Stress-reducing interventions in pregnancy for the prevention of preterm birth: a systematic review and meta-analysis

Abstract

Preterm birth (PTB) is the leading cause of neonatal morbidity and mortality. Maternal stress during pregnancy is an established risk factor for PTB. We aimed to review the effects of stress-reducing interventions during pregnancy on PTB. Studies reporting on stress-reducing interventions during pregnancy and PTB rates in general low-risk obstetric populations were included. PTB rates, low birth weight (LBW) rates, mean gestational age and birth weight, maternal anxiety and stress, and adverse perinatal outcomes were investigated. Data were extracted using a standardized extraction form, pooled effect sizes were calculated with the random effects model. Ten studies with a total of 4.816 women were included. The interventions included Pilates, yoga, a multidisciplinary stress reduction program, combination therapy (combining mindfulness, yoga, music, baby bonding, and education), and hypnosis. The incidence of PTB was significantly lower in the intervention group (RR 0.50, 95% CI 0.35 − 0.71). The overall quality of the included studies was low, and the risk of bias was high. In conclusion, this study provides evidence supporting the potential efficacy of stress-reducing interventions in reducing the incidence of PTB in low-risk women. We propose a RCT of high quality to determine the effectiveness of stress-reducing interventions in reducing PTB risk.

Keywords:

• Hypnosis
• meditation
• mindfulness
• Pilates
• preterm
• stress-reduction
• yoga

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Acknowledgements

We thank Dr. J.M. Limpens of the Medical Library, Department of Research Support Amsterdam UMC for assisting in identifying the literature. We thank Dr. R. van Eekelen of the Department of Epidemiology and Data Science Amsterdam UMC for statistical support.

Disclosure statement

The authors report there are no competing interests to declare.

Data availablity statement

The protocol can be accessed on PROSPERO (Registration number: CRD42020149469). Data can be accessed upon request by e-mailing the corresponding author. The data that support the findings of this study are available in the supplementary material of this article.

Correction Statement

This article was originally published with errors, which have now been corrected in the online version. Please see Correction (http://dx.doi.org/10.1080/0167482X.2024.2335858)

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Laura E. Janssen

Laura E. Janssen, She studied Medicine at the VU in Amsterdam, The Netherlands. After receiving her medical degree she started working as a PhD-student, primary focus on maternal cardiovascular health after spontaneous preterm birth and the identification of risk factors of spontaneous preterm birth. Worked as an obstetrical and surgical resident and currently works as an operational manager at Incision.

Adelia A. Gieskes

Adelia A. Gieskes, She studied Medicine at the Catholic University of Leuven, Belgium. After receiving her medical degree she worked for two years as a peripheral doctor not in training at the Gynecology Department in Alkmaar and Enschede, the Netherlands. She currently works at the Gynecology Department of the academic center in Amsterdam (AMC).

Marjolein Kok

Marjolein Kok, She studied Medicine at the University of Amsterdam (UvA), The Netherlands. Finished her PhD in 2008 entitled ‘‘External Cephalic Version’’. She worked as a gynecologist in Amsterdam UMC, location AMC, Amsterdam, The Netherlands until 2021. She currently works on creating a holistic birth center in the Netherlands.

Christianne J. M. de Groot

Christianne J.M. de Groot, She studied Medicine at the University in Leiden, The Netherlands. Finished her PhD in 1995 about Preeclampsia. She currently works as a professor in gynecology in Amsterdam UMC, location AMC, Amsterdam, The Netherlands. Specialized in obstetric high care, pregnancy complications and hypertensive disorders in pregnancy.

Martijn A. Oudijk

Martijn A. Oudijk, He studied Medicine at the University in Utrecht, The Netherlands. Finished his PhD in 2003 entitled ‘‘Fetal tachycardia, diagnosis and treatment’’. He currently works as a professor in gynecology in Amsterdam UMC, location AMC, Amsterdam, The Netherlands. Specialized in preterm birth and cardiac diseases in pregnancy.

Marjon A. de Boer

Marjon A. de Boer, She studied Medicine at the University in Leiden, The Netherlands. Finished her PhD in 2007 entitled ‘‘Molecular aspects of human papillomavirus in cervical cancer’’. Currently she works as a gynecologist in Amsterdam UMC, location AMC, Amsterdam, The Netherlands. Specialized in perinatology, maternal health and preterm birth.