Nurse- and Midwife-Led Interventions for the Prevention and Management of Depression and Anxiety During Pregnancy: A Systematic Review

Background: Depression and anxiety are common during pregnancy and are associated with adverse maternal and infant outcomes, and many women prefer non-pharmacological approaches because of concerns about medication safety. Nurses and midwives are well positioned to deliver such interventions within routine antenatal care, yet the evidence on their effectiveness remains inconsistent across intervention types, populations, and study designs. This systematic review aimed to synthesize and critically evaluate the evidence on the effectiveness of nurse- and midwife-led interventions for the prevention and management of depression and anxiety during pregnancy. Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A comprehensive literature search was performed in PubMed, CINAHL, Education Source (EBSCOhost), DBpia, KISS, and RISS. Randomized controlled trials (RCTs) and nonrandomized controlled studies evaluating nurse- or midwife-led interventions for pregnant women were included. Due to substantial heterogeneity in intervention characteristics, participant populations, outcome measures, assessment time points, and statistical reporting, a meta-analysis was not feasible; therefore, the findings were synthesized narratively. Results: Ten studies met the inclusion criteria, comprising eight RCTs and two nonrandomized controlled studies. Depression outcomes were evaluated in six studies, four of which reported statistically significant between-group improvements. Anxiety outcomes were assessed in six studies, four of which reported statistically significant reductions. Significant findings were observed across psychosocial, antenatal care–based, and complementary interventions, although their effects varied according to study design, participant characteristics, and outcome measures. All RCTs were assessed as having some concerns using Risk of Bias 2 (RoB 2), whereas both nonrandomized studies were judged to have a moderate risk of bias using Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I). Given the methodological limitations, substantial heterogeneity, and the absence of quantitative synthesis, confidence in the available evidence remains limited. Conclusion: Current evidence suggests that nurse- and midwife-led interventions may improve selected psychological outcomes during pregnancy, including depression and anxiety, particularly among women at elevated risk. However, these findings should be interpreted with caution because no included study was judged to have a low overall risk of bias, intervention characteristics varied considerably, and meta-analysis was not feasible. Further high-quality RCTs using standardized intervention protocols and outcome measures are needed. PROSPERO Registration: The study has been registered on https://www.crd.york.ac.uk/PROSPERO/ (registration number: CRD420261427348; registration link: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261427348).