Mental health-related telemedicine interventions for pregnant women and new mothers: a systematic literature review

**Background:** Pregnancy and the postpartum period are times of increased risk for mental health problems, with 10% of pregnant women and 13% of new mothers in high-income countries experiencing mental disorders. Untreated maternal mental disorders can negatively affect both mother and fetus, leading to preterm birth, lower birth weight, impaired mother-child bonding, and long-term developmental consequences for the child. Despite effective treatments, treatment rates remain low due to barriers including stigma, lack of time, childcare issues, and limited resources in rural areas. Telemedicine interventions offer a promising low-threshold approach to address these barriers.

**Methods:** This systematic review was conducted according to PRISMA guidelines and registered in PROSPERO (registry no. 166180). Inclusion criteria were randomized controlled trials involving pregnant women or new mothers (infants up to 12 months), any telemedicine intervention (e.g., websites, apps, chats, telephone), and any mental health-related outcome. The literature search was conducted in PubMed, Cochrane Library, Web of Science, and PsycINFO using terms for telemedicine, mental stress, pregnant women, and new mothers with synonyms and MeSH terms. Studies from 2007 to November 2020 were included. Screening, inclusion, and data extraction were performed independently by two researchers using CADIMA, with a Kappa value of 0.7 indicating good consistency. Risk of bias was assessed using the revised Cochrane RoB 2 tool.

**Key Results:** Of 4036 identified records, 44 RCTs were included. Studies came from North America (36%, n=16), Europe (30%, n=12), Asia (14%, n=6), Australia (9%, n=4), Africa (1 article), and multiple continents (n=4). Sample sizes ranged from 24 to 1340 women (mean 242, median 132). Control groups were 57% TAU, 23% waitlist, 7% information only, 7% another intervention, 5% distraction control, and 2% placebo training. A majority (62%, n=28) reported significantly improved mental health-related outcomes for telemedicine interventions compared to control. For specific outcomes: 14 of 28 articles on postnatal depression reported significant improvement; 11 of 19 on depression; 8 of 22 on anxiety; and 5 of 12 on stress. Internet-delivered CBT was successful for depression (6 of 8 studies) and stress (3 of 3 studies). Peer support improved outcomes for postnatal depression (2 of 2 studies) and anxiety (2 of 2 studies). Mindfulness interventions were successful in all 5 studies reporting them. Interventions with preventive approaches (63% successful) and symptom reduction (65% successful) were largely successful. Website interventions (69% successful) and telephone interventions (67% successful) showed positive results, while app-based interventions showed mixed results. Notably, 80% of interventions without personal contact were successful compared to 55% with personal contact. Risk of bias was low in 55% of studies, with some concerns in 11%, and high in 32%.

**Clinical Implications:** Telemedicine interventions are generally suitable for addressing perinatal mental health and do no harm—only one article reported significant worsening. However, there is no one-size-fits-all approach. For depression and stress, iCBT is the most evidence-backed intervention. For postnatal depression and anxiety, peer support appears promising. Anxiety remains difficult to address via telemedicine, with only 36% of symptom-reduction interventions showing significant improvement. Preventive approaches are particularly promising for postnatal depression and anxiety. The telephone remains an accessible and effective delivery mode, especially for anxiety interventions. Future research should focus on tailoring interventions to specific mental health outcomes and investigating which components work best for which conditions, particularly for anxiety.