Effectiveness of non-pharmacological interventions on stress and anxiety management in pregnancy: a systematic review

Prenatal stress and anxiety are two of the most common mental health concerns during pregnancy and are public health issues. Therefore, non-pharmacological interventions to prevent and manage stress, anxiety and fear of childbirth are recommended. This systematic review aimed to synthesize non-pharmacological interventions to prevent and manage stress, anxiety and fear of childbirth during pregnancy. It provides an updated and broader synthesis of the available evidence, encompassing diverse populations and intervention approaches. This review followed PRISMA guidance and was conducted using PubMed, PsycINFO, CINAHL and Web of Science from 2014 to 2026. PROSPERO registration was obtained before the beginning of the study (CRD42024611014). While previous systematic reviews and meta-analyses focused on one specific criterion, this review included both online and in-person interventions, individual and group-based formats, and both high-risk and low-risk pregnancies. Risk of bias was assessed using ROB-2 or ROBINS-I. Results were analyzed using a narrative synthesis. Sixty-nine articles were included and classified as mindfulness (26%), psychotherapy (23%), antenatal classes (22%), mind-body interventions (16%), art-therapy interventions (6%), peer-support-based interventions (4%) and attachment-based interventions (3%). This review provides a comprehensive overview of interventions which prevent or manage prenatal stress, anxiety and fear of childbirth. However, heterogeneity across studies made comparisons of effectiveness impossible. Greater standardization is needed in future studies. Specific populations such as coparents and specific medical conditions such as participants with psychiatric comorbidities must be included in future studies. Finally, a reduction in the risk of bias is required to allow findings to inform clinical practice.