Non-pharmacological interventions for the management of perinatal anxiety in primary care: a meta-review of systematic reviews

Victoria Silverwood; Laurna Bullock; Joanne Jordan; Katrina Turner; Carolyn A Chew-Graham; Tom Kingstone; Shoba Dawson

doi:10.3399/BJGPO.2023.0022

Non-pharmacological interventions for the management of perinatal anxiety in primary care: a meta-review of systematic reviews

BJGP Open. 2023 Sep 19;7(3):BJGPO.2023.0022. doi: 10.3399/BJGPO.2023.0022. Print 2023 Sep.

Authors

Victoria Silverwood¹, Laurna Bullock², Joanne Jordan², Katrina Turner³, Carolyn A Chew-Graham^{2

4

5}, Tom Kingstone^{2

4}, Shoba Dawson³

Affiliations

¹ School of Medicine, Keele University, Keele, UK v.silverwood@keele.ac.uk.
² School of Medicine, Keele University, Keele, UK.
³ Centre of Academic Primary Health Care, Bristol Medical School, University of Bristol, Bristol, UK.
⁴ Midlands Partnership NHS Foundation Trust,Trust Headquarters, St George's Hospital, Stafford, UK.
⁵ Applied Research Collaboration (ARC) West Midlands, Keele University, Keele, UK.

Abstract

Background: Perinatal anxiety (PNA), anxiety that occurs during pregnancy and/or up to 12 months postpartum, is estimated to affect up to 21% of women, and may impact negatively on mothers, children, and their families. The National Institute for Health and Care Excellence (NICE) has called for further research around non-pharmacological interventions in primary care for PNA.

Aim: To summarise the available international evidence on non-pharmacological interventions for women with PNA in a primary care population.

Design & setting: A meta-review of systematic reviews (SRs) with narrative synthesis was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance.

Method: Systematic literature searches were conducted in 11 health-related databases up to June 2022. Titles, abstracts, and full-text articles were dual-screened against pre-defined eligibility criteria. A variety of study designs were included. Data were extracted about study participants, intervention design, and context. Quality appraisal was performed using the AMSTAR 2 tool (A MeaSurement Tool to Assess systematic Reviews). A patient and public involvement group informed and contributed towards this meta-review.

Results: Twenty-four SRs were included in the meta-review. Interventions were grouped into the following six categories for analysis purposes: psychological therapies; mind-body activities; emotional support from healthcare professionals (HCPs); peer support; educational activities; and alternative or complementary therapies.

Conclusion: In addition to pharmacological and psychological therapies, this meta-review has demonstrated that there are many more options available for women to choose from that might be effective to manage their PNA. Evidence gaps are present in several intervention categories. Primary care clinicians and commissioners should endeavour to provide patients with a choice of these management options, promoting individual choice and patient-centred care.

Keywords: general practitioners; interventions; meta-review; narrative synthesis; perinatal anxiety; pregnancy; primary health care; systematic review.