The long-term course of perinatal anxiety: A systematic review and meta-analysis protocol.

BACKGROUND: The perinatal period represents a high-risk period for anxiety, with symptoms of anxiety associated with a range of adverse outcomes for birthing people and children. Previous reviews have assessed the prevalence of anxiety during the perinatal period. However, the long-term course of perinatal anxiety remains unclear. This review protocol aims to investigate the long-term, natural course of anxiety symptoms, anxiety disorders, and anxiety-related disorders (AAARDS) among birthing people. METHODS: A systematic review and, if appropriate, meta-analysis will be conducted according to the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search terms will be applied to the following databases: MEDLINE, EMBASE, CINAHL, Web of Science, and PsycINFO. Inclusion criteria will be: (1) prevalence of AAARDS assessed at least once during the perinatal period and at ≥24 months post-birth, (2) AAARDS assessed using a validated measure and/or diagnostic interview, (3) full-text available online. Exclusion criteria will be: (1) grey literature, (2) qualitative, interventional, or animal studies, (3) studies with a selected sample, (4) studies with a small sample size (N < 10), and (5) studies that synthesise existing research. Screening and data extraction will be conducted by two independent reviewers, with any conflicts resolved by a third reviewer. Risk of bias will be assessed using a modified version of the Downs and Black checklist. Data will be narratively synthesised, and meta-analyses will be conducted where appropriate. DISCUSSION: The present protocol describes the methodology for a systematic review investigating the long-term course of perinatal AAARDS. Findings will address a gap in the literature and enhance our understanding of the natural course of perinatal anxiety, which could help to inform clinical services and resource allocation. REGISTRATION: This review has been registered on PROSPERO (registration code: CRD420251073221).