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

IF 3.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

American Journal of Obstetrics & Gynecology Mfm Pub Date : 2025-01-23 DOI:10.1016/j.ajogmf.2025.101613

John R. Soehl MD , Kathryn Anthony MD , Adam K. Lewkowitz MD, MPHS , Lauren Fletcher MLIS, MA , L.G. Ward PhD , Emily S. Miller MD, MPH

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引用次数: 0

Abstract

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 3 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

查看原文本刊更多论文

目的：系统评价住院干预措施对减轻孕妇产前住院期间焦虑、抑郁或压力症状的作用。数据来源：从数据库建立到2023年4月，在Ovid MEDLINE、Embase、CINAHL Plus、Cochrane CENTRAL和PsycINFO中进行检索。研究资格标准：随机对照试验和队列研究符合纳入标准，如果干预措施与常规治疗（TAU）相比，可以减少医院产前住院孕妇的焦虑、抑郁或压力症状。研究评价和综合方法：两位作者独立筛选了所有的摘要，并审查了所有可能符合条件的全文文章。主要结果是干预后对焦虑、抑郁或压力症状的评估得分。采用Hedges方法检测不同心理测量量表的标准化平均差异（SMD），采用加权平均差异（WMD）检测相同心理测量量表的研究。使用Cochrane干预措施系统评价手册评估偏倚风险。结果：在最初确定的1185篇文章中，审查了19篇全文手稿，并纳入了3项研究（均为随机对照研究）-对应于随机分配到干预组的226例患者和随机分配到tau组的263例患者。与TAU相比，干预显著降低了评估焦虑（SMD -0.65[95%可信区间(CI) -0.83, -0.46]）、抑郁（WMD -0.52 [95% CI -0.76, -0.28]）和压力（WMD -0.57 [95% CI -0.82, -0.31]）症状的有效量表的平均得分。结论：虽然数据有限，但对经历过产前住院治疗的产妇进行干预，适度但显著地减少了焦虑、抑郁和压力的症状。这些数据强调需要进一步进行高质量的试验，以支持这一高危人群的心理健康需求。资助：本项目由布朗大学阿尔伯特医学院母胎医学系支持。AKL由NICHD （K23HD103961）支持。ESM得到NICHD （R01HD105499）和NINR （R01NR021126-01）的支持。LGW由K23HD107296-01A1和P20GM139767支持。系统评价注册：PROSPERO， CRD42023444189。

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来源期刊

American Journal of Obstetrics & Gynecology Mfm Medicine-Medicine (all)

CiteScore

7.40

自引率

3.20%

发文量

254

审稿时长

40 days

期刊介绍： The American Journal of Obstetrics and Gynecology (AJOG) is a highly esteemed publication with two companion titles. One of these is the American Journal of Obstetrics and Gynecology Maternal-Fetal Medicine (AJOG MFM), which is dedicated to the latest research in the field of maternal-fetal medicine, specifically concerning high-risk pregnancies. The journal encompasses a wide range of topics, including: Maternal Complications: It addresses significant studies that have the potential to change clinical practice regarding complications faced by pregnant women. Fetal Complications: The journal covers prenatal diagnosis, ultrasound, and genetic issues related to the fetus, providing insights into the management and care of fetal health. Prenatal Care: It discusses the best practices in prenatal care to ensure the health and well-being of both the mother and the unborn child. Intrapartum Care: It provides guidance on the care provided during the childbirth process, which is critical for the safety of both mother and baby. Postpartum Issues: The journal also tackles issues that arise after childbirth, focusing on the postpartum period and its implications for maternal health. AJOG MFM serves as a reliable forum for peer-reviewed research, with a preference for randomized trials and meta-analyses. The goal is to equip researchers and clinicians with the most current information and evidence-based strategies to effectively manage high-risk pregnancies and to provide the best possible care for mothers and their unborn children.