The Effectiveness Of Prenatal Education Interventions On Maternal Anxiety And Birth Outcomes: A Systematic Review
DOI:
https://doi.org/10.58439/jhrt.v3i2.390Keywords:
prenatal education, maternal anxiety, birth outcomes, pregnancy, systematic review, self-efficacyAbstract
Background: Prenatal education interventions are widely implemented in routine antenatal care to enhance maternal and neonatal outcomes. However, evidence regarding their effectiveness remains inconsistent across populations and intervention modalities. Objective: This systematic review aimed to evaluate the effectiveness of prenatal education interventions in reducing maternal anxiety and improving birth-related outcomes. Methods: A systematic search of PubMed, CINAHL, Cochrane Library, and PsycINFO was conducted from database inception to January 2024. Eligible studies included randomised controlled trials (RCTs) and quasi-experimental designs assessing prenatal education interventions with outcomes related to maternal anxiety and birth metrics. Two reviewers performed screening, data extraction, and risk of bias assessments independently, following PRISMA guidelines and utilising the Cochrane Risk of Bias tool. Results: Twenty-eight studies encompassing 5,847 participants were included. Meta-analysis showed a significant reduction in maternal anxiety associated with prenatal education (standardised mean difference [SMD] = –0.42, 95% CI: –0.58 to –0.26, p < 0.001). While significant improvements were observed in maternal knowledge (SMD = 0.65) and self-efficacy (SMD = 0.51), evidence for effects on clinical outcomes such as cesarean delivery rates and birth weight was limited and inconsistent. Conclusions: Prenatal education interventions are effective in reducing maternal anxiety and enhancing maternal knowledge and self-efficacy. However, their impact on clinical birth outcomes remains unclear, highlighting the need for further high-quality studies with standardised methodologies and long-term follow-up.
References
Abdulahi, M., Fretheim, A., Argaw, A., & Magnus, J. H. (2021). Breastfeeding Education and Support to Improve Early Initiation and Exclusive Breastfeeding Practices and Infant Growth: A Cluster Randomized Controlled Trial From a Rural Ethiopian Setting. Nutrients, 13(4), 1204. https://doi.org/10.3390/nu13041204
Akhtarkia, Z., Kamrani, M. A., Farid, M., & Dana, H. F. (2023). Relationship Among Maternal Perception of Childbirth Experience, Spiritual Health and Maternal-Infant Relationship in the Postpartum Women: A Cross-Sectional Study. Iranian Journal of Nursing and Midwifery Research, 28(3), 332–338. https://doi.org/10.4103/ijnmr.ijnmr_404_20
Akın, B., Koçak, M. Y., Küçükaydın, Z., & Güzel, K. (2021). The Effect of Showing Images of the Foetus With the Virtual Reality Glass During Labour Process on Labour Pain, Birth Perception and Anxiety. Journal of Clinical Nursing, 30(15–16), 2301–2308. https://doi.org/10.1111/jocn.15768
Andrzejczak, M., Jones, G. J. F., & Nye, G. (2024). Examining Effective Patient-Provider Communication in Antenatal Settings Across England: An in-Depth Analysis of Woman’s Experiences. https://doi.org/10.1101/2024.05.02.24306775
Bao, W., Sun, Y., Zhang, T., Zou, L., Wu, X., Wang, D., & Chen, Z. (2020). Exercise Programs for Muscle Mass, Muscle Strength and Physical Performance in Older Adults With Sarcopenia: A Systematic Review and Meta-Analysis. Aging and Disease, 11(4), 863. https://doi.org/10.14336/ad.2019.1012
Barrera, C. M., Powell, A. R., Biermann, C. R., Siden, J. Y., Nguyen, B.-H., Roberts, S. J., James, L., Chopra, V., & Peahl, A. (2021). A Review of Prenatal Care Delivery to Inform the Michigan Plan for Appropriate Tailored Healthcare in Pregnancy Panel. Obstetrics and Gynecology, 138(4), 603–615. https://doi.org/10.1097/aog.0000000000004535
Bright, K., Stuart, S., McNeil, D., Murray, L., & Kingston, D. (2022a). Feasibility and Acceptability of Internet-Based Interpersonal Psychotherapy for Stress, Anxiety, and Depression in Prenatal Women: Thematic Analysis. Jmir Formative Research, 6(6), e23879. https://doi.org/10.2196/23879
Bright, K., Stuart, S., McNeil, D., Murray, L., & Kingston, D. (2022b). Feasibility and Acceptability of Internet-Based Interpersonal Psychotherapy for Stress, Anxiety, and Depression in Prenatal Women: Thematic Analysis (Preprint). https://doi.org/10.2196/preprints.23879
Bryanton, J., Beck, C. T., & Morrison, S. (2021). When Fear Surrounding Childbirth Leads Women to Request a Planned Cesarean Birth. Western Journal of Nursing Research, 44(7), 643–652. https://doi.org/10.1177/01939459211010192
Chaharrahifard, L., Motlagh, A. J., Kamrani, M. A., Ataee, M., & Saeieh, S. E. (2021). The Effect of Midwife-Led Psycho-Education on Parental Stress, Postpartum Depression and Parental Competency in High Risk Pregnancy Women: A Randomized Controlled Trial. Journal of Caring Sciences, 10(2), 70–76. https://doi.org/10.34172/jcs.2021.014
Cowell, W., Khoury, J. E., Petty, C. R., Day, H. E., Benítez, B. E., Cunningham, M. K., Schulz, S. M., Ritz, T., Wright, R. J., & Enlow, M. B. (2020). Integrated and Diurnal Indices of Maternal Pregnancy Cortisol in Relation to Sex‐specific Parasympathetic Responsivity to Stress in Infants. Developmental Psychobiology, 63(2), 350–363. https://doi.org/10.1002/dev.22015
Dachew, B. A., Scott, J. G., Heron, J., Ayano, G., & Alati, R. (2021). Association of Maternal Depressive Symptoms During the Perinatal Period With Oppositional Defiant Disorder in Children and Adolescents. Jama Network Open, 4(9), e2125854. https://doi.org/10.1001/jamanetworkopen.2021.25854
Dağgez, M., & Yener, C. (2024). Elevated Depression, Anxiety and Hopelesness Among Pregnant Individuals With Ovarian Cyst. Acibadem Universitesi Saglik Bilimleri Dergisi. https://doi.org/10.31067/acusaglik.1348303
Dwiarini, M. (2022). Factors Related to Childbirth Self-Efficacy Among Primigravida in Yogyakarta. Jnki (Jurnal Ners Dan Kebidanan Indonesia) (Indonesian Journal of Nursing and Midwifery), 10(2), 151. https://doi.org/10.21927/jnki.2022.10(2).151-157
Flynn, K. E., McDonnell, S. M., Brazauskas, R., Ahamed, S. I., McIntosh, J. J., Pitt, M. B., Pizur‐Barnekow, K., Kim, U. O., Kruper, A., Leuthner, S. R., & Basir, M. (2023). Smartphone-Based Video Antenatal Preterm Birth Education. Jama Pediatrics, 177(9), 921. https://doi.org/10.1001/jamapediatrics.2023.1586
Ghaffari, S. F., Elyasi, F., Mousavinasab, N., & Shahhosseini, Z. (2021). The Effect of Midwifery-Led Counseling on Expectant Fathers’ Fear of Childbirth: A Smartphone- Based Randomized Controlled Trial. https://doi.org/10.21203/rs.3.rs-640232/v1
Gramszlo, C., Karpyn, A., Demianczyk, A. C., Shillingford, A. J., Riegel, E., Kazak, A. E., & Sood, E. (2020). Parent Perspectives on Family-Based Psychosocial Interventions for Congenital Heart Disease. The Journal of Pediatrics, 216, 51-57.e2. https://doi.org/10.1016/j.jpeds.2019.09.059
Kim, S. Y., & Kim, H. W. (2020). Prenatal Nursing Intervention Studies Published in Korean Nursing Journals: A Scoping Review. Korean Journal of Women Health Nursing, 26(2), 109–119. https://doi.org/10.4069/kjwhn.2020.06.12
Liu, X., Wang, G., & Cao, Y. (2022). Physical Exercise Interventions for Perinatal Depression Symptoms in Women: A Systematic Review and Meta-Analysis. Frontiers in Psychology, 13. https://doi.org/10.3389/fpsyg.2022.1022402
Masoudi, Z., Kasraeian, M., & Akbarzadeh, M. (2022). Assessment of Educational Intervention and Acupressure During Labor on the Mother’s Anxiety Level and Arterial Oxygen Pressure of the Umbilical Cord of Infants (PO2). A Randomized Controlled Clinical Trial. Journal of Education and Health Promotion, 11(1), 86. https://doi.org/10.4103/jehp.jehp_685_20
Mongelli, F., Calandrino, A., Vinci, F., Traggiai, C., Rebora, D., Maggiora, E., & Ramenghi, L. A. (2025). Three Years of Human Milk Banking: Assessing the Impact on Lactation Rates at Discharge in VLBW Preterm Infants in an Italian Reference NICU. Nutrients, 17(9), 1440. https://doi.org/10.3390/nu17091440
Oh, H., Kim, K., Lee, K.-H., Yoo, D.-W., & Yoon, I. M. (2022). Efficacy of Potassium-Competitive Acid Blockers vs. Proton Pump Inhibitors on Gastric Ulcers: Bayesian and Frequentist Network Meta-Analysis With Cross-Inference Through a Quality Management System. https://doi.org/10.21203/rs.3.rs-2167246/v1
Oh, H., Nguyen, H. D., Yoon, I. M., Ahn, B.-R., & Kim, M. (2021). Antidiabetic Effect of Gemigliptin: A Systematic Review and Meta-Analysis of Randomized Controlled Trials With Bayesian Inference Through a Quality Management System. Scientific Reports, 11(1). https://doi.org/10.1038/s41598-021-00418-z
Pei, F., Yu, Y., Dong, B., Guan, H., Dong, X., & Zhao, F. (2021). Efficacies and Toxicities of Seven Chemotherapy Regimens for Advanced Hodgkin Lymphoma. Frontiers in Pharmacology, 12. https://doi.org/10.3389/fphar.2021.694545
Pergialiotis, V., Panagiotopoulos, M., Constantinou, T., Vokotopoulou, L. V, Koumenis, A., Stavros, S., Voskos, A., & Daskalakis, G. (2022). Efficacy and Safety of Oral and Sublingual Versus Vaginal Misoprostol for Induction of Labour: A Systematic Review and Meta-Analysis. Archives of Gynecology and Obstetrics, 308(3), 727–775. https://doi.org/10.1007/s00404-022-06867-9
Schuyler, A. Q., & Carlo, W. A. (2023). Preterm Prenatal Education—A Novel Approach. Jama Pediatrics, 177(9), 887. https://doi.org/10.1001/jamapediatrics.2023.2569
Souza, F. M. de L. C., Santos, W. N. d., Santos, R. S. da C., Silva, V. L. M. da, Abrantes, R. M. d., Soares, V. F. R., & Silva, R. A. R. da. (2021). Effectiveness of Mobile Applications in Pregnant Women’s Adherence to Prenatal Consultations: Randomized Clinical Trial. Revista Brasileira De Enfermagem, 74(suppl 5). https://doi.org/10.1590/0034-7167-2019-0599
Tian, E., Nguyen, C., Chung, L., Morris, C., & Kumar, S. (2024). The Effectiveness of Public Awareness Initiatives Aimed at Encouraging the Use of Evidence-Based Recommendations by Health Professionals: A Systematic Review. Journal of Patient Safety, 20(3), 147–163. https://doi.org/10.1097/pts.0000000000001202
Tuxunjiang, X., Li, L., Wumaier, G., Zhang, W., Sailike, B., & Jiang, T. (2022). The Mediating Effect of Resilience on Pregnancy Stress and Prenatal Anxiety in Pregnant Women. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.961689
Valdes, V., Craighead, L. W., Nelson, C. A., & Enlow, M. B. (2024). Longitudinal Interactions Between Maternal Depression Symptoms and Familial Stressful Life Events on Child Anxiety Symptoms at 5 years of Age. Infancy, 30(1). https://doi.org/10.1111/infa.12628
Zou, Q., Liu, X., Yang, Y., Yang, Y., & Duan, X. (2025). Factors Influencing the Intention of Women With Perinatal Depression and Their Spouses to Seek Professional Psychological Help: A Cross-Sectional Latent Profile Analysis. Frontiers in Public Health, 13. https://doi.org/10.3389/fpubh.2025.1544463
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