Interventions during pregnancy and the postnatal period for parents in vulnerable life situations

Background

Psychosocial vulnerability during pregnancy and the postnatal period can negatively affect parental well‑being, parent–infant relationships, and child development. Early interventions delivered by maternity care providers may mitigate these risks, but the evidence from high‑income countries remains unclear.

Methods

We conducted a systematic review of randomised controlled trials published between 2000 and 2025. Eligible interventions targeted parents in high-income countries experiencing psychosocial vulnerability, requiring support beyond routine maternity care and were delivered by maternity care providers during pregnancy or within six months postpartum to enhance parenting skills. Nine studies met inclusion criteria. Data were synthesised narratively and grouped by intervention modality, resource demand, and timing. Risk of bias was assessed using the Cochrane tool, and certainty of evidence was evaluated using Core GRADE principles.

Results

Across the nine studies, interventions varied in design, delivery mode, and intensity. Statistically significant effects appeared sporadically and did not form consistent or clinically meaningful patterns. Most primary outcomes related to parenting competence and parent–infant interaction remained non-significant, while findings for secondary outcomes were similarly inconsistent. All studies had high risk of bias in at least two key domains, and the certainty of evidence was low or very low.

Conclusions

This review found limited and inconsistent evidence for the effectiveness of early parenting interventions for psychosocially vulnerable parents in high‑income countries. While isolated positive effects were reported, they were not consistent across studies. The findings highlight substantial gaps in the evidence base and underline the need for rigorously designed, adequately powered trials that integrate feasibility, participant engagement, and responsiveness to the complex support needs of vulnerable families.

Key messages

• Evidence for early parenting interventions for psychosocially vulnerable parents in high‑income countries is limited and inconsistent, highlighting a critical gap in effective early support.

• Findings show a need for rigorously designed, well‑powered trials to identify feasible, context‑sensitive interventions that can genuinely strengthen early parenting among vulnerable families.