Comparison of the effect of non-pharmaceutical interventions on pregnant women's stress using network meta-analysis

The primary objective of this study is to determine the effectiveness of non-pharmacological methods used during pregnancy on the stress of the pregnant woman, and the secondary objectives are to determine the effectiveness these methods on the level of anxiety and depression of the pregnant woman by using network meta-analysis method. The study included 38 randomized studies searched in PubMed, APA PsycNET, Web of Science, The Cochrane Library, Scopus electronic databases and other sources. Three main intervention groups named psychotherapy (cognitive behavioral therapy, mindfulness-based cognitive therapy, supportive therapy), mind-body interventions from complementary and integrative medicine approaches (relaxation techniques, yoga, mindfulness-based stress reduction), and other complementary and integrative medicine interventions (music, spiritual meditation), the interventions in these groups and control group were compared in terms of stress, anxiety and depression levels during pregnancy using network meta-analysis. Stata 15 statistical software was used in statistical analysis. As of risk of bias in studies included in the study; 23 were evaluated as high, 12 as uncertain, and three as low. As a result of the research, it was determined in terms of stress that other complementary and integrative medicine interventions were statistically more effective than the control group and psychotherapy interventions; and from the sub-interventions, spiritual meditation was statistically more effective than the control group. In terms of anxiety, other complementary and integrative medicine interventions were found to be more effective than the control group, and from the sub-interventions, spiritual meditation was more effective than control group, yoga, cognitive behavioral therapy, mindfulness-based stress reduction and music interventions. In terms of depression, it was determined that spiritual meditation and mindfulness-based cognitive therapy were more effective than the control group, yoga, cognitive behavioral therapy and music interventions, and spiritual meditation was more effective than mindfulness-based stress reduction intervention. According to SUCRA values and rankogram graphs, it is seen that the most effective main intervention method is other complementary and integrative medicine interventions in stress, anxiety and depression, and the most effective sub-intervention is spiritual meditation in stress, anxiety and depression. In conclusion, the risk of bias of the included studies should be considered when interpreting the findings, and more high-quality studies specific to this field should be conducted.