Digital interventions for fear of childbirth and related maternal outcomes: a systematic review and meta-analysis of randomized controlled trials.

In 30 seconds

This systematic review and meta-analysis assessed randomized trials of structured digital behavioural, educational, or psychological interventions begun during pregnancy in women aged 18 years or older. Fourteen trials involving 1,563 randomized participants were included. The pooled estimate suggested lower antenatal fear of childbirth with digital interventions (Hedges’ g = -1.54, 95% CI -2.66 to -0.43), but heterogeneity was extreme (I² = 96.8%), the prediction interval crossed the null, and certainty was very low. Childbirth self-efficacy was not significantly improved, and evidence for other maternal outcomes was inconclusive.

Key findings

• Antenatal fear of childbirth was lower on average with digital interventions (g = -1.54, 95% CI -2.66 to -0.43; I² = 96.8%; very-low-certainty evidence).
• The 95% prediction interval for antenatal fear ranged from -5.81 to 2.72, crossing the null.
• Childbirth self-efficacy was not significantly improved (g = 2.64, 95% CI -1.27 to 6.55; very-low-certainty evidence).
• Early postpartum fear favoured intervention in an exploratory analysis (g = -1.81, 95% CI -3.58 to -0.03), with I² = 97.3%.

Why it matters

Fear of childbirth is a relevant antenatal outcome, and digital approaches may offer a way to deliver behavioural, educational, or psychological support during pregnancy. However, the highly variable trial results mean the pooled average may not predict effects in a particular setting. The findings also do not establish improvement in self-efficacy or other maternal outcomes.

What to keep in mind

Extreme heterogeneity, a prediction interval crossing the null, influential large effects, and very-low-certainty evidence limit confidence in the pooled estimate. Several other outcomes could not be meta-analysed because measures, timings, or constructs were not sufficiently comparable.