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Anxiety Disorders During Pregnancy and the Postpartum Period: A Systematic Review
Lori E. Ross, Ph.D.; and Linda M. McLean, Ph.D., C.Psych.
Objective: The postpartum period is recognized as a time of vulnerability to affective disorders, particularly postpartum depression. In contrast, the prevalence and clinical presentation of anxiety disorders during pregnancy and the postpartum period have received little research attention. In this article, we review the medical literature as it relates to the prevalence and clinical presentation of panic disorder, obsessive-compulsive disorder, posttraumatic stress disorder, and generalized anxiety disorder during pregnancy and the postpartum period.
Data Sources: MEDLINE (1966 to July 2005 week 1) and PsycInfo (1840 to July 2005 week 1) were searched using combinations of the following search terms: pregnancy, childbirth, postpartum, panic disorder, phobia, obsessive-compulsive disorder, posttraumatic stress disorder, and generalized anxiety disorder.
Study Selection: All relevant papers published in English and reporting original data related to perinatal anxiety disorders were included.
Data Extraction: Studies were examined for data related to the prevalence, presentation, predictors/risk factors, new onset, course, and treatment of anxiety disorders during pregnancy and the postpartum period.
Data Synthesis: Anxiety disorders are common during the perinatal period, with reported rates of obsessive-compulsive disorder and generalized anxiety disorder being higher in postpartum women than in the general population. The perinatal context of anxiety disorders presents unique issues for detection and management.
Conclusions: Future research is needed to estimate the prevalence of perinatal anxiety disorders more precisely, to identify potential implications of maternal anxiety disorders for maternal quality of life and child development, and to determine safe and effective treatment methods.
(J Clin Psychiatry 2006;67:1285-1298)
Received Sept. 19, 2005; accepted January 30, 2006. From the Women's Mental Health and Addiction Research Section, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto (Dr. Ross); and Princess Margaret Hospital-University Health Network (Dr. McLean), Toronto, Ontario, Canada.
Dr. Ross is supported by a Career Scientist Award from the Ontario Ministry of Health and Long-Term Care and the Ontario Women's Health Council, Ontario, Canada.
Portions of this manuscript were presented at the XIII World Congress of Psychiatry, September 10-15, 2005, Cairo, Egypt.
In the spirit of full disclosure and in compliance with all ACCME Essential Areas and Policies, the faculty for this CME article were asked to complete a statement regarding all relevant financial relationships between themselves or their spouse/partner and any commercial interest (i.e., any proprietary entity producing health care goods or services consumed by, or used on, patients) occurring within at least 12 months prior to joining this activity. The CME Institute has resolved any conflicts of interest that were identified. The disclosures are as follows: Drs. Ross and McLean have no personal affiliations or financial relationships with any proprietary entity producing health care goods or services consumed by, or used on, patients to disclose relative to the article.
The authors thank Diane Meschino, M.D., and Cindy-Lee Dennis, Ph.D., for their helpful comments on an earlier version of this manuscript; Alicja Fishell, M.D., and Jasmine Gandhi, M.D., for their clinical expertise; and Raliza Stoyanova, B.Sc., and Corrie Goldfinger, B.A., for their assistance in the preparation of the manuscript.
The opinions, results, and conclusions are those of the authors, and no endorsement by the Ontario Ministry of Health and Long-Term Care is intended or should be inferred.
Corresponding author and reprints: Lori E. Ross, Ph.D., the Women's Mental Health and Addiction Research Section, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, 250 College St., Toronto, Ontario M5T 1R8 (e-mail: firstname.lastname@example.org).