Effectiveness of Antenatal Interventions in Preventing Pregnancy-Related Complications: A Systematic Review

Gestational diabetes mellitus, preeclampsia, and other adverse pregnancy outcomes continue to contribute substantially to maternal and neonatal morbidity worldwide. The increasing burden of metabolic and hypertensive complications during pregnancy has strengthened the need for effective, targeted preventive strategies. Although pharmacological, lifestyle, dietary, and healthcare system interventions have been widely studied, their effects vary according to the clinical outcome, population risk profile, intervention intensity, timing, adherence, and healthcare setting. Gaps therefore remain in identifying which approaches provide consistent benefit across different maternal and neonatal outcomes. This review synthesized evidence from randomized controlled trials evaluating interventions intended to improve pregnancy-related outcomes. A structured systematic search and study-selection process was undertaken, and eligible trials included pharmacological, lifestyle, dietary, behavioral, and healthcare system interventions. Data were synthesized qualitatively, and methodological quality and risk of bias were assessed using established criteria. The findings indicate that pharmacological interventions, including aspirin, calcium supplementation, and antenatal corticosteroids, showed benefits for selected outcomes in appropriately defined clinical populations and settings. Lifestyle and dietary interventions showed heterogeneous findings, with structured and intensive approaches demonstrating favorable outcomes in some populations, whereas lower-intensity interventions produced less consistent effects on major clinical endpoints. Behavioral and healthcare system interventions improved selected aspects of care delivery and patient-centered outcomes, although effects on major maternal and neonatal clinical outcomes were less consistent. Overall, the evidence supports targeted, context-specific use of preventive interventions rather than direct ranking of intervention categories, while recognizing substantial heterogeneity across populations, interventions, and outcomes.