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Prematurity

Poster Session 1

(269) Stress-reducing interventions in pregnancy for prevention of preterm birth: a systematic review and meta-analysis.

Tuesday, February 13, 2024
10:30 AM – 12:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Preterm birth (PTB) is the leading cause of neonatal morbidity and mortality. Maternal stress during pregnancy is an established risk factor for PTB. Therefore, our primary aim was to assess whether stress-reducing interventions during pregnancy can reduce the incidence of PTB.

Study Design: This systematic review and meta-analysis searched MEDLINE, Embase, ClinicalTrials.gov, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library for (randomized) controlled trials (RCTs), cohort studies, and observational studies reporting on stress-reducing interventions during pregnancy and PTB rates. Studies investigating women already in preterm labor, or aiming at women at high risk of PTB or depression, or with a history of depression or anxiety disorders, were excluded.

Results: Ten studies with a total of 4.816 women were included, with five studies on yoga, two on hypnosis, and three multidisciplinary programs with a mindfulness and psychosomatic approach. The incidence of PTB was significantly lower in the intervention group (RR 0.50, 95% CI 0.35 – 0.71). The incidence of LBW was significantly lower, and mean gestational age was significantly higher in the intervention groups. Our subgroup analysis focusing on the intervention type yoga (N= 5; 757 women), showed a significant reduction in PTB and LBW rates (RR 0.30, 95% CI 0.13 – 0.71, RR 0.57, 95% CI 0.41 – 0.81 respectively). Two studies on maternal anxiety and two studies on maternal stress could not be meta-analyzed due to incomplete data. The overall quality of the included studies was low and risk of bias was high. When excluding high risk studies (N=3; 3046 women), the previously significant associations could no longer be confirmed.

Conclusion: This study provides substantial evidence supporting the efficacy of stress-reducing interventions, in particular yoga, in reducing the incidence of PTB in low risk women. Given the low quality and high risk of bias in the included studies, yet promising results, we propose a RCT of high quality to determine the effectiveness of stress-reducing interventions in reducing PTB risk.