Antenatal interventions to reduce maternal distress: a systematic review and meta-analysis of randomised trials

Abstract

Background: Maternal distress can have adverse health outcomes for mothers and their children. Antenatal interventions may reduce maternal distress.

Objective: To assess the effectiveness of antenatal interventions for the reduction of maternal distress during pregnancy and for up to 1 year postpartum.

Search strategy: EBSCO, Medline, PubMed, Cochrane, secondary references of Cochrane reviews and review articles, and experts in the field.

Selection criteria: Randomised controlled trials in which the association between an antenatal intervention and the reduction of maternal distress was reported.

Data collection and analysis: Two authors independently abstracted data from each trial. A random-effects meta-analysis assessed the reduction of maternal distress associated with antenatal preventive and treatment interventions, compared with routine antenatal care or another intervention.

Main results: Ten trials with 3167 participants met the inclusion criteria, and nine trials (n = 3063) provided data for the meta-analysis of six preventive interventions and three treatment interventions. The preventive interventions indicated no beneficial reduction of maternal distress (six trials; n = 2793; standardised mean difference, SMD -0.06; 95% confidence interval, 95% CI -0.14-0.01). The treatment interventions indicated a significant effect for the reduction of maternal distress (three trials; n = 270; SMD -0.29; 95% CI -0.54 to -0.04). A sample of women, selected retrospectively, who were more vulnerable for developing maternal distress showed a significant reduction of maternal distress after the interventions (three trials; n = 1410; SMD -0.25; 95% CI -0.37 to -0.14).

Author's conclusions: Preventive antenatal interventions for maternal distress show no effect. Antenatal interventions for women who have maternal distress or are at risk for developing maternal distress are associated with a small reduction in maternal distress.

Keywords: Interventions; maternal distress; mental health; midwifery; pregnancy; public health.