The effect of virtual reality on pregnant women and fetuses: a systematic review and meta-analysis of randomized controlled trials.

Abstract

Objective: Virtual reality (VR), as a low-cost, non-invasive, and highly promising complementary therapeutic approach, has garnered increasing attention for its potential positive impacts on pregnant women, fetuses, and the childbirth process. The aim of this study was to systematically evaluate the specific effects of VR interventions on the psychological status, physiological indicators, and fetal outcomes of pregnant women.

Methods: We conducted a comprehensive literature search in PubMed, EMBASE, MEDLINE, PsycINFO, Web of Science, the Cochrane Library, and Chinese databases (CNKI, Wanfang Data, VIP Database, SinoMed) up to July 2024. The RoB2 tool was used to assess the risk of bias, while the GRADE approach evaluated the certainty of the evidence. RevMan 5.4 was used for data analysis, including subgroup analyses, while meta-regression analyses were performed in Stata 16.0 to explore sources of heterogeneity. Additionally, TSA 0.9.5.10 Beta was utilized to determine the required information size (RIS) for assessing the credibility and conclusiveness of the evidence.

Results: A total of five randomized controlled trials involving 807 pregnant women were included in this meta-analysis. The findings revealed that VR interventions significantly reduced anxiety levels among pregnant women (MD = - 7.63, 95% CI [- 12.98, - 2.28], Z = 2.8, p = 0.005). Despite substantial heterogeneity observed (I² = 94%, p < 0.001), sensitivity analysis confirmed the robustness of the results, with no single study exerting a significant influence. Subgroup analyses by country of origin further revealed that the impact of VR on reducing anxiety levels among pregnant women differed between Turkey and Spain. Additionally, VR effectively improved systolic blood pressure (MD = - 7.87, 95% CI [- 9.60, - 6.14], Z = 8.92, p < 0.001) and diastolic blood pressure (MD = - 4.80, 95% CI [- 6.21, - 3.38], Z = 6.65, p < 0.001), and significantly decreased maternal heart rate (MD = - 3.9, 95% CI [- 5.52, - 2.28], Z = 4.71, p < 0.001). VR interventions also shortened the duration of Non-Stress Test (NST) (MD = - 5.76, 95% CI [- 10.05, - 1.48], Z = 2.64, p = 0.008) and increased fetal movement accelerations (MD = 1.19, 95% CI [0.82, 1.57], Z = 6.22, p < 0.001). However, the meta-analysis of four studies with a total of 681 pregnant women did not find a statistically significant direct effect on fetal heart rate (MD = 1.25, 95% CI [- 1.38, 3.88], Z = 0.93, p = 0.35), with observed heterogeneity (I² = 73%, p = 0.01).

Conclusions: This study demonstrates that VR has significant advantages in optimizing the psychological and physiological states of pregnant women, but its direct impact on fetal heart rate is not significant. Further research is needed to explore the potential mechanisms of VR on fetal health, thereby comprehensively evaluating its clinical value as an adjunct to childbirth interventions.

Prospero registration number: CRD42024561354.