Aim: To assess the efficacy of non-pharmacological interventions for pregnant women with a history of anxiety.
Background: Many women suffer from anxiety during pregnancy, which can cause maternal and foetal health consequences. Currently, the first-line treatment in Australia is the use of selective serotonin re-uptake inhibitors, despite the fact that they are classified as a Category C drug during pregnancy. Therefore, there is a need for evidence-based, non-pharmacological methods of preventing and managing anxiety to be incorporated into perinatal care.
Design: A systematic review of literature.
Data sources: Studies published since 2000 and in English were identified for inclusion from the databases Medline, PsycINFO, CINAHL and MIDIRS (N=661). Additional papers were identified through reference lists (N=6).
Review methods: After removal of duplicates, papers were screened (N=584), assessed for eligibility (N=34) and selected for inclusion (N=23). Participants included pregnant women with a history of anxiety, and interventions were categorised as psychological or mind-body. Studies were quality assessed using the Joanna Briggs Institute's Critical Appraisal. A narrative description of data was conducted.
Results: Psychological and mind-body interventions were delivered individually and to groups of pregnant women over single or multiple sessions. The most commonly used anxiety measure was the State-Trait Anxiety Inventory. Sixteen studies found a statistically significant reduction in anxiety, and seven studies found no effect.
Conclusion: There is some evidence to suggest that cognitive behavioural therapy, relaxation, mindfulness and interpersonal therapy may reduce anxiety during pregnancy. However, due to the significant heterogeneity between studies, particularly in duration of intervention and outcome measures, overall conclusions regarding the benefit of interventions cannot be drawn. Further, adequately powered randomised controlled trials with standardised outcome measures are required.