Prenatal Maternal Anxiety in South Asia: A Rapid Best-Fit Framework Synthesis

Abstract

<b>Background:</b> Most research efforts toward prenatal maternal anxiety has been situated in high-income countries. In contrast, research from low- and middle-income countries has focused on maternal depression and prenatal maternal anxiety in low- and middle-income countries remains poorly understood. <b>Objectives:</b> To examine whether dimensions and attributes of current maternal anxiety assessment tools appropriately capture South Asia women's experiences of perinatal distress during pregnancy. <b>Design:</b> We conducted a rapid review with best fit framework synthesis, as we wished to map study findings to an <i>a priori</i> framework of dimensions measured by prenatal maternal anxiety tools. <b>Data Sources:</b> We searched MEDLINE, PsycINFO, and CINAHL and gray literature in November 2016. Studies were included if published in English, used any study design, and focused on women's experiences of prenatal/antenatal anxiety in South Asia. <b>Review Methods:</b> Study quality was assessed using the Effective Public Health Practice Project Quality Assessment Tool and Critical Appraisal Skills Programme Qualitative Checklist. Study findings were extracted to an <i>a priori</i> framework derived from pregnancy-related anxiety tools. <b>Results:</b> From 4,177 citations, 9 studies with 19,251 women were included. Study findings mapped to the <i>a priori</i> framework apart from <i>body image</i>. A new theme, <i>gender inequality</i>, emerged from the studies and was overtly examined through gender disparity, gender preference of fetus, or domestic violence. <b>Conclusions:</b> Gender inequality and societal acceptability of domestic violence in South Asian women contextualizes the experience of prenatal maternal anxiety. Pregnancy-related anxiety tools should include domains related to gender inequality to better understand their influence on pregnancy outcomes.