Stress-reducing interventions in pregnancy for the prevention of preterm birth: a systematic review and meta-analysis

Preterm birth (PTB) is the leading cause of neonatal morbidity and mortality. Maternal stress during pregnancy is an established risk factor for PTB. We aimed to review the effects of stress-reducing interventions during pregnancy on PTB. Studies reporting on stress-reducing interventions during pregnancy and PTB rates in general low-risk obstetric populations were included. PTB rates, low birth weight (LBW) rates, mean gestational age and birth weight, maternal anxiety and stress, and adverse perinatal outcomes were investigated. Data were extracted using a standardized extraction form, pooled effect sizes were calculated with the random effects model. Ten studies with a total of 4.816 women were included. The interventions included Pilates, yoga, a multidisciplinary stress reduction program, combination therapy (combining mindfulness, yoga, music, baby bonding, and education), and hypnosis. The incidence of PTB was significantly lower in the intervention group (RR 0.50, 95% CI 0.35 − 0.71). The overall quality of the included studies was low, and the risk of bias was high. In conclusion, this study provides evidence supporting the potential efficacy of stress-reducing interventions in reducing the incidence of PTB in low-risk women. We propose a RCT of high quality to determine the effectiveness of stress-reducing interventions in reducing PTB risk.

早产（Preterm Birth, PTB）是导致新生儿发病及死亡的首要原因。孕期母体应激已被证实为早产的明确危险因素。本研究旨在评估孕期减压干预措施对早产发生风险的影响。研究纳入针对普通低危产科人群开展的、涉及孕期减压干预与早产发生率的相关研究，分析的结局指标包括早产发生率、低出生体重（Low Birth Weight, LBW）发生率、平均胎龄与出生体重、产妇焦虑与应激水平，以及不良围产期结局。研究采用标准化数据提取表进行资料提取，并通过随机效应模型计算合并效应量。最终纳入10项研究，共涉及4816名女性。所纳入的干预措施包括普拉提、瑜伽、多学科减压项目、联合疗法（结合正念、瑜伽、音乐、亲子联结与知识宣教）以及催眠疗法。干预组的早产发生率显著低于对照组（相对风险RR=0.50，95%置信区间CI：0.35~0.71）。纳入研究的整体质量偏低，偏倚风险较高。综上，本研究提供的证据表明，减压干预措施或可有效降低低危产妇的早产发生风险。未来需开展高质量随机对照试验（Randomized Controlled Trial, RCT），以进一步明确减压干预降低早产风险的实际效果。