Modifiable and vulnerability factors for maternal stress and anxiety in the first 1000 days: An umbrella review and framework

Background: Maternal stress and anxiety during pregnancy and up to 2 years postpartum have important implications for the physical health and psychological wellbeing of women and children. Aim: An umbrella review synthesised the modifiable and vulnerability factors related to perinatal and early parenthood stress and anxiety from the literature to develop a theoretically-informed framework for future interventions. Methods: MEDLINE, CINAHL, PsycINFO, and Maternity and Infant Care databases were searched from database inception to September 2023. All systematic reviews, meta-analyses, qualitative evidence syntheses, and rapid or scoping reviews that focused on pregnant women and/or up to 2 years postpartum and examined factors associated with perinatal and/or early parenthood maternal stress and/or anxiety were included. Each paper was reviewed using A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2). Narrative synthesis and framework development were informed by the social ecological and diathesis-stress models. Findings: Forty-three reviews were included. Factors related to maternal stress and anxiety were identified across social-ecological levels. The strongest evidence for modifiable factors was identified for existing mental health issues and interpersonal factors, such as social support. There was moderate evidence for modifiable factors including social norms and stigma, health behaviours, and expectancies. Vulnerability factors identified included sociodemographic factors, life history, maternal health, and birth-related factors, interpersonal factors, and child-related factors. Conclusion: Addressing identified modifiable factors across multiple ecological levels, with consideration of vulnerability factors that impact on stress and anxiety outcomes is essential. The theoretically informed framework developed in this umbrella review can guide identifying and addressing these factors to reduce perinatal and early parenthood maternal stress and anxiety.