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BMJ Publishing Group, BMJ Open, 9(7), p. e017802, 2017

DOI: 10.1136/bmjopen-2017-017802

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Psychological and support interventions to reduce levels of stress, anxiety or depression on women’s subsequent pregnancy with a history of miscarriage: an empty systematic review

This paper is made freely available by the publisher.
This paper is made freely available by the publisher.

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Abstract

ObjectiveThe aim of this systematic review was to assess the effect of interventions to reduce stress in pregnant women with a history of miscarriage.DesignA systematic review of randomised controlled trials (RCTs).Data sourceA total of 13 medical, psychological and social electronic databases were searched from January 1995 to April 2016 including PUBMED, CENTRAL, Web of Science and EMBASE.Eligibility criteriaThis review focused on women in their subsequent pregnancy following miscarriage. All published RCTs which assessed the effect of non-medical interventions such as counselling or support interventions on psychological and mental health outcomes such as stress, anxiety or depression when compared with a control group were included. Stress, anxiety or depression had to be measured at least preintervention and postintervention.ResultsThis systematic review found no RCT which met our initial inclusion criteria. Of the 4140 titles screened, 17 RCTs were identified. All of them were excluded. One RCT, which implemented a caring-based intervention, included pregnant women in their subsequent pregnancy; however, miscarriage was analysed as a composite variable among other pregnancy losses such as stillbirth and neonatal death. Levels of perceived stress were measured by four RCTs. Different types of non-medical interventions, time of follow-up and small sample sizes were found.ConclusionCohort studies and RCTs in non-pregnant women suggest that support and psychological interventions may improve pregnant women’s psychological well-being after miscarriage. This improvement may reduce adverse pregnancy-related outcomes in subsequent pregnancies. However, this review found no RCTs which met our criteria. There is a need for targeted RCTs that can provide reliable and conclusive results to determine effective interventions for this vulnerable group.