Abstract
The idea that risk for psychiatric disorders may be transmitted intergenerationally
via prenatal programming places interest in the prenatal period as a critical moment
during which intervention efforts may have a strong impact, yet studies testing whether
prenatal interventions also protect offspring are limited. The present umbrella review
of systematic reviews and meta-analyses (SRMAs) of randomized controlled trials aimed
to synthesize the available evidence and highlight promising avenues for intervention.
Overall, the literature provides mixed and limited evidence in support of prenatal
interventions. Thirty SRMAs were included. Of the 23 SRMAs that reported on prenatal
depression interventions, 16 found a significant effect (average standard mean difference = −0.45,
SD = 0.25). Similarly, 13 of the 20 SRMAs that reported on anxiety outcomes documented
significant reductions (average standard mean difference = −0.76, SD = 0.95 or −0.53/0.53
excluding one outlier). Only 4 SRMAs reported child outcomes, and only 2 (of 10) analyses
showed significant effects of prenatal interventions (massage and telephone support
on neonatal resuscitation [relative risk = 0.43] and neonatal intensive care unit
admissions [relative risk = 0.91]). Notably missing, perhaps due to our strict inclusion
criteria (inclusion of randomized controlled trials only), were interventions focusing
on key facets of prenatal health (e.g., whole diet, sleep). Structural interventions
(housing, access to health care, economic security) were not included, although initial
success has been documented in non-SRMAs. Most notably, none of the SRMAs focused
on offspring mental health or neurodevelopmental outcomes. Given the possibility that
interventions deployed in this period will positively impact the next generation,
randomized trials that focus on offspring outcomes are urgently needed.
Keywords
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Article info
Publication history
Published online: February 06, 2023
Accepted:
January 31,
2023
Received in revised form:
January 20,
2023
Received:
July 29,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Society of Biological Psychiatry.
