title: 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.
  
  
  METHODS
  EBSCO, Medline, PubMed, Cochrane, secondary references of Cochrane reviews and review articles, and experts in the field.
  
  
  METHODS
  Randomised controlled trials in which the association between an antenatal intervention and the reduction of maternal distress was reported.
  
  
  METHODS
  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.
  
  
  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).
  
  
  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.
authors.affiliation: Midwifery Education & Studies Maastricht-ZUYD, Maastricht, the Netherlands.
authors.forename: Y J
authors.initials: YJ
authors.lastname: Fontein-Kuipers
authors.forename: M J
authors.initials: MJ
authors.lastname: Nieuwenhuijze
authors.forename: M
authors.initials: M
authors.lastname: Ausems
authors.forename: L
authors.initials: L
authors.lastname: Budé
authors.forename: R
authors.initials: R
authors.lastname: de Vries
mesh_terms: D001007:Anxiety / Q000517:prevention & control / Q000628:therapy*; D003863:Depression / Q000517:prevention & control / Q000628:therapy*; D005260:Female; D006801:Humans; D015233:Models, Statistical; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control / Q000628:therapy*; D011295:Prenatal Care / Q000379:methods*; D011644:Puerperal Disorders / Q000517:prevention & control / Q000628:therapy; D016032:Randomized Controlled Trials as Topic; D013315:Stress, Psychological / Q000517:prevention & control / Q000628:therapy*; D016896:Treatment Outcome
keywords: Interventions; maternal distress; mental health; midwifery; pregnancy; public health