Skin-to-skin contact to improve premature mothers' anxiety and stress state: A meta-analysis

Premature mothers present more anxiety and stress after delivery, which may be caused by mother-infant separation while hospitalised. Skin-to-skin contact (SSC), a mitigating factor for mother-infant separation, can benefit infants and mothers in many ways, but few studies focused on its efficacy on maternal anxiety and stress states. Therefore, this review aims to evaluate the effect of SSC on anxiety and stress. Comprehensive research was conducted in nine databases. Meta-analysis was conducted to investigate the effect of SSC, and subgroup analyses were performed to explain the sources of heterogeneity. Eight randomised controlled trials with 728 participants were included, and SSC significantly reduced the level of anxiety ([standardised mean difference, SMD] -0.72; 95% CI -1.08 to -0.35) and stress state ([SMD] -0.84; 95% CI -1.59 to -0.09). One subgroup analysis revealed that SSC can relieve anxiety if performing SSC no less than 1 h per day ([SMD] -0.94; 95% CI -1.34 to -0.53). Another subgroup analysis suggested that applying SSC repeatedly and lasting less than 1 week ([SMD] -1.49; 95% CI -2.31 to -0.66) or for 1 week to 2 weeks ([SMD] -1.04; 95% CI -1.29 to -0.79) can significantly reduce maternal anxiety level but no significance if lasting over 2 weeks ([SMD] -0.33; 95% CI -0.67 to 0.01). SSC can effectively improve anxiety and stress states among premature mothers after delivery, and not definitive finding presents that only SSC that was performed no less than 60 min could improve postpartum anxiety states, while SSC alone was not as effective when carried out over 2 weeks.