Global prevalence of depression, anxiety, and stress symptoms in different trimesters of pregnancy: A meta-analysis and meta-regression

The global prevalence of psychological problems in different trimesters is unclear due to methodological constraints in previous reviews. A precise estimate would be a key first step in raising awareness and allocating resources. This review aims to (1) calculate the global prevalence of depression, anxiety, and stress symptoms during different trimesters and (2) determine the factors influencing their prevalence estimates. A comprehensive search across eight databases was conducted. The meta packages in R software were used to perform meta-analysis, subgroup analysis, and meta-regression analysis. The Newcastle Ottawa Scale was used to assess the study quality, while the Grading of Recommendations, Assessment, Development, and Evaluation method was utilized to assess the certainty of the evidence. A total of 88 studies with 61,719 participants across 48 countries were included. The prevalences of depression, anxiety, and stress symptoms during all trimesters were 27% (95% CI: 23-31), 37% (95% CI: 31-42), and 26% (95% CI: 9-49), respectively. The second trimester had the highest prevalence of depression (30%) and anxiety (28%) symptoms, whereas the third trimester had the highest prevalence of stress symptoms (52%). A series of subgroup and meta-regression analyses revealed that regions, economic levels of the country, setting, the COVID-19 pandemic, and quality of study were significant factors. Most studies were high quality, but the certainty of the evidence was very low. Findings can contribute as evidence to raising awareness about specific psychological problems during different trimesters. Implementing effective policies and launching targeted interventions can help minimize the prevalence.