The relationship between preterm birth and postpartum anxiety: A first-in-field systematic review

Introduction: Preterm birth poses substantial risks to infant health and maternal mental health, particularly anxiety. The evidence base for associations between gestational age and postpartum anxiety has yet to be synthesised as a whole. This first-in-field systematic review aimed to investigate the relationship between gestational age at delivery and postpartum anxiety, and explore the experiences of mothers of premature infants with postpartum anxiety. Materials and Methods: Searches were conducted across 10 psychological, clinical, and allied health databases from inception to 6th October 2024 (PROSPERO CRD: CRD42023369647). There were no restrictions on language or study design. Only studies that assessed the relationship between gestational age at delivery, or preterm birth, and maternal anxiety assessed during the first postpartum year were eligible for inclusion in this review. Initial searches were conducted by one author. Identification and data extraction of studies were performed by two different authors independently. Results: Twenty-three studies were eligible for inclusion in the review. All studies were quantitative; no qualitative studies were eligible for inclusion. Data were synthesised via narrative synthesis. Taken together, the results indicate an inverse association between gestational age at delivery (preterm birth) and anxiety. Conclusions: Variable timing of assessment and tool(s) used to measure postpartum anxiety, alongside limited consideration of categories of gestational age (i.e., extremely, very, moderate-to-late preterm) limit the ability to make firm conclusions about the extent of this relationship.