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Early Educational and Behavioral RCT Interventions to Reduce Maternal Symptoms of Psychological Trauma Following Preterm Birth: A Systematic Review

Kraljevic, Marijana MSN, RN; Warnock, Fay F. PhD, RN

The Journal of Perinatal & Neonatal Nursing: October/December 2013 - Volume 27 - Issue 4 - p 311–327
doi: 10.1097/JPN.0b013e3182a8bfe2
Feature Articles

Early behavioral and educational interventions have been developed to reduce maternal symptoms of psychological trauma (depression, anxiety, parenting stress, acute stress disorder, and posttraumatic stress disorder) following preterm birth (PTB). Aims of this systematic review were to critically assess study methodology and provide a synthesis of existing randomized control trial (RCT) interventions and to estimate effects of the interventions in reducing the maternal symptoms across studies. Four electronic databases were systematically searched to locate relevant RCTs using preestablished eligibility criteria. Data from 8 qualifying RCTs were synthesized. Two reviewers independently assessed study methodology using appraisal checklists. Considerable heterogeneity precluded calculation of pooled estimates. There is evidence that mothers of very preterm infants of low-birth-weight experience major depression for up to 12 months following PTB. Sound interventions implemented during and following infant hospitalization and grounded in coping and self-regulation had a small to moderate effect in reducing maternal depression and anxiety and parenting stress for up to 2 months and 12 months respectively. Clinicians can use existing evidence to help guide best practices. Future high-quality RCTs and meta-analysis require that researchers improve study methodology and include analysis of data on maternal hormonal stress and history of psychological symptoms including during the pregnancy.

University of British Columbia School of Nursing, Vancouver, British Columbia, Canada.

Corresponding Authors: Marijana Kraljevic, MSN, RN, School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3, Canada (

Disclosure: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Submitted for publication: June 23, 2013; accepted for publication: August 9, 2013.

© 2013 by Wolters Kluwer Health | Lippincott Williams & Wilkins.