Mercy Perinatal, Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia.
Mercy Hospital for Women, Heidelberg, Victoria, Australia.
JAMA Netw Open. 2023 Nov 1;6(11):e2343711. doi: 10.1001/jamanetworkopen.2023.43711.
Anxiety disorders are associated with poor maternal and neonatal outcomes. Women in low- and middle-income countries (LMICs) are thought to be disproportionally burdened by these disorders, yet their prevalence is unclear.
To conduct a systematic review and meta-analysis to determine the prevalence of 6 anxiety and related disorders among perinatal women in LMICs.
Embase, MEDLINE, PsycINFO, Cochrane Library, CINAHL, and Web of Science databases were searched from inception until September 7, 2023.
Studies conducted in World Bank-defined LMICs and reporting prevalence of generalized anxiety disorder, obsessive-compulsive disorder, social anxiety disorder, posttraumatic stress disorder, panic disorder, or adjustment disorder during the perinatal period (conception to 12 months post partum) using a validated method were included.
This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. Study eligibility, extracted data, and risk of bias of included studies were assessed by 2 independent reviewers. Random-effects meta-analysis was used to estimate pooled point prevalence. Subgroup analyses were performed by specific anxiety disorder.
Main outcomes were prevalence estimates of each anxiety disorder, measured as percentage point estimates and corresponding 95% CIs.
At total of 10 617 studies were identified, 203 of which met the inclusion criteria and reported the outcomes of 212 318 women from 33 LMICs. Generalized anxiety disorder was the most reported (184 studies [90.6%]) and most prevalent disorder at 22.2% (95% CI, 19.4%-25.0%; n = 173 553). Posttraumatic stress disorder was the second most prevalent (8.3%; 95% CI, 5.0%-12.2%; 33 studies; n = 22 452). Adjustment disorder was least prevalent (2.9%; 95% CI, 0.0%-14.1%; 2 studies; n = 475). The prevalence of generalized anxiety varied by country income status, with the highest prevalence among lower-middle-income countries (27.6%; 95% CI, 21.6%-33.9%; 59 studies; n = 25 109), followed by low-income (24.0%; 95% CI, 15.3%-33.8%; 11 studies; n = 4961) and upper-middle-income (19.1%; 95% CI, 16.0%-22.4%; 110 studies; n = 138 496) countries.
These findings suggest that 1 in 5 women living in LMICs experience anxiety disorders during pregnancy and post partum. Targeted action is needed to reduce this high burden.
焦虑障碍与母婴不良结局有关。据认为，中低收入国家（LMICs）的女性受到这些障碍的影响不成比例，但目前尚不清楚这些障碍的流行程度。
进行系统评价和荟萃分析，以确定 LMICs 围产期女性中 6 种焦虑和相关障碍的患病率。
从开始到 2023 年 9 月 7 日，Embase、MEDLINE、PsycINFO、Cochrane 图书馆、CINAHL 和 Web of Science 数据库进行了搜索。
包括在世界银行定义的 LMICs 中进行的研究，并使用经过验证的方法报告了围产期（受孕至产后 12 个月）期间广泛性焦虑障碍、强迫症、社交焦虑障碍、创伤后应激障碍、惊恐障碍或适应障碍的患病率。
本研究遵循系统评价和荟萃分析的首选报告项目报告准则。两名独立评审员评估了研究的合格性、提取的数据和纳入研究的偏倚风险。使用随机效应荟萃分析来估计汇总点患病率。进行了亚组分析，以确定特定的焦虑障碍。
主要结果是每种焦虑障碍的患病率估计值，以百分比点估计值和相应的 95%置信区间表示。
共确定了 10617 项研究，其中 203 项符合纳入标准，并报告了来自 33 个 LMICs 的 212318 名女性的结果。广泛性焦虑症是报告最多的（184 项研究[90.6%]），也是最常见的疾病，患病率为 22.2%（95%CI，19.4%-25.0%；n=173553）。创伤后应激障碍是第二常见的（8.3%；95%CI，5.0%-12.2%；33 项研究；n=22452）。适应障碍的患病率最低（2.9%；95%CI，0.0%-14.1%；2 项研究；n=475）。广泛性焦虑症的患病率因国家收入状况而异，中低收入国家的患病率最高（27.6%；95%CI，21.6%-33.9%；59 项研究；n=25109），其次是低收入国家（24.0%；95%CI，15.3%-33.8%；11 项研究；n=4961）和中高收入国家（19.1%；95%CI，16.0%-22.4%；110 项研究；n=138496）。
这些发现表明，居住在 LMICs 的每 5 名女性中就有 1 名在怀孕和产后期间患有焦虑障碍。需要采取有针对性的行动来减轻这一沉重负担。
