JMIR Mhealth Uhealth. 2026 Jan 26;14:e66267. doi: 10.2196/66267.
ABSTRACT
BACKGROUND: Psychological stress during pregnancy is common and has been associated with adverse maternal and neonatal outcomes. Digital health interventions (DHIs) have emerged as a scalable approach to support stress management during pregnancy, yet evidence remains fragmented, and prior reviews have largely focused on broad perinatal mental health outcomes or delivery platforms rather than stress-specific effects and targeted intervention components.
OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the effectiveness of DHIs specifically designed to reduce stress during pregnancy and to examine how intervention strategies and delivery methods are associated with stress outcomes.
METHODS: We conducted a systematic review and meta-analysis following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Randomized controlled trials and quasi-experimental studies involving pregnant women were eligible if they evaluated any digitally delivered intervention-such as mobile apps, web-based programs, or telemedicine-intended to reduce stress, and reported validated stress outcomes. We searched CINAHL, the Cochrane Library, Embase, and PubMed from database inception through November 2025. Risk of bias was assessed using the Cochrane risk of bias 2 tool for randomized trials and the risk of bias in nonrandomized studies of interventions tool for nonrandomized studies. Where appropriate, effect sizes were pooled using random-effects meta-analysis with the Hartung-Knapp-Sidik-Jonkman method and reported as standardized mean differences.
RESULTS: A total of 19 studies were included. Overall, DHIs were associated with a significant reduction in stress compared with control conditions (standardized mean difference -0.45, 95% CI -0.59 to -0.32; 95% prediction interval -0.78 to -0.13), with low to moderate heterogeneity. Strategy-based subgroup analyses indicated that mindfulness- and education-focused interventions showed favorable effects, but formal tests for between-subgroup differences were not statistically significant. Evidence certainty was rated as moderate, primarily due to risk-of-bias concerns in some trials.
CONCLUSIONS: This review provides stress-focused evidence that DHIs can support stress reduction during pregnancy and extends existing literature by systematically disaggregating interventions according to delivery methods, functional features, and content strategies. This study offers a component-oriented synthesis that informs the design and selection of digital stress-management interventions for pregnant women. In real-world antenatal care, these tools may complement clinician-delivered services by expanding access to low-intensity, scalable support, particularly when interventions integrate skills-based content with supportive digital functions. Future research should directly compare single versus combined strategies and evaluate implementation across diverse populations and care settings.
PMID:41587461 | DOI:10.2196/66267
