Describing the available non-pharmacological interventions for perinatal anxiety (PNA) used in primary care: a systematic review of systematic reviews

Conference:

2021 SAPC North (virtual)

Talk Code:

2B.6

Presenter:

V Silverwood

Twitter:

@@v_silverwood

Co-authors:

Silverwood V, Bullock L, Kingstone T, Turner K, Jordan J, Chew-Graham CA.

Author institutions:

VS, LB, JJ, TK, CC-G – School of Medicine, Keele University KT – Centre of Academic Primary Health Care, Bristol University TK, CC-G – Midlands Partnership NHS Foundation Trust CC-G - WM ARC

Background

Perinatal anxiety (PNA) occurs during pregnancy and up to 12 months post-partum. Global prevalence of PNA is estimated to be >15% of women; as common as perinatal depression. PNA may impact negatively on pregnancy and neonatal outcomes, parenting behaviours and childhood development.

There is limited evidence to inform the management of women with PNA in primary care, especially non-pharmacological interventions. The 2014 NICE guidance recommended that further research is required.

This study will provide an overview of the evidence for non-pharmacological interventions for PNA and will highlight gaps in the current literature.

The Approach

Systematic review with narrative synthesis, registered on PROSPERO, reported in line with PRISMA guidelines. Systematic searches in twelve health-related databases. All titles and abstracts screened by VS following pre-defined eligibility criteria; LB screened 20%. Discrepancies resolved through discussion/third reviewer. VS and LB completed full paper screening and data extraction.

Systematic reviews reporting results from a variety of study designs included. Data extracted about study participants, methodology, and intervention design and context. Narrative synthesis performed following Popay guidelines. A maternal mental health patient and public involvement group has been involved throughout.

Findings

Systematic literature searches found 3456 titles to be screened after duplicates removed. 155 abstracts screened and 63 full papers read. 39 papers included in the final review. Interventions designed ranged from psychological therapies such as ‘Cognitive behavioural therapy’ and ‘Behavioural activation’, mind/body based interventions such as ‘Mindfulness’ and ‘Yoga’, educational activities around subjects including diet and exercise and supportive interventions such as home visits from healthcare professionals. The methods by which interventions were delivered varied considerably.

Implications

This review presents a wide range of potential interventions available to manage PNA in primary care. Insights gained from data analysis will be used to make recommendations for future research, clinical implications and policy changes.

Funding acknowledgement:

VS is a Wellcome Trust PhD Clinical Fellow – this systematic review forms part of a PhD.