Abstract
BACKGROUND: Stress, anxiety, and depression during pregnancy can adversely affect maternal, fetal, and child health. To alleviate these symptoms, nonpharmacological interventions have been increasingly utilized as supportive approaches. AIM: To compare nonpharmacological interventions and determine their effectiveness in reducing stress, anxiety, and depression levels during pregnancy. METHODS: This systematic review adheres to the network meta-analysis extension for the Preferred Reporting Items for Systematic Review and Meta-analysis 2015 statement for design and reporting. The included studies were comprised of quasi-randomized and randomized controlled trials that aimed to assess the effectiveness of nonpharmacological interventions on stress, anxiety, and depression in pregnant women. The methodological quality of the included studies was assessed using the Cochrane Collaboration Risk of Bias Tool. Statistical analysis was conducted using the "mvmeta" package in Stata/SE 15. PubMed, APA PsycNET, Web of Science, The Cochrane Library, and Scopus were searched for randomized controlled trials up to December 2021. RESULTS: This star network meta-analysis included 38 trials with 3555 pregnant women and eight nonpharmacological interventions for stress, anxiety, and depression. The findings indicate that spiritual meditation was the most effective intervention in reducing stress, anxiety, and depression during pregnancy. Mindfulness-based stress reduction was identified as another effective intervention specifically for reducing stress. Furthermore, during pregnancy, mindfulness-based cognitive therapy was found to be the second most effective intervention in reducing depression. LINKING EVIDENCE TO ACTION: Our research showed that spiritual meditation might be the most effective intervention for reducing stress, anxiety, and depression in pregnant women. Health professionals could consider recommending spiritual meditation as a complementary therapy to pregnant women to reduce stress, anxiety, and depression. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews: CRD42021261089.