Depression and anxiety during pregnancy: a risk factor for obstetric, fetal and neonatal outcome? A critical review of the literature.

OBJECTIVE: Research from the past two decades has suggested a link between prenatal maternal psychological distress and adverse obstetric, fetal and neonatal outcome. Comparability of study results, however, is complicated by a diversity of definitions and measurements of prenatal maternal stress and different time points of assessment. Our aim was to critically review studies assessing maternal anxiety and depression during pregnancy and their impact on obstetric, fetal and neonatal outcome.
METHODS: We carried out a computerized literature search of PubMed, PsycLIT and EMBASE (1990-2005) and a manual search of bibliographies of pertinent articles. In total 35 studies were identified that fulfilled the inclusion criteria.
RESULTS: Elevated levels of depression and anxiety were found to be associated with obstetric outcome (obstetric complications, pregnancy symptoms, preterm labor and pain relief under labor), and had implications for fetal and neonatal well-being and behavior. However, prediction of the impact of mood and anxiety disorders during pregnancy is very limited due to methodological problems. Most notably, the majority of the studies included pregnant women with elevated symptoms of depressed mood and anxiety and did diagnose mood and anxiety disorders. Also, potentially confounding and protecting factors as well as biological mechanisms with a possible role in adverse outcome in pregnant women with depression and anxiety disorders have received little attention.
CONCLUSIONS: Enhanced levels of depression and anxiety symptoms during pregnancy contribute independently of other biomedical risk factors to adverse obstetric, fetal and neonatal outcome. However, conclusions for women with mood or anxiety disorders are limited.