Department of Psychiatry, Nepean Hospital, Sydney/Penrith, NSW, Australia; University of Sydney, Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, Sydney/Penrith, NSW, Australia.
University of Sydney, Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, Sydney/Penrith, NSW, Australia; The Whiteley-Martin Research Centre, Discipline of Surgery, Sydney/Penrith, NSW, Australia.
J Affect Disord. 2019 Aug 1;255:27-40. doi: 10.1016/j.jad.2019.05.016. Epub 2019 May 11.
Anxiety disorders during pregnancy are associated with various adverse outcomes. Previous reviews of anxiety disorders during pregnancy have methodological limitations and were conducted without a meta-analysis. The present study is a systematic review and meta-analysis of the published research on the prevalence, onset and course of all anxiety disorders during pregnancy plus obsessive-compulsive disorder (OCD) and posttraumatic stress disorder.
A comprehensive literature search was performed on a wide range of databases. A random effects model was used for the meta-analysis.
Thirty-six studies were included. Prevalence rates of anxiety disorders during pregnancy varied considerably. The pooled prevalence rate of each disorder during pregnancy was 3%, except for specific phobia, where it was 6%. Between 13% and 39% of pregnant OCD women had the onset of OCD during pregnancy, and this occurred mainly in the 2nd trimester. The onset of panic disorder (PD) was more common in the 1st and 2nd trimesters of pregnancy.
Different designs of the included studies, as well as different assessment tools and assessment times during pregnancy and the paucity of studies of the onset and course, preclude definitive conclusions.
Anxiety disorders are common during pregnancy. Unlike prevalence rates of other anxiety disorders during pregnancy, prevalence rates of PD and OCD during pregnancy were higher than their lifetime prevalence rates in women in the general population. The onset of OCD during pregnancy is not rare and the course of PD and OCD during pregnancy is highly variable. These findings suggest that pregnancy may be a specific risk factor for the occurrence and/or exacerbation of PD and OCD and underscore the importance of their early diagnosis and management.
孕期焦虑障碍与多种不良结局相关。之前关于孕期焦虑障碍的综述存在方法学局限性，且没有进行荟萃分析。本研究对孕期所有焦虑障碍（包括强迫症和创伤后应激障碍）和强迫症的患病率、发病和病程进行了系统评价和荟萃分析。
对多个数据库进行了全面的文献检索。荟萃分析采用随机效应模型。
共纳入 36 项研究。孕期焦虑障碍的患病率差异较大。每种疾病在孕期的患病率均为 3%，除了特定恐惧症为 6%。13%-39%的孕期强迫症患者在孕期出现强迫症，主要发生在孕中期。惊恐障碍的发病更常见于孕期的 1 期和 2 期。
纳入研究的设计不同，以及孕期评估工具和评估时间不同，再加上对发病和病程的研究较少，这些都限制了结论的确定性。
焦虑障碍在孕期很常见。与其他孕期焦虑障碍的患病率不同，孕期惊恐障碍和强迫症的患病率高于普通人群中女性的终生患病率。孕期强迫症的发病并不罕见，孕期惊恐障碍和强迫症的病程变化很大。这些发现表明，孕期可能是惊恐障碍和强迫症发生和/或恶化的特定危险因素，并强调了早期诊断和管理的重要性。
