Table 1.
Characteristics of included studies
| Author (s) Location/(year) | Study design | Study groups | Type of intervention/s | Type of blinding | Follow-up period | Number of participants in each group | Health status of participants | Main outcome/s | Secondary outcome/s | Results |
|---|---|---|---|---|---|---|---|---|---|---|
| Beydokhti et al. Iran/(2020) | RCTa |
Group 1: Intervention group Group 2: Control group |
Intervention group: Educational intervention programme included training sessions for 12 people once a week for 60 to 90 min for four consecutive weeks Control group: Routine pregnancy care |
Open-label design | Fourth–sixth week postpartum |
Intervention group: 60 Control group: 70 |
Women in 30–35 weeks of pregnancy, no history of depression, reading and writing literacy, a healthy fetus in ultrasonography, living in the city |
Postpartum depression | - |
Prevalence of postpartum depression after the intervention was 6.7% and 34% in the intervention and control groups, respectively, and a significant difference was observed between the two groups in terms of depression prevalence (p = 0.001) |
|
Calpbinici & Özçirpan. Turkey/(2022) |
RCTa |
Group 1: Intervention group Group 2: Control group |
Intervention group: Training Program through Motivational Interview Method in 4 sessions of 45 to 90 min once a week Control group: Routine hospital practices |
Open-label design | Within 24 h after delivery |
Intervention group:37 Control group: 36 |
Primiparous pregnant women who were between the 24th to 28th weeks of gestation had no contraindications for vaginal delivery and did not have risks |
Fear of childbirth, childbirth self-efficacy, delivery mode | - |
It was found that the mean W-DEQ score of the women in the intervention group during the 37th to 40th weeks of gestation was statistically significantly lower than those in the control group |
| Çankaya & Şimşek. Turkey/(2019) | RCTa |
Group 1: Intervention group Group 2: Control group |
Intervention group: Antenatal education: The sessions were held using simulator models, animation videos, role-playing, creative drama, and slide presentations in classes of 8 to 10 people twice a week for two weeks Control group: Prenatal care services |
single-blind | Sixth – eighth weeks of postpartum |
Antenatal education: 55 Prenatal care services: 57 |
Nulliparous women older than 18 years of age with a healthy singleton pregnancy in 20 and 32 weeks of gestation with childbirth at full term, having a healthy newborn (born at 38–42 weeks), and not participating in another prenatal Program without mental disorder, high-risk pregnancies, stillbirth, or postpartum complications. |
Childbirth self-efficacy; depression, anxiety, and stress symptoms during pregnancy and postpartum; fear of birth during pregnancy and postpartum; and mode of delivery | - |
Childbirth self-efficacy (p < 0.001), outcome expectancy (p < 0.001), and efficacy expectancy (p = 0.002) scores the pregnant women receiving antenatal education were significantly higher than those of the control group. Childbirth fear of the women receiving antenatal education was significantly less than the control group (p < 0.001). |
| Dai et al. china/(2021) | RCTa |
Group 1: Intervention group Group 2: Control group |
Intervention group: Simulation-based childbirth education (SBCE) in four 70-minute childbirth education sessions with four to six participants at each session. Control group: Routine prenatal care and health education |
Open-label design | After birth |
Intervention group: 26 Control group: 30 |
Primiparous women with a singleton pregnancy, aged 20–35 years, gestational age of 24–32 weeks, having FOC | Fear of childbirth. | Childbirth self-efficacy and birth outcomes, including delivery method, labour duration and Apgar scores | After the SBCE, the mean post-test WDEQ-A score of the intervention group was 60.96 (SD = 14.10), while the score of the control group was 70.79 (SD = 14.85). There was a significant change in the intervention group, up to 14.54 (SD = 11.67, P < 0.001). As for the control group, there was no statistical decrease in FOC scores (mean=-3.23, SD = 12.04, P = 0.152) |
| Kurdy et al. Egypt/ (2017) | RCTa |
Group 1: Intervention group Group 2: Control group |
Intervention group: antenatal education classes in three 90-minute weekly sessions with ten women in each group by using posters, slide powerpoint presentations, animation videos, and demonstration Control group: Routine antenatal care |
Open-label design | Childbirth process (the first and second stages of childbirth) |
Intervention group: 52 Control group: 52 |
Primigravida who: Aged from 20 to 35 years old, was at their 32nd to 34th weeks of gestation, had a singleton vaginal delivery, had no medical or psychological problems | childbirth self-efficacy | Labour pain |
The mean score of labour pain during the 1st stage among women in the antenatal education and control groups were 5.08 ± 0.68 & 7.40 ± 0.5, respectively. Also, the mean score of labour pain in the 2nd stage among women in the antenatal education and control groups were 6.52 ± 0.5 & 8.56 ± 0.7, respectively. The two groups had highly significant differences regarding the mean score of labour pain at the 1st and 2nd stages of labour (p = < 0.001). |
| Firouzbakht et al. Iran/ (2015) | Semi-experimental study |
Group 1: Case group Group 2: Control group |
Case group: Prenatal education” on the process of childbirth in eight 90-minute weekly sessions Control group: Routine care |
Open-label design | Childbirth process |
Case group: 63 Control group: 132 |
Women completed the 5th grade of elementary school, current gestational age of 16–20 weeks, 17–35-year-old, and no contraindication for a vaginal delivery without any complication during pregnancy. |
Hospital depression and anxiety, the intensity of pain and intervention in labour |
The anxiety level in the case group (who received education) was 14.47 (4.69), and in the control group, it was 16 (4.86) (P < 0.001). The pain intensity in the case group was 85.68 (1.85), and in the control group was 90.99 (14.72) (P = 0.03). |
|
| Gurkan & Ekşi. Turkey/(2017) | Nonrandomized, post-test-control group design |
Group 1: Education group Group 2: Control group |
Education group: Antenatal education in a 4-week program (12 h) Control group: Routine antenatal care |
Open-label design | Sixth month postpartum |
Education group = 31 Control group = 34 |
Women who were aged over 18 years were in the 20th-36th gestational weeks, were primipara, were married, did not have pregnancy- related complications or were not diagnosed with depression in the pre-pregnancy period |
Functional status after childbirth and postpartum depression |
The mean EPDS score at the 6th postpartum week was 8.3 ± 5.8 in the education group and 8.7 ± 6.2 in the control group. The mean EPDS score in the 6th postpartum month was 5.7 ± 4.7 in the education group and 6.1 ± 5.6 in the control group. EPDS scores were similar within the groups at the 6th week and the 6th month, and there was no significant difference between groups (p > 0.05) |
|
| Isbir et al. Turkey/(2017) | Quasi-experimental study. |
Group 1: Intervention group Group 2: Control group |
Intervention group: Antenatal education in classes with 5–8 women and four 240-minute weekly sessions Control group: Routine prenatal care |
Open-label design | Sixth –eighth weeks of postpartum |
Intervention group: 44 Control group: 46 |
Nulliparous women, between 20–32 weeks gestation, have no history of pregnancy complications, graduated from at least primary school, and can communicate in Turkish. | Fear of childbirth, maternal self -efficacy and Post-traumatic Stress Disorder Symptoms following childbirth |
The difference in fear of birth in the postpartum period between the groups was significant (p < 0.05). Women in the the intervention group had significantly lower PTSD symptoms following childbirth than women in the control group in the postpartum period (p < 0.01) |
|
| Karabulut et al. Turkey/(2016) | a quasi-experimental and prospective study |
Group 1: Education group Group 2: Control group |
Education group: group education for five weeks once a day for 180 min using relevant appropriate models and figurines, visual instruments and videos, motion, demonstration and interactive education methods Control group: Routine prenatal care |
Open-label design |
30th − 34th weeks of gestation |
Education group: 69 Control group:123 |
Primipara women aged 18 years and older who could speak and understand Turkish, had a single foetus and were within weeks 24–28 of pregnancy |
Women’s adaptation to pregnancy and motherhood and fear of childbirth |
There was a significant difference in the levels of APb between the EG’s post-education measurement and the CG’s second measurement (P < 0.001) the EG’s post-education and CG’s second measurement levels of IMRc showed no significant differences (P > 0.05). The EG’s post-education and CG’s second measurement levels of FOCd also showed significant differences (P < 0.005) |
|
| Masoumi et al. Iran/(2016) | RCTa |
Group 1: Intervention group Group 2: Control group |
Intervention group: training preparation for childbirth in 8 sessions of 2 h weekly Control group: routine prenatal education |
Open-label design | Childbirth process |
Intervention group: 75 Control group:75 |
Pregnant women with a single fetus, no chronic disease such as diabetes, heart and lung chronic diseases, no infertility, no high-risk pregnancy and no history of psychiatrist visits, do not use specific drugs, gestational age of 20 weeks |
Fear of normal vaginal delivery and type of delivery |
After the intervention, the mean fear score in the intervention group compared to the control group was significantly reduced (51.7 ± 22.4 vs. 58.7 ± 21.7) (p = 0.007). And mean score in the intervention group after training was lower than before. | |
| Mehrabadi et al. Iran/(2020) | RCTa |
Group 1: Intervention group Group 2: Control group |
Intervention group: Antenatal education in 8 sessions of 90 min Control group: Routine prenatal care |
Open-label design |
14 day after childbirth |
Intervention group: 56 Control group:44 |
Primipara women with singleton low-risk pregnancies between 20 to 24 gestation weeks with no history of mental illness and with the ability to read and write without previous history of drug and substance abuse | Fear of childbirth, | The comparison of the two intervention and control groups showed that the mean score of the Wijma questionnaire after the intervention was higher in the intervention group compared to the control group (p < 0.001). | |
| Ondieki. Kenya/(2022) | RCTa |
Group 1: Intervention group Group 2: Control group |
Intervention group: Integrated antenatal education module in 5 sessions of 120 min with 7 participants Control group: Routine antenatal care clinic visits |
Single blind |
37th − 40th weeks of gestation |
Intervention group:56 Control group: 53 |
Primipara women aged 18 to 45 years with singleton low-risk pregnancy between 22 to 26 gestation weeks with no history of mental illness and with the ability to read and write either in English or Kiswahili language without previous history of drug and substance abuse | Fear of childbirth | There was a significant difference in the W-DEQ-A mean scores before (M = 79.89, SD = 10.66) and after the integrated antenatal education (M = 66.75, SD = 19.69, p < 0.001). | |
| Ozcoban et al. Turkey/(2022) | RCTa |
Group 1: Intervention group 1 Group 2: Intervention group 2 Group 3: Control group |
Intervention group 1: Antenatal education focused on improving health literacy in 15 h of education for five weeks with 10–15 participants Intervention group 2: Antenatal education in 15 h of education for five weeks with 10–15 participants Control group: No intervention |
Single blind |
Five weeks post-education |
Intervention group 1: 53 Intervention group 2: 56 Control group: 73 |
Primiparous pregnant women who volunteered, were 18 years old or over, had no diseases, and were in their second trimesters |
Personal Information | Prenatal Self-evaluation, Fear of Childbirth, Postpartum Period Scale, General Self-Efficacy, Turkey Health Literacy Scale |
Post-education fear of childbirth scores was significantly higher in the control group compared to the other two groups (p = 0.036), |
| Sanaati et al. Iran/(2018) | RCTa |
Group 1: Intervention group 1 Group 2: Intervention group 2 Group 3: Control group |
Intervention group 1: lifestyle-based education for both the women and their husbands Intervention group 2: lifestyle-based education for only the women in four 60- to 90-min sessions with an_7-day interval (weeks 24–28) with 5–15 participant Control group: Routine care. |
Single blind | Six weeks postpartum |
Intervention group 1: 62 Intervention group 2: 62 Control group: 63 |
Pregnant mothers with a gestational age of 24–28 weeks, an uncomplicated singleton pregnancy, an Edinburgh Postnatal Depression Inventory score of lower than 12, first or second pregnancy, at least a secondary education |
Postnatal depression and anxiety |
When compared with the control group, significant reductions in PPD (adjusted difference: -5.5), state anxiety (-13.6) and trait anxiety (-12.6) scores were observed in the lifestyle education–dyad group, and also significant reductions in PPD (-3.2), state anxiety (-5.8) and trait anxiety (-4.9) scores were observed in the lifestyle education– women only group |
|
| Serçekuş & Başkale. Turkey/(2015) | quasi-experimental design |
Group 1: Experimental group Group 2: Control group |
Experimental group: Antenatal education was provided to groups of four to six couples once a week (120 min) for eight weeks Control group: Routine antenatal care |
Open-label design | Six months postpartum |
Experimental group: 28 women and their husband Control group: 27 women and their husbands |
Women with a gestation of 26–28 weeks, minimum education level of primary school graduation, nulliparous, not at high risk in pregnancy, not attended any other antenatal programme in the antenatal period, give birth at full term, have a healthy newborn and have experienced no postnatal complications |
Fear of childbirth, self- efficacy and parental attachment, |
The mean W-DEQ score of the women in the experimental group was lower than that of the women in the control group, which indicates that their fear of childbirth was less than that of the women in the control group (p < 0.01). Mean MAIe and PPAQf scores of the couples in the experimental group and those in the control group showed no significant difference was found between the groups (p > 0.05). |
|
| Taheri et al. Iran/(2014) | quasi‑experimental study |
Group 1: Intervention group Group 2: Control group |
Intervention group: Antenatal education in three60-90 min sessions during a week (including 8–10 persons in each session) Control group: Routine prenatal care |
Open-label design | One month after training |
Intervention group: 63 Control group: 65 |
Pregnant women at 24–32 weeks of pregnancy, without medical indications for cesarean sections and the cases of premature delivery or emergency caesarean delivery |
Fear of childbirth and self-efficacy |
There was a significant difference between two groups in terms of childbirth fear, childbirth expectation and childbirth self-efficacy after (P < 0.001) but not before intervention (P > 0.05) |
|
| Toosi et al. Iran/(2012) | RCTa |
Group 1: Intervention group Group 2: Control group |
Intervention group: Antenatal education in four 90 min sessions weekly Control group: Routine prenatal care |
Open-label design. | After intervention |
Intervention group: 42 Control group: 42 |
Primipara women aged 18 to 35 years with singleton low-risk pregnancy between 32 to 35 gestation weeks, minimum education level of primary school graduation, not at high risk in pregnancy with no history of mental illness | Mother-infant attachment | There was no statistically significant difference in the average attachment score in the two groups at the beginning of the study (p = 0.44), but after the study, this difference was significant (p < 0.001). | |
|
Uludag et al. Turkey/(2022) |
RCTa |
Group 1: Intervention group Group 2: Control group |
Intervention group: Online antenatal childbirth preparation education in groups of 7–8 participants lasted four h weekly for two weeks. Control group: Routine prenatal care |
Single-blind |
Intervention group: 23 Control group: 21 |
Women at the age of 18 years or more, the gestation of 24–34 weeks, graduation at least from primary school, nulliparity, not being at high risk in pregnancy, ability to use the application of Microsoft Teams, not having a psychiatric disease and not having attended any other antenatal programmes in the antenatal period. | Worries about labour, fear of birth, Prenatal self-evaluation, fear of COVID-19 | The pregnant women in the intervention group were significantly less worried about labour (p < 0.05), significantly less afraid of birth ( p < 0.05) and significantly less afraid of COVID-19 (p < 0.05), significantly more prepared for labour (p < 0.01) and had significantly more positive feelings about their wellbeing and their babies’ wellbeing (p < 0.05) |
a Randomized Controlled Trial; bAcceptance of pregnancy; cIdentification with the motherhood role; dFear of childbirth; e Maternal attachment inventory; fPostnatal paternal–infant attachment questionnaire