Pregnancy Complications; D037841:Pregnant People / Q000523:psychology*; D047928:Premature Birth / Q000208:ethnology / Q000517:prevention & control; D012044:Regression Analysis; D012307:Risk Factors; D016896:Treatment Outcome