Universal prevention of distress aimed at pregnant women: a systematic review and meta-analysis of psychological interventions

Background: There is sufficient meta-analytic evidence that antenatal interventions for women at risk (selective prevention) or for women with severe psychological symptoms (indicated prevention) are effective in reducing postpartum distress. However, women without risk or severe psychological symptoms might also experience distress. This meta-analysis focused on the effectiveness of preventive psychological interventions offered to universal populations of pregnant women on symptoms of depression, anxiety, and general stress. Paternal and infant outcomes were also included. Method: We included 12 universal prevention studies in the meta-analysis, incorporating a total of 2559 pregnant women. Results: Overall, ten studies included depression as an outcome measure, five studies included stress, and four studies anxiety. There was a moderate effect of preventive interventions implemented during pregnancy on the combined measure of maternal distress (d =.52), on depressive symptoms (d =.50), and on stress (d =.52). The effect on anxiety (d =.30) was smaller. The effects were not associated with intervention timing, intervention type, intervention delivery mode, timing of post-test, and methodological quality. The number of studies including partner and/or infant outcomes was too low to assess their effectiveness. Conclusions: This meta-analysis suggests that universal prevention during pregnancy is effective on decreasing symptoms of maternal distress compared to routine care, at least with regard to depression. While promising, the results with regard to anxiety and stress are based on a considerably lower number of studies, and should thus be interpreted with caution. More research is needed on preventing other types of maternal distress beyond depression. Furthermore, there is a lack of research with regard to paternal distress. Also, given the large variety in interventions, more research is needed on which elements of universal prevention work. Finally, as maternal distress symptoms can affect infant development, it is important to investigate whether the positive effects of the preventive interventions extend from mother to infant. Systematic review registration number: International prospective register of systematic reviews (PROSPERO) registration number: CRD42018098861