Treatment for anxiety, depression, and stress in pregnant people experiencing antepartum hospitalization: a systematic review and meta-analysis

Objective: To systematically evaluate inpatient interventions to reduce symptoms of anxiety, depression, or stress in pregnant individuals during antepartum hospitalization.

Data sources: Searches were conducted in Ovid MEDLINE, Embase, CINAHL Plus, Cochrane CENTRAL, and PsycINFO from database inception through April 2023.

Study eligibility criteria: Randomized controlled trials and cohort studies were eligible for inclusion if an intervention was compared to treatment as usual (TAU) to reduce symptoms of anxiety, depression, or stress among pregnant individuals admitted to a hospital's antepartum unit.

Study appraisal and synthesis methods: Two authors independently screened all abstracts for eligibility and reviewed all potentially eligible full-text articles for inclusion. The primary outcome was the score on the assessment for symptoms of anxiety, depression, or stress after the intervention. The Hedges method was used to detect standardized mean difference (SMD) in studies using different psychometric scales, and weighted mean differences (WMD) were used in studies using the same psychometric scales. Risk of bias was assessed using the Cochrane Handbook for Systematic Reviews of Interventions.

Results: Of 1185 articles originally identified, 19 full-text manuscripts were reviewed, and three studies (all randomized controlled studies)-corresponding to 226 patients randomized to an intervention and 263 patients randomized to TAU-were included. Compared to TAU, interventions significantly reduced mean scores on validated scales assessing symptoms of anxiety (SMD -0.65 [95% Confidence Interval (CI) -0.83, -0.46]), depression (WMD -0.52 [95% CI -0.76, -0.28]), and stress (WMD -0.57 [95% CI -0.82, -0.31]).

Conclusion: Though data are limited, interventions given to birthing people who experience antepartum hospitalization modestly-but significantly-reduce symptoms of anxiety, depression, and stress. These data highlight a need for further high-quality trials to support the mental health needs of this high-risk population.

Funding: This project was supported by the Department of Maternal Fetal Medicine at the Alpert School of Medicine of Brown University. AKL was supported by NICHD (K23HD103961). ESM was supported by NICHD (R01HD105499) and NINR (R01NR021126-01). LGW was supported by K23HD107296-01A1 and P20GM139767.

Systematic review registration: PROSPERO, CRD42023444189.