Zeng Guowei, Niu Jianfeng, Zhu Ke, Li Fei, Li Liwen, Gao Kaiming, Zhuang Yanlong, Zhang Boyang, Han Xiaoqiang, Ye Gang, Gao Zhikun, Li Haobai
College of Competitive Sports, Beijing Sport University, Beijing, China.
School of Medicine, Tsinghua University, Beijing, China.
EClinicalMedicine. 2024 Dec 18;79:103011. doi: 10.1016/j.eclinm.2024.103011. eCollection 2025 Jan.
Given the distinctive physiological characteristics of pregnant women, non-pharmacological therapies are increasingly being used to improve depressive and anxiety symptoms. Our objective was to explore and compare the impact of various non-pharmacological interventions in improving depressive and anxiety symptoms, and to identify the most effective strategies for pregnant women with depressive and/or anxiety symptoms.
We conducted a systematic search of PubMed, Embase, the Cochrane Library, and Web of Science for randomized controlled trials (RCTs) that compared non-pharmacological interventions to usual care, from the inception of each database up to October 5, 2024. We included pregnant women with singleton pregnancies who, at baseline, exhibited early signs of depressive and/or anxiety symptoms but did not meet clinical diagnostic criteria or exceed the threshold for clinically significant symptoms. We excluded pregnant women diagnosed with schizophrenia, bipolar disorder, or severe acute psychiatric conditions, those with a history of substance abuse, and those undergoing in vitro fertilisation. We performed both pairwise meta-analyses and random-effects network meta-analyses (NMAs), calculating standardised mean differences (SMDs) with 95% credible intervals (CrI). We used the surface under the cumulative ranking probability curve (SUCRA) to estimate treatment ranking probabilities. The outcomes were assessed in two groups of participants: a high-risk pregnancy group, including pregnant women with depressive and/or anxiety symptoms and high-risk pregnancies (defined as having a history of miscarriage, pregnancy complications such as gestational hypertension, gestational diabetes mellitus, or preeclampsia, and advanced maternal age (i.e., over 35 years old); and a healthy group, including participants who exhibited depressive and/or anxiety symptoms only during pregnancy and did not have other high-risk pregnancy conditions or underlying health issues. This study is registered with PROSPERO, CRD42024523053.
We included 101 studies (92 RCTs and 9 quasi-RCTs) involving a total of 15,330 participants across 11 interventions (mindfulness, education, counseling, cognitive behavioral therapy, muscle acupoint therapy, relaxation, mind-body exercise, psychotherapy, foetal movement counting, physical exercise, and music). Among the studies included in this analysis, 73 studies exhibited a low risk of bias, 9 studies had an unclear risk of bias, and 19 studies demonstrated a high risk of bias. The results indicate that, for both high-risk pregnancy population and healthy populations, mindfulness therapy was found to be an effective non-pharmacological treatment for significantly improving depressive and anxiety symptoms in pregnant women compared with control groups. For pregnant women with depressive symptoms, mindfulness therapy (SUCRA = 80%; SMD = -0.86, 95% CrI = -1.2, -0.52; Nn = 598), cognitive behavioral therapy (CBT) (SUCRA = 65%; SMD = -0.69, 95% CrI = -1.0, -0.39; Nn = 712), and education therapy (SUCRA = 48%; SMD = -0.54, 95% CrI = -0.86, -0.23; Nn = 2285) all significantly improve depressive symptoms. In the subgroup analysis of healthy populations, muscle acupoint therapy (SUCRA = 77.17%; SMD = -0.89, 95% CrI = -1.55, -0.23; N = 99) and mind-body exercise (SUCRA = 47.54%; SMD = -0.53, 95% CrI = -0.88, -0.19; N = 352) also significantly reduce depressive symptoms. Subgroup analysis shows that, in addition to mindfulness therapy, mind-body exercises (SUCRA = 67.43%; SMD = -0.97, 95% CrI = -1.61, -0.33; N = 382) and cognitive-behavioral therapy (SUCRA = 52.60%; SMD = -0.74, 95% CrI = -1.38, -0.09; N = 480) may also be effective in alleviating anxiety symptoms among healthy pregnant women.
Our findings indicate that mindfulness therapy significantly reduces the risk of depressive and anxiety symptoms in both high-risk pregnancy population and healthy populations. Therefore, when selecting non-pharmacologic therapies for managing depressive and anxiety symptoms during pregnancy, it is recommended that this therapy be considered. We cannot overlook the limitations of this study. For example, some interventions, such as muscle acupoint therapy for depressive symptoms and relaxation therapy for anxiety symptoms, have limited literature support. Additionally, the diversity of conditions within the high-risk pregnancy population and the high heterogeneity observed in certain interventions are also issues that require attention. These factors may affect the accuracy of the data results. Although we have employed reliable methods to address these issues, the findings of this study should still be interpreted with caution.
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鉴于孕妇独特的生理特征，非药物疗法越来越多地被用于改善抑郁和焦虑症状。我们的目的是探索和比较各种非药物干预措施对改善抑郁和焦虑症状的影响，并确定针对有抑郁和/或焦虑症状的孕妇最有效的策略。
我们对PubMed、Embase、Cochrane图书馆和Web of Science进行了系统检索，以查找从每个数据库建立到2024年10月5日将非药物干预与常规护理进行比较的随机对照试验（RCT）。我们纳入了单胎妊娠的孕妇，这些孕妇在基线时表现出抑郁和/或焦虑症状的早期迹象，但未达到临床诊断标准或超过临床显著症状的阈值。我们排除了被诊断患有精神分裂症、双相情感障碍或严重急性精神疾病的孕妇、有药物滥用史的孕妇以及接受体外受精的孕妇。我们进行了成对荟萃分析和随机效应网络荟萃分析（NMA），计算标准化平均差（SMD）及95%可信区间（CrI）。我们使用累积排序概率曲线下面积（SUCRA）来估计治疗排序概率。在两组参与者中评估结果：高危妊娠组，包括有抑郁和/或焦虑症状以及高危妊娠的孕妇（定义为有流产史、妊娠并发症如妊娠期高血压、妊娠期糖尿病或先兆子痫，以及高龄产妇（即35岁以上））；健康组，包括仅在孕期出现抑郁和/或焦虑症状且没有其他高危妊娠情况或潜在健康问题的参与者。本研究已在PROSPERO注册，注册号为CRD42024523053。
我们纳入了101项研究（92项RCT和九项准RCT），涉及11种干预措施（正念、教育、咨询、认知行为疗法、肌肉穴位疗法、放松、身心锻炼、心理治疗、胎动计数、体育锻炼和音乐）的总共15330名参与者。在本分析纳入的研究中，73项研究显示偏倚风险低，9项研究偏倚风险不明确，19项研究显示偏倚风险高。结果表明，对于高危妊娠人群和健康人群，与对照组相比，正念疗法被发现是一种有效的非药物治疗方法，可显著改善孕妇的抑郁和焦虑症状。对于有抑郁症状的孕妇，正念疗法（SUCRA = 80%；SMD = -0.86，95% CrI = -1.2，-0.52；Nn = 598）、认知行为疗法（CBT）（SUCRA = 65%；SMD = -0.69，95% CrI = -1.0，-0.39；Nn = 712）和教育疗法（SUCRA = 48%；SMD = -0.54，95% CrI = -0.86，-0.23；Nn = 2285）均能显著改善抑郁症状。在健康人群的亚组分析中，肌肉穴位疗法（SUCRA = 77.17%；SMD = -0.89，95% CrI = -1.55，-0.23；N = 99）和身心锻炼（SUCRA = 47.54%；SMD = -0.53，95% CrI = -0.88，-0.19；N = 352）也能显著减轻抑郁症状。亚组分析表明，除正念疗法外，身心锻炼（SUCRA = 67.43%；SMD = -0.97，95% CrI = -1.61，-0.33；N = 382）和认知行为疗法（SUCRA = 52.60%；SMD = -0.74，95% CrI = -1.38，-0.09；N = 480）也可能有效减轻健康孕妇的焦虑症状。
我们的研究结果表明，正念疗法显著降低了高危妊娠人群和健康人群中抑郁和焦虑症状的风险。因此，在选择非药物疗法来管理孕期抑郁和焦虑症状时，建议考虑这种疗法。我们不能忽视本研究的局限性。例如，一些干预措施，如用于抑郁症状的肌肉穴位疗法和用于焦虑症状的放松疗法，文献支持有限。此外，高危妊娠人群中情况的多样性以及某些干预措施中观察到的高异质性也是需要关注的问题。这些因素可能影响数据结果的准确性。尽管我们采用了可靠的方法来解决这些问题，但本研究的结果仍应谨慎解读。
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