State anxiety in pregnancies affected by obstetric complications: A systematic review

• Published in: Journal of affective disorders 2019-10, Vol.257, p.214-240
• Main Authors: Fischbein, Rebecca L., Nicholas, Lauren, Kingsbury, Diana M., Falletta, Lynn M., Baughman, Kristin R., VanGeest, Jonathan
• Format: Article
• Language: English
• Subjects: Antenatal anxiety; Medically high-risk pregnancy; Obstetric complications; State anxiety
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2019.07.007

•Between 20% to 100% of women with obstetric complications have high state anxiety.•Maternal anxiety can lead to poor maternal outcomes.•Maternal state anxiety levels differ by complication type and severity.•Anxiety during complicated pregnancy differs by demographics and other factors.•State anxiety typically decreases during complicated pregnancies but remains high.•Women with obstetric complications should be assessed and referred for anxiety. Maternal mental health status remains an important area of study due to its influence on maternal health outcomes. Past reviews on anxiety in pregnancy have included multiple mental health diagnoses and pre-existing conditions. A systematic review was performed to understand maternal state anxiety during pregnancies affected by obstetrical complications. A systematic search of electronic databases was performed including quantitative, primary studies in the English language. The population of interest was women whose pregnancies were affected by maternal and/or fetal obstetric (not pre-existing) complications with state anxiety as the outcome. Twenty-six studies met the inclusion and methodological criteria and were included in the review. The review revealed that 20% to 100% of women experiencing pregnancies affected by obstetric complications had high levels of state anxiety, and these rates are negatively influenced by complication type and severity, demographic characteristics, and maternal perceptions and expectations. Overall, antenatal state anxiety was shown to improve over the course of the pregnancy, though levels remained above clinical thresholds. This review was based only on English peer-reviewed articles, many of which used convenience sampling with homogenous samples, limiting generalizability. Additional limitations include how anxiety prevalence was aggregated due to differences in measurement across studies. Anxiety is prevalent among women experiencing pregnancies affected by obstetric complications. Based on this review, we recommend that all women treated for obstetric complications are screened for anxiety; facilitating detection, referral, and treatment, ultimately contributing to optimal maternal outcomes.