Antenatal interventions to reduce maternal distress: a systematic review and meta‐analysis of randomised trials
Open accessAbstract
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.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
To overcome high attrition rates and improve effectiveness, interventions should be aimed primarily at at-risk women and should fit the unique preferences and needs of pregnant women.
“From previous trials, we also know that to overcome high attrition rates and improve effectiveness, interventions should be aimed primarily at at-risk women (e.g., women with subclinical depression) and should fit the unique preferences and needs of pregnant women [22–24].”
Cites
Quantifying heterogeneity in a meta‐analysis
Higgins, J. P. T., & Thompson, S. G. (2002) · Statistics in Medicine · doi:10.1002/sim.1186 · Cited by 36,763 · see citing works
Cochrane Handbook for Systematic Reviews of Interventions: Cochrane Book Series
(2008) · doi:10.1002/9780470712184 · Cited by 25,048 · see citing works
Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2009) · doi:10.1002/9780470743386 · Cited by 14,225 · see citing works
CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials
the CONSORT Group, Schulz, K. F., Altman, D. G., & Moher, D. (2010) · BMC Medicine · doi:10.1186/1741-7015-8-18 · Cited by 13,371 · see citing works
Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2021) · doi:10.1002/9781119558378 · Cited by 9,799 · see citing works
CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials
Schulz, K. F., Altman, D. G., Moher, D., & for the CONSORT Group (2010) · BMJ · doi:10.1136/bmj.c332 · Cited by 9,329 · see citing works
The course of anxiety and depression through pregnancy and the postpartum in a community sample
Heron, J., O'Connor, T. G., Evans, J., Golding, J., & Glover, V. (2004) · Journal of Affective Disorders · doi:10.1016/j.jad.2003.08.004 · Cited by 1,151 · see citing works
Van den Bergh, B. R. H., Mulder, E. J. H., Mennes, M., & Glover, V. (2005) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2004.10.007 · Cited by 1,104 · see citing works
Antenatal risk factors for postnatal depression: A large prospective study
Milgrom, J., Gemmill, A. W., Bilszta, J. L., Hayes, B., Barnett, B., Brooks, J., Ericksen, J., Ellwood, D., & Buist, A. (2008) · Journal of Affective Disorders · doi:10.1016/j.jad.2007.10.014 · Cited by 953 · see citing works
Subgroup analysis in randomised controlled trials: importance, indications, and interpretation
Rothwell, P. M. (2005) · The Lancet · doi:10.1016/s0140-6736(05)17709-5 · Cited by 942 · see citing works
Risk factors for antenatal depression, postnatal depression and parenting stress
Leigh, B., & Milgrom, J. (2008) · BMC Psychiatry · doi:10.1186/1471-244x-8-24 · Cited by 888 · see citing works
A Review of Methods for Missing Data
Pigott, T. (2001) · Educational Research and Evaluation · doi:10.1076/edre.7.4.353.8937 · Cited by 654 · see citing works
Maternal anxiety during the transition to parenthood: A prospective study
Grant, K., McMahon, C. A., & Austin, M. (2007) · Journal of Affective Disorders · doi:10.1016/j.jad.2007.10.002 · Cited by 467 · see citing works
Screening for depression across the lifespan: a review of measures for use in primary care settings.
Sharp, L. K., & Lipsky, M. S. (2002) · PubMed · Cited by 399 · see citing works
Vieten, C., & Astin, J. (2008) · Archives of Women's Mental Health · doi:10.1007/s00737-008-0214-3 · Cited by 369 · see citing works
Postpartum depression screening: importance, methods, barriers, and recommendations for practice
Gjerdingen, D. K., & Yawn, B. P. (2007) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2007.03.060171 · Cited by 344 · see citing works
Anxiety measures validated in perinatal populations: A systematic review
Meades, R., & Ayers, S. (2011) · Journal of Affective Disorders · doi:10.1016/j.jad.2010.10.009 · Cited by 329 · see citing works
Craft, A. (2015) · Cited by 323 · see citing works
Systematic reviews of the effectiveness of quality improvement strategies and programmes
Grimshaw, J. (2003) · BMJ Quality & Safety · doi:10.1136/qhc.12.4.298 · Cited by 290 · see citing works
Using the Edinburgh Postnatal Depression Scale to screen for anxiety disorders
Matthey, S. (2007) · Depression and Anxiety · doi:10.1002/da.20415 · Cited by 256 · see citing works
Effects of music therapy on psychological health of women during pregnancy
Chang, M., Chen, C., & Huang, K. (2008) · Journal of Clinical Nursing · doi:10.1111/j.1365-2702.2007.02064.x · Cited by 236 · see citing works
Maternal anxiety during pregnancy and subsequent infant development
Brouwers, E. P. M., van Baar, A. L., & Pop, V. J. M. (2001) · Infant Behavior and Development · doi:10.1016/s0163-6383(01)00062-5 · Cited by 225 · see citing works
Bastani, F., Hidarnia, A. A., Kazemnejad, A., Vafaei, M. A., & Kashanian, M. (2005) · Journal of Midwifery & Women s Health · doi:10.1016/j.jmwh.2004.11.008 · Cited by 220 · see citing works
Parent-training programmes for improving maternal psychosocial health
Barlow, J., & Coren, E. (2001) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002020 · Cited by 193 · see citing works
Revision of the Postpartum Depression Predictors Inventory
Beck, C. T. (2002) · Journal of Obstetric, Gynecologic & Neonatal Nursing · doi:10.1111/j.1552-6909.2002.tb00061.x · Cited by 193 · see citing works
Acupuncture for Depression During Pregnancy: A Randomized Controlled Trial
Manber, R., Schnyer, R. N., Lyell, D., Chambers, A. S., Caughey, A. B., Druzin, M., Carlyle, E., Celio, C., Gress, J. L., Huang, M. I., et al. (2010) · Obstetrics & Gynecology · doi:10.1097/aog.0b013e3181cc0816 · Cited by 180 · see citing works
To screen or not to screen — that is the question in perinatal depression
Buist, A., Milgrom, J., Barnett, B. E. W., Pope, S., Condon, J. T., Ellwood, D. A., Boyce, P. M., Austin, M., & Hayes, B. A. (2002) · The Medical Journal of Australia · doi:10.5694/j.1326-5377.2002.tb04866.x · Cited by 179 · see citing works
Milgrom, J., Schembri, C., Ericksen, J., Ross, J., & Gemmill, A. W. (2011) · Journal of Affective Disorders · doi:10.1016/j.jad.2010.10.045 · Cited by 175 · see citing works
Antenatal and postnatal mental health: summary of updated NICE guidance
Howard, L. M., Megnin-Viggars, O., Symington, I., Pilling, S., & On behalf of the Guideline Development Group (2014) · BMJ · doi:10.1136/bmj.g7394 · Cited by 162 · see citing works
Ickovics, J. R., Reed, E., Magriples, U., Westdahl, C., Rising, S. S., & Kershaw, T. (2011) · Psychology and Health · doi:10.1080/08870446.2011.531577 · Cited by 159 · see citing works
DiPietro, J. A., Costigan, K. A., & Sipsma, H. L. (2008) · Journal of Psychosomatic Obstetrics & Gynecology · doi:10.1080/01674820701701546 · Cited by 158 · see citing works
Mind-body interventions during pregnancy for preventing or treating women's anxiety
Marc, I., Toureche, N., Ernst, E., HODNETT, E. D., Blanchet, C., Dodin, S., & Njoya, M. M. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007559.pub2 · Cited by 153 · see citing works
Long-term cognitive sequelae of antenatal maternal anxiety: involvement of the orbitofrontal cortex
Mennes, M., Stiers, P. L. J., Lagae, L. G., & den Bergh, B. R. H. V. (2006) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2006.04.003 · Cited by 146 · see citing works
Bergström, M., Kieler, H., & Waldenström, U. (2009) · BJOG: an International Journal of Obstetrics and Gynaecology · doi:10.1111/j.1471-0528.2009.02144.x · Cited by 144 · see citing works
Taft, A. J., Small, R., Hegarty, K. L., Watson, L. F., Gold, L., & Lumley, J. A. (2011) · BMC Public Health · doi:10.1186/1471-2458-11-178 · Cited by 140 · see citing works
Maternal distress: a concept analysis
Emmanuel, E. N., & John, W. S. (2010) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2010.05371.x · Cited by 121 · see citing works
Verkerk, G. J. M., Pop, V. J. M., van Son, M. J. M., & Heck, G. L. V. (2002) · Journal of Affective Disorders · doi:10.1016/s0165-0327(02)00146-5 · Cited by 103 · see citing works
Oppo, A., Mauri, M. F., Ramacciotti, D., Camilleri, V., Banti, S., Borri, C., Rambelli, C., Montagnani, M. S., Cortopassi, S., Bettini, A., et al. (2009) · Archives of Women s Mental Health · doi:10.1007/s00737-009-0071-8 · Cited by 101 · see citing works
Jomeen, J. (2004) · Clinical Effectiveness in Nursing · doi:10.1016/j.cein.2005.02.001 · Cited by 99 · see citing works
Dennis, C.-L., & Giavedoni, K. (2007) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006795 · Cited by 95 · see citing works
Randomised-controlled trial of two antenatal education programmes
Svensson, J., Barclay, L. M., & Cooke, M. (2007) · Midwifery · doi:10.1016/j.midw.2006.12.012 · Cited by 91 · see citing works
Are we overpathologising motherhood?
Matthey, S. (2010) · Journal of Affective Disorders · doi:10.1016/j.jad.2009.05.004 · Cited by 81 · see citing works
Nair, N. P. V., Amin, M., Holm, P., Katona, C., Klitgaard, N. A., Kin, N. M. K. N. Y., Kragh-Sørensen, P., Kühn, H.-J., Leek, C. A., & Stage, K. B. (1995) · Journal of Affective Disorders · doi:10.1016/0165-0327(94)00047-d · Cited by 77 · see citing works
Pilling, S., Adams, H., Barlow, J., Bavetta, M., Clarke, S. D., Day, A., Demilew, J., Grayson, K., Grégoire, A., Jones, I. R., et al. (2014) · Cited by 62 · see citing works
A RCT of peer-mentoring for first-time mothers in socially disadvantaged areas (The MOMENTS Study)
Cupples, M., Stewart, M. C., Percy, A., Hepper, P. G., Murphy, C., & Halliday, H. L. (2010) · Archives of Disease in Childhood · doi:10.1136/adc.2009.167387 · Cited by 55 · see citing works
Bernazzani, O., Marks, M. N., Bifulco, A., Siddle, K., Asten, P., & Conroy, S. (2005) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-005-0917-y · Cited by 45 · see citing works
Early intervention for perinatal depression
Thoppil, J., Riutcel, T. L., & Nalesnik, S. W. (2005) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2004.12.073 · Cited by 38 · see citing works
Bergström, M., Kieler, H., & Waldenström, U. (2010) · Obstetric Anesthesia Digest · doi:10.1097/01.aoa.0000386822.05009.6e · Cited by 14 · see citing works
Why the prevention paradox is a paradox, and why we should solve it: A philosophical view
John, S. D. (2011) · Preventive Medicine · doi:10.1016/j.ypmed.2011.07.006 · Cited by 13 · see citing works
34: Acupuncture for depression during pregnancy
Manber, R., Schnyer, R. N., Chambers, A. S., et al. (2009) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2009.10.048 · Cited by 5 · see citing works
(2009)
Flagged first, then by citations
Cited by
Sorted by citations
Physical activity during pregnancy and postpartum depression: systematic review and meta- analysis
Nakamura, A., van der Waerden, J., Melchior, M., Bolze, C., El-Khoury, F., & Pryor, L. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.12.009 · Cited by 186 · see citing works
Morrell, C. J., Sutcliffe, P., Booth, A., Stevens, J., Scope, A., Stevenson, M., Harvey, R., Bessey, A., Cantrell, A., Dennis, C.-L., et al. (2016) · Health Technology Assessment · doi:10.3310/hta20370 · Cited by 155 · see citing works
Music interventions to reduce stress and anxiety in pregnancy: a systematic review and meta-analysis
Corbijn van Willenswaard, K., Lynn, F., McNeill, J., McQueen, K., Dennis, C.-L., Lobel, M., & Alderdice, F. (2017) · BMC Psychiatry · doi:10.1186/s12888-017-1432-x · Cited by 140 · see citing works
Nath, S., Pearson, R. M., Moran, P., Pawlby, S., Molyneaux, E., Challacombe, F. L., & Howard, L. M. (2019) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2019.102148 · Cited by 68 · see citing works
Scherer, S., Alder, J., Gaab, J., Berger, T., Ihde, K., & Urech, C. (2016) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2015.10.011 · Cited by 51 · see citing works
Prenatal maternal mood entropy is associated with child neurodevelopment.
Howland, M. A., Sandman, C. A., Davis, E. P., Stern, H. S., Phelan, M., Baram, T. Z., & Glynn, L. M. (2021) · Emotion · doi:10.1037/emo0000726 · Cited by 40 · see citing works
Missler, M., Donker, T., Beijers, R., Ciharova, M., Moyse, C., de Vries, R., Denissen, J., & van Straten, A. (2021) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-021-03752-2 · Cited by 40 · see citing works
Self-citationEvans, K., Morrell, C. J., & Spiby, H. (2018) · Journal of Advanced Nursing · doi:10.1111/jan.13456 · Cited by 33 · see citing works
Urech, C., Scherer, S., Emmenegger, M., Gaab, J., Tschudin, S., Hoesli, I., Berger, T., & Alder, J. (2017) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2017.10.014 · Cited by 29 · see citing works
Witteveen, A. B., Henrichs, J., Walker, A. L., Bohlmeijer, E. T., Burger, H., Fontein-Kuipers, Y., Schellevis, F. G., Stramrood, C. A. I., Olff, M., Verhoeven, C. J., et al. (2020) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-020-03395-9 · Cited by 13 · see citing works
Self-citation
- Authors
- Fontein‐Kuipers, Y., Nieuwenhuijze, M., Ausems, M., Budé, L., & de Vries, R.
- Affiliations
- Midwifery Education & Studies Maastricht‐ZUYD Maastricht the Netherlands
- Venue
- BJOG: An International Journal of Obstetrics & Gynaecology
- Publisher
- Wiley
- Published
- 2014-01-08
- Volume
- 121
- Issue
- 4
- Pages
- 389-397
- ISSN
- 0306-5456 (ISSN-L)
- 1470-0328
- 1471-0528
- OpenAlex
- W2124259832
- Cited by
- 91
- References
- 51
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 5 · 2023: 7 · 2022: 4 · 2021: 14 · 2020: 11 · 2019: 12 · 2018: 8 · 2017: 11 · 2016: 6 · 2015: 8 · 2014: 1
- FWCI
- 1.35
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BJOG An International Journal of Obstetrics & Gynaecology (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion)
- Research Output (Edinburgh Napier University) (submittedVersion)
- Edinburgh Napier Research Repository (Edinburgh Napier University) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion)
- Funders
- Regional Attention and Action for Knowledge (PRO 2-014)
- Foundation Innovation Alliance
- Ministry of Education, Culture, and Science
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Keywords
- maternal distress, antenatal interventions, postpartum depression, preventive interventions, therapeutic interventions, pregnancy, vulnerable women, maternal mental health
- MeSH terms
- Anxiety, Depression, Female, Humans, Pregnancy, Pregnancy Complications, Prenatal Care, Puerperal Disorders, Stress, Psychological, Models, Statistical, Randomized Controlled Trials as Topic, Treatment Outcome
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
