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

Abstract

Objective: To evaluate the effectiveness of digital interventions for reducing antenatal fear of childbirth and improving related maternal outcomes. Design: Systematic review and meta-analysis of randomized controlled trials. Data sources: PubMed, Scopus, Web of Science, the Cochrane Library, and Google Scholar were searched for studies published from January 2015 through December 2025; reference lists were also screened. Eligibility criteria: Randomized trials of structured digital behavioural, educational, or psychological interventions initiated during pregnancy for women aged 18 years or older were eligible. Intrapartum-only distraction interventions were excluded. Methods: Two reviewers independently screened studies, re-verified outcome-level data against full reports, assessed risk of bias using RoB 2, and graded certainty using GRADE. Hedges' g was pooled with REML random-effects models, Hartung-Knapp confidence intervals, and prediction intervals. Outcomes unsuitable for pooling were synthesized using SWiM. Results: Fourteen independent trials (1563 randomized participants; 1334 in the primary endpoint analysis) were included. Digital interventions were associated with lower antenatal fear of childbirth (g = -1.54, 95% CI -2.66 to -0.43; I2 = 96.8%; 95% prediction interval -5.81 to 2.72; very-low-certainty evidence). Childbirth self-efficacy was not significantly improved (g = 2.64, 95% CI -1.27 to 6.55; I2 = 97.1%; very-low-certainty evidence). Early postpartum fear favoured intervention in an exploratory analysis (g = -1.81, 95% CI -3.58 to -0.03; I2 = 97.3%; prediction interval -6.73 to 3.12). Depression, labour pain, anxiety, childbirth experience, and obstetric outcomes were synthesized without meta-analysis because measures, timings, or constructs were not sufficiently comparable. Conclusions: The average estimate suggests that digital interventions may reduce antenatal fear of childbirth, but extreme heterogeneity, a prediction interval crossing the null, influential large effects, and very-low certainty preclude a universal effectiveness claim. Evidence for self-efficacy and other maternal outcomes remains inconclusive. Registration: PROSPERO CRD420251252742. ©