Table 1: Antenatal
- randomised controlled trial universal interventions.
Author |
Setting |
Sample Size |
Intervention |
Jadad Score |
Results |
Effect Size |
Barakat, Pelaez,
et al. (2012) |
Obstetrics department of Hospital Universitaris de Fuenlabrada
(Madrid, Spain). |
N = 290 healthy pregnant Caucasian (Spanish)
women with a singleton g estation. Exercise (n = 138) Control (n
= 152) |
Structured, moderate intensity exercise program
during the entire length of the pregnancy. |
3 |
The percentage of cesarean and instrumental
deliveries in the exercise group were lower than in the control group
(15.9%, n = 22; 11.6%, n = 16 vs. 23%, n = 35; 19.1%, n = 29; respectively). |
Comparisons between exercise and control groups
on pregnancy outcome: Cohen’s d: Cesarean, Cohen’s d = -0.23 Instrumental, Cohen’s d = -0.32 |
Barakat, Cordero, et al. (2012) |
Obstetric Hospital Department (Centro de Salnd de Torrelodones, Madrid,
Spain) |
N = 83 healthy pregnant women Exercise (n = 40) Control (n = 43) |
A physical activity (PA) program during the
entire pregnancy. (PA, land/aquatic). The conditioning program was 35-45 min
session performed three times a week. |
2 |
Significant differences were found between the
exercise group and the control group on the 50 Maternal Glucose Screen. |
Comparisons between exercise and control groups
on maternal glucose tolerance: Cohen’s d
= -0.90 |
Eggen, et al. (2012) |
Primary care maternity units in two suburban
municipalities in the southeastern part of Norway. |
257 pregnant women between the ages of 18 and
40, before gestation week 20. |
The training group received supervised exercises
in groups once a week. |
3 |
No statistically significant differences were
found between the supervised group exercise and the control group on the prevalence
on Pelvic Girdle Pain (PGP) or Lower Back Pain (LBP). |
Comparisons between supervised exercise group
and control groups at 36 weeks gestation as evaluated by self-report
measures, Cohen’s d: 1.
PGP = -0.02 2.
LBP = -0.07 |
Gedde-Dahl and Fors (2012) |
Staranger University Hospital. |
54 healthy pregnant women. Intervention (n = 27) Control (n = 27) |
CD with a booklet. Self-administered practice of
relaxation techniques, positive affirmation and guided imagery. |
1 |
CD-intervention group had significantly better
score on total Wellbeing after delivery compared to no intervention.
However, no statistically significant results were reported for Anxiety at
delivery and Pain at delivery. |
Comparisons between CD-intervention and no
intervention, Cohen’s d: 1. Wellbeing after delivery (measured one day
after delivery, Edmonton Scale or ESAS) = -0.65 2.
Anxiety at delivery (Visual Analogue Scale, VAS) = -0.36 3. Pain at Delivery (Numeric Rating Scale (NRS),
0-10) = 0.00 |
Kronborg, et al. (2012) |
The Aarhus Midwifery Clinic, a large clinic
connected to a Danish University hospital in an urban area of Denmark. |
1193 nulliparous women were recruited before 21 +
6 days of gestation. Intervention (n = 603) Reference group (n = 590) |
Structured antenatal training program attended
mid pregnancy. |
3 |
No significant differences were found between
groups according self-efficacy score, or breast feeding problems, but after
participation in the course, at 6 weeks after birth they reported to have
obtained sufficient knowledge about breast feeding. |
Comparisons between intervention group and
reference group through self-report questionnaire at 6 weeks postpartum,
Cohen’s d: 1.
Self-efficacy score = 0.00 2.
Breast-feeding problems = 0.00 3.
Sufficient knowledge = 0.19 |
Robledo-Colonia, et al. (2012) |
One of three tertiary hospitals in Cali,
Colombia. |
74 nulliparous pregnant women. Experimental (n = 37) Control (n = 37) |
A 3 month supervised exercise program, commencing
at 16-20 weeks of gestation. Each session included walking (10 min), aerobic
exercise (30 min), stretching (10 min), and relaxation (10 min). |
3 |
After the 3 months intervention, the experimental
group reduced their depressive symptoms on the Centre for Epidemiological
Studies Depression scale (CES-D) questionnaire. |
Comparisons between experimental group and
control group evaluating depressive symptoms (CES-D), at 3 months, Cohen’s d = -0.86 |
Signe N. Stafne, Kjell Å. Salvesen, et al. (2012) |
St. Olavs Hospital,
Trondheim University Hospital, and Stavanger University Hospital |
702 women in gestational weeks 18-22. |
12-week standard exercise program. The exercise
program followed standard recommendations and included moderate-intensity to
high intensity activity 3 or more days per week. |
4 |
At 32-36 weeks of gestation, there were no
differences between groups in prevalence of gestational diabetes: 25 of 375
(7%) in the intervention group compared with 18 of 327 (6%) in the control
group. |
Comparisons between intervention group and
control group at 32 - 36 weeks of gestation, Cohen’s d: 1.
Prevalence of Diabetes = -0.11 |
S. N. Stafne, et al.
(2012) |
Trondheim University Hospital and Stavanger
University Hospital in Norway |
761 pregnant women Intervention (n = 396) control (n = 365) |
12-week exercise program, including pelvic floor
muscle training conducted between 20 and 36 weeks of gestation. One weekly
group session was led by physiotherapists and home exercises were encouraged
at least twice a week. |
4 |
Fewer women in the intervention group reported
any weekly urinary incontinence or faecal
incontinence but this difference was not statistically significant. |
Comparisons between intervention group and
control group as evaluated by self-report measures at 32 - 36 weeks of
gestation, Cohen’s d: 1.
Urinary incontinence = -0.16 2.
Faecal incontinence = -0.04 |
Signe N. Stafne, Kjell Å Salvesen, et al. (2012) |
St Olavs Hospital,
Trondheim University Hospital and Stavanger University Hospital |
761 pregnant women. Intervention (n = 396) Control (n = 365) |
12-week exercise program, including aerobic and
strengthening exercises, conducted between 20 and 36 weeks of pregnancy. One
weekly session was led by physiotherapists, and home exercises were
encouraged twice a week. |
4 |
There were no statistically significant
differences between groups of women reporting lumbopelvic
pain at 36 weeks. |
Comparisons between intervention group and
control group as evaluated by self-report measures at 36 weeks of gestation,
Cohen’s d: 1.
Lumbopelvic pain = -0.03 |
Yuenyong, et al. (2012) |
Regional teaching hospital in the eastern part of
Thailand. |
114 primiparous women
whose gestational ages were
≥ 36 weeks. |
Usual care and support from a chosen close female
relative from admission until 2 hours after the birth. |
4 |
Those in the experimental group had a
significantly shorter duration of active labor, but no statistically
significant results for 2nd and 3rd stages of labor
respectively. |
Comparisons between experimental group and
control group measuring duration of labor, Cohen’s d: 1.
Active labor in minutes = -0.53 2.
2nd stage in minutes = -0.04 3.
3rd stage in minutes = -0.02 |
Bø and Haakstad
(2011) |
University-conducted primary care study. |
90 primiparous women. Intervention (n = 43) Control (n = 47) |
12 weeks of training comprising twice-weekly one
hour fitness classes including three sets of 8-12 maximal pelvic floor muscle
contractions. |
4 |
No statistically significant differences were
found in the number of women reporting urinary, flatus or anal incontinence
between the exercise group and the control group during pregnancy or at 6
weeks post-partum. |
Comparisons between exercise group and control
group as evaluated by self-report measures at 6-8 weeks postpartum, Cohen’s d: 1.
Urinary incontinence = -0.01 2.
Flatus = -0.13 3.
Anal incontinence = -0.08 |
Gau, et al. (2011) |
Two birth units, one at a regional hospital and
one at a medical centre with 600 and 1022 annual
births, respectively. |
87 expectant mothers. Intervention (n = 48)
Control (n = 39) |
Birth ball exercise programme consisted of a
26-page booklet and a 19-minute videotape, with periodic follow-ups during
prenatal checks. |
4 |
Birth ball exercises provided statistically
improvements in child birth pain. Mothers in the experimental group had
marginally shorter second stage labor duration, less epidural anesthesia and
fewer caesarean deliveries than the control group. |
Comparisons between experimental group and
control group, Cohen’s d: 1.
Pain Scales - ·
Visual Analogue Scale (8 cm) = -1.42 ·
Verbal Response Scale (8 cm) = -0.69 ·
Present Pain Intensity Scale (8 cm) = -1.15 2.
Epidural anesthesia = -0.20 3.
Duration of 1st stage labor (min) = -0.45 4.
Duration of 2nd stage labor (min) = - 0.22 5.
Caesarean deliveries = -0.09 |
SongØ Ygard,
et al. (2012) |
Trondheim and Stavanger University Hospital,
Norway. |
719 pregnant women. Intervention (n = 379) Control (n = 340) |
12-week exercise program, including aerobic and
strengthening exercises, conducted between week 20 and 36 of pregnancy. |
4 |
There were no statistically significant
differences between intervention and control groups for women that scored
less than 10 on the Edinburg Postnatal Depression Scale (EPDS). However, there was a statistically significant
difference between women who did not exercise before pregnancy. |
Comparisons between intervention and control
group regarding depressive symptoms at 3 months postpartum, Cohen’s d: 1.
EPDS < 10 = -0.09 2.
Women who did not exercise before pregnancy EPDS < 10 = -0.50 |
Mason, et al. (2010) |
Two hospitals in Northwest England. |
148 pregnant women. Intervention (n = 68) Control (n = 80) |
Four sessions of taught pelvic floor exercise
training during pregnancy and 8-12 maximal contractions repeated twice daily
at home. |
3 |
No statistically significant results were found
between the intervention and control groups. However, the intervention group
was more likely to exercise their pelvic floor muscles compared to controls
at 3 months, reported fewer episodes of incontinence and scored lower on the
Leicester Impact Scale (LIS). |
Comparisons between intervention and control
group at 3 months , Cohen’s d: 1.
Incontinence (self-report) =
-0.16 2.
LIS = -0.47 |
Rakhshani, et al. (2010) |
Obstetric units in Bangalore, India. |
102 pregnant women at 18-20 weeks of gestation between
20 and 35 years of age. |
Integrated yoga – one hour, three times a week
from 20th to 36th week of gestation. |
3 |
Of the domains of World Health Organization
Quality of Life (WHOQOL – 100), between groups analysis showed significant
improvements in the Yoga group compared to the control group. |
Comparisons between Yoga and control group as
measured by the WHOQOL-100) following the intervention (post-test), Cohen’s d: 1.
Physical = 0.68 2.
Psychological = 0.74 3.
Independence = 0.42 4.
Social relationships = 0.60 5.
Environment = 0.68 6.
Spiritual = 0.23 7.
General health quality = 0.72 |
Urech, et al. (2010) |
Pregnant women from the outpatient unit of the
university women’s hospital of Basel, Switzerland |
39 pregnant women Progressive muscle relaxation (n = 13 ) Guide Imagery (n = 13) Passive relaxation control group ( n = 13) |
Progressive muscle relaxation (PMR) Guided Imagery (GI) Passive relaxation control condition (CG) |
2 |
Guided Imagery (GI) was especially effective in inducing
self-reported relaxation in pregnant women while also reducing cardiovascular
activity. |
Comparisons between Interventions (PMR & GI)
and control groups (CG), Cohen’s d: 1.Relaxation Visual Analogue Scale (VAS): GI vs. CG
= 0.73 PMR vs. CG
= 0.27 2.Decline in Cardiovascular (HR): GI vs. CG
= 0.48 PMR vs.
CG = 0.46 |
Satyapriya, et al. (2009) |
Women receiving prenatal care at various
obstetric units in the south side of Bangalore, India |
122 healthy pregnant women were recruited between
the 18th and 20th week of pregnancy. Yoga group ( n = 59) Control group ( n = 63) |
Intervention = practising
yoga and deep relaxation Control group = standard prenatal exercises
1-hour daily |
3 |
Between the 20th week and the 36th
week, perceived stress (as measured by the perceived stress scale, PSS)
decreased by 31.57% in the yoga group and increased by 6.60% in the control
group (p < 0.001). |
Perceived Stress of Yoga group vs. Control group
following intervention at 36 weeks gestation, Cohen’s d = -1.25. Comparison between Yoga and control group
measures at 36th week for Heart Rate Variability, Cohen’s d: - Low Frequency -LF (Sympathetic) = -0.24 -High Frequency-HF (Parasympathetic) = -0.24 -LF/HF = -0.18 -PSS = -1.26 |
Svensson, et al. (2009) |
Specialist referral maternity hospital in Sydney,
Australia |
170 primiparous women. New program (n = 91) Regular program (n = 79) |
Antenatal education ‘Having a Baby’ (HB)
programme |
3 |
The postnatal perceived maternal parenting
self-efficacy scores of women who attended “HB” programme were significantly
higher than those who attended the regular programme. Perceived parenting
knowledge scores of women who attended the ‘HB’ programme were also
significantly higher than those attending the regular programme. Worry scores
were lower for HB mothers but the difference was not statistical significance
|
Comparison between HB and regular programs at 8
weeks post-birth, Cohen’s d: 1. Self-Efficacy Score (self-report Pre- and
Postnatal Parent Expectations Survey (PES)) = 0.74 2. Worry about the baby (Cambridge Worry Scale
(CWS)) = -0.04 3. Parenting knowledge (participant ratings of
knowledge concerning labour, baby care and role of
a parent) = 0.33 4. Epidural used in labour
= -0.06 |
Wan-Yim, et al. (2009) |
First-time pregnant women who sought antenatal
services at out-patient clinics of a regional teaching hospital, Hong Kong |
192, but full results only for 133. Experimental (n = 60) Control (n = 73) |
Self-efficacy enhancing educational programme
(SEEEP) to promote pregnant women’s ability to cope in labour.
This included two 90-minute sessions of the educational programme in between
the 33rd - 35th weeks of pregnancy. |
2 |
The experimental group was significantly more
likely than the control group to demonstrate higher levels of self-efficacy
for childbirth, and greater performance of coping behavior during labour. No significant differences between groups at last
stage of labour on anxiety and pain as measured by
the Visual Analogue Scales (VAS). |
Comparison between Experimental and Control
groups on birth outcome data, Cohen’s d: 1. Anxiety (VAS): I.
2. Pain (VAS): II.
3. Self-efficacy (short form of the Chinese childbirth self-efficacy
inventory (CBSEI- C32): III.
i. OE-16: 0.80 IV.
ii. EE-16: 0.89 |
Chuntharapat, et al. (2008) |
Primiparous women were recruited
from two public hospitals in Southern Thailand |
66-Primigravid women Experimental group (n = 33) Control group ( n = 33) |
Yoga program involving 6, 1-hour sessions |
1 |
The experimental group was found to have higher levels
of maternal comfort during labor and 2-hour post labor. No differences were
found between the groups regarding pethadine usage,
labor augmentation or newborn Apgar scores at 1 and 5 minutes. The
experimental group was found to have a shorter duration of the first stage of
labor, as well as the total time of labor.
Both groups showed an increase in pain throughout active labor,
however, pain scores (VASPS) for the experimental group were consistently
lower than those in the control.
Similarly, the experimental group demonstrated higher scores on the
PBOS measure, indicating lower pain. |
Comparison between experimental and control
groups, Cohen’s d:
Visual Analogue Sensation of Pain Scale (VASPS) a.
Time 1 = -0.44 b.
Time 2 = -0.54 c.
Time 3 = -0.54 Observed Labor Pain (PBOS) a.
Time 1 = -0.49 b.
Time 2 = -0.52 c.
Time 3 = -0.70 |
Jareethum, et al. (2008) |
Siriray Hospital, Bangkok. |
61 healthy pregnant women. Intervention (n = 32) Control (n = 29) |
Two SMS messages per week from 28 weeks of gestation
until birth. |
4 |
Comparison between intervention and control group
showed no statistically significant differences in anxiety levels in
perinatal period, nor did it have significant results for pregnancy outcomes.
|
Comparison between intervention and control
groups, Cohen’s d: 1.
Anxiety level across perinatal period (Visual Analogue Scale (VAS)) =
-0.37 2.
Caesarean section = -0.03 |
Chang, et al. (2007) |
Participants for this study were recruited from a
medical center in Southern Taiwan September 2002 and February 2003 |
236 women Received music therapy (n = 116) General prenatal care (n = 120) |
Examine effects of two-week music therapy on
stress, anxiety and depression in Taiwanese pregnant women |
3 |
Comparing the two groups at posttest, the music
therapy group did not show significant decreases in Perceived Stress Scale,
State Scale of the State-Trait Anxiety Inventory and the EPDS results. |
Comparison between Music Therapy Group and
General Prenatal Care group after two-week changes, Cohen’s d: 1.Perceived Stress Scale measure (PSS) = -0.09 2.State Scale of the State-Trait Anxiety measure
(S-STAI) = -0.19 3.Edinburg Postnatal Depression scale measure
(EPDS) = -0.44 |
Mattar, et al. (2007) |
Recruited from clinics in the National University
Hospital, Singapore |
N = 401 women Group A received breastfeeding educational
material and individual coaching from a lactation counselor. Group B received breastfeeding educational
material with no counselling. Group C received routine antenatal care only |
Antenatal educational interventions on
breastfeeding practice Group A = Received booklet about breastfeeding,
watched educational video, had one session with a lactation consultant Group C = No form of special intervention. |
3 |
Where breastfeeding practices are suboptimal,
simple one-encounter antenatal education and counselling significantly
improve breastfeeding practice up to 6 months after delivery. |
Comparison between Group A women (intervention)
compared with Group C women: 1. Practising exclusive
and predominant breastfeeding at 3 months, Cohen’s d = 0.37 2. Practising exclusive
and predominant breastfeeding at 6 months, Cohen’s d = 0.48 |
Guse, et al. (2006) |
Women experiencing their first pregnancy were
recruited from childbirth education classes. |
46 women Hypnotherapeutic programme (n = 23) received Control (n = 23) did not receive the programme
but completed psychological and well-being questionnaire antenatally
and postnatally |
Hypnotherapeutic programme consisting of 6
individual sessions developed from Erickson theory and ego state therapy antenatally. |
2 |
At 10 weeks postpartum mothers in the
experimental group showed significantly less general symptoms of
psychopathology and less depression. Concluding that the programme
contributed to psychological well-being and alleviated depression in first
time mothers. |
Comparison between Programme and Control groups
at 10 weeks postpartum, Cohen’s d: 1. Edinburg Postnatal Depression scale (EPDS) =
-0.56 2.General Health Questionnaire (GHQ) = -0.58 3. Satisfaction with Life Scale (SWLS) = 0.36 |
Hawkins, et al. (2006) |
Couples were recruited through existing
childbirth education classes at three hospitals in Utah County Utah. |
118 pregnant couples Instructor-encouraged treatment – IE ( n = 38) Self-guided treatment –SG (n = 43) Control- CG ( n = 37) |
Intervention 1 = Five weekly antenatal classes
with relationship education homework activities. Intervention 2 = Same as intervention 1,
delivered as self-paced education And a comparable control group. |
2 |
No significant main effects. Control group
consistently higher on all comparisons. |
Comparison between Treatment (IE & SG) and Control (CG) groups, Cohen’s d, using Wives scores only at 9 months postpartum: 1. Marital Virtues Profile measures IE vs. CG = -0.33 SG vs. CG = -0.54 2.Relationship Evaluation measure IE vs. CG = -0.22 SG vs. CG = -0.41 3.Transition Adjustment Scale measure IE vs. CG = -0.19 SG vs. CG = -0.23 |
Campbell, et al. (2006) |
A women’s ambulatory care center at a tertiary perinatal
care hospital New Jersey |
N = 586 nulliparous, Doula group (n = 291) Control group (n = 295) |
To compare labour
outcomes in women accompanied by an additional support person (doula group)
with outcomes in women who didn’t have the additional person (control group). |
4 |
Significant shorter length of labour
was observed in women in the Doula group, greater cervical dilation at the
time of epidural anesthesia and higher Apgar scores at birth, 1 and 5
minutes. |
Comparison between doula and control group,
Cohen’s d: 1. Length of Labour
(hours) = -0.29 2. Epidural rate = -0.14 3. Apgar Score (5-min) = 0.34 |
Forster, et al. (2004) |
Tertiary Women’s Hospital in Melbourne,
Australia. |
889 primiparous who
attended a public, tertiary women’s hospital. Practical skills (n = 297) Attitudes (n = 293) Standard care (n = 299) |
Two strategies – i) Practical skills:
intervention 1.5-hour class on practical aspects of breastfeeding. ii) Attitudes: two 1-hour classes exploring
family and community attitudes toward, and experiences of, breastfeeding. |
4 |
Neither intervention increased breast feeding
initiation nor duration compared with standard care. |
Comparisons between practical skills group and attitudes
group with standard care group at 6 months postpartum: 1. Exclusive breastfeeding up to 6 months: -
Practical skills group = 0.03 -
Attitudes group = 0.02 |
Mehl-Madrona (2004) |
San Francisco California Tucson Arizona Burlington |
N = 520 pregnant women Intervention 1 = Hypnosis group Intervention 2 = Supportive psychotherapy group Control = No contact comparison and attention
only group No sample size provided for each group |
Intervention =
Hypnosis (mean no of visits 5) Control Group = Supportive psychotherapy.
Discussion of any issues that arose in the assessment (conducted with
graduate psychology intern). |
2 |
Hypnosis was associated with improved obstetrical
outcome e.g. significantly fewer complicated births, caesareans, oxytocin
augmentation and induction, epidural use, or analgesia use in comparison to
supportive psychotherapy group. |
Comparison between Intervention and Control
group, Cohen’s d: 1.Complications of birth = -0.41 |
Salvesen and Mørkved
(2004) |
Trondheim University Hospital and three
outpatient physiotherapy clinics in a primary care setting |
N = 301 nulliparous women Training group (n = 148) Control group (n = 153) |
A structured training programme with exercises
for the pelvic floor muscles between 20th and 36th week
of pregnancy. |
3 |
Women randomised to
pelvic floor muscle training had a lower rate of prolonged second stage labour than women allocated to no training and fewer
women had episiotomies and third or fourth degree tears. |
Comparison between Training (TG) and Control
group (CG): 1. Deliveries with prolonged second stage > 60mins, Cohen’s d = -0.53 2. Episiotomy, Cohen’s d = -0.28 3. Third or fourth degree tear, Cohen’s d = -0.28 4. Epidural analgesia, Cohen’s d = -0.05 |
Morkved, et al. (2003) |
Trondheim University Hospital and three
outpatient physiotherapy clinics in a primary care setting. |
289 healthy nulliparous women Training group (n = 143) Control (n = 146) |
12 week intensive pelvic floor muscle training
program during pregnancy supervised by physiotherapists. |
4 |
Intensive Pelvic floor muscle training during
pregnancy demonstrates statistically significant results in preventing
urinary incontinence during pregnancy and after delivery. |
Comparison between training group and control
group of women with self-reported urinary incontinence, Cohen’s d: 1. 36 Weeks = -0.33 2. 3 months after delivery = -0.29 |
Chang, et al. (2002) |
Regional hospital in Southern Taiwan |
N = 60 Experimental = Massage intervention (n = 30) Control = Routine care (n = 30) |
The experimental group received massage
intervention whereas the control group did not. The nurse-rated present
behavioral intensity (PBI) was used as a measure of labour
pain. Anxiety was measured with the visual analogue scale for anxiety (VASA).
The intensity of pain and anxiety between the two groups was compared in the
latent phase (cervix dilated 3-4 cm), active phase (5-7 cm) and transitional
phase (8-10 cm). |
4 |
A t-test demonstrated that the experimental group
had significantly lower pain reactions in the latent, active and transitional
phases. Anxiety levels were only significantly different between the two
groups in the latent phase. Twenty-six of the 30 (87%) experimental group subjects
reported that massage was helpful, providing pain relief and psychological
support during labour. |
Comparison between Experimental and Control
groups at Phase 3, Cohen’s d: 1. Present Behavior Intensity (Pain): Phase 1- latent: -1.08 Phase 2- active: -0.84 Phase 3- transitional: -1.05 2. Visual Analogue Scale (Anxiety): Phase 1- latent: -0.77 Phase 2- active: -0.38 Phase 3- transitional: -0.24 |