Maternal perinatal mental health has always been a major public health issue because of its adverse impact on the well-being of the mother, baby, and family (Howard et al., 2014; Stein et al., 2014). Pregnancy brings about numerous changes, including changes in physical, social, and psychological aspects, which increase women's risk of mental health problems, especially in low- and middle-income (LAMICs) countries (Fisher et al., 2012). Anxiety is among the most common mental health condition in women during the perinatal period from pregnancy to 12 months postpartum (Kendig et al., 2017). Some studies have found that anxiety is often comorbid with or even more common than depression during pregnancy and is associated with postpartum depression in many countries (Heron et al., 2004; Kessler et al., 2002; Nasreen et al., 2010). However, perinatal anxiety has received relatively limited attention.

Perinatal anxiety can have a substantial negative impact on both women and their children. Women with prenatal anxiety have been associated with a greater tendency for cesarean section (Rubertsson et al., 2014), a higher fear of childbirth (Hall et al., 2009), eating disorders (Micali et al., 2011), reduced effective coping strategies (George et al., 2013), and even an increased risk of suicide (Farias et al., 2013). Simultaneously, prenatal anxiety has been considered to be related to adverse birth outcomes, including intrauterine growth restriction (Lobel et al., 2008; Schetter, 2011), premature labor (Hasanjanzadeh and Faramarzi, 2017; Lobel et al., 2008; Staneva et al., 2015), and low birth weight (Hasanjanzadeh and Faramarzi, 2017). Anxiety during pregnancy may also adversely affect the mother-infant bond (Tietz et al., 2014). Moreover, maternal perinatal anxiety has a far-reaching impact on children. The offspring of pregnant women with perinatal anxiety had an increased risk of attention deficit/hyperactivity disorder (Glover et al., 2009; O'Connor et al., 2002a; O'Connor et al., 2002b; Rice et al., 2010), depressive symptoms, impulsivity, and adolescent cognitive impairment (Pawlby et al., 2009; Van den Bergh et al., 2005).

A recent study estimated that the prevalence of perinatal depression was 16.3 % in China, which was similar to that in LAMICs but higher than that in high-income countries (HICs) (Nisar et al., 2020). Many studies have demonstrated numerous influencing factors of perinatal mental health problems, including psychological, social, and biological exposures (Burger et al., 2020; Louise et al., 2014). In China, the first generation of the post-one-child policy has reached childbearing age within the past decade, most of whom are experiencing their first pregnancy and delivery (Ding, 2015a). Some studies from China showed that primiparas are more likely to suffer from perinatal anxiety and depression, which requires more effective prevention and treatment (Cui, 2013). In addition, some traditional cultural aspects, such as gender preference for male children, were found to be associated with anxiety and depression among Chinese mothers (Kang et al., 2016; Nisar et al., 2020). These characteristics suggest the need to be aware of the role of societal trends and cultural aspects in interpreting data and planning further research.

The prevalence of self-reported anxiety symptoms in each trimester of pregnancy was estimated to be 18.2–24.6 % in international studies (Dennis et al., 2017). Many studies have focused on perinatal anxiety in Chinese women but there may be substantial differences among regions in China. To the best of our knowledge, there is no systematic review of the prevalence of perinatal anxiety in mainland China. We conducted a systematic review and meta-analysis of the prevalence of perinatal anxiety and its determinants in mainland China to obtain an accurate sense of the prevalence rates and the moderators of these rates, and provide recommendations for future research and policy planning.