Timing Matters: A Meta-Analysis and Systematic Review of Digital Cognitive Behavioral Therapy Effectiveness in the Perinatal Period

Depressive symptoms during and after pregnancy are a major concern in perinatal mental health, with implications for both mother and child. Digital cognitive behavioral therapy (CBT) is a scalable and accessible intervention. Yet, it remains unclear whether its effectiveness depends on the timing of delivery — a potentially crucial factor, as pregnancy and the postpartum period differ in both psychological demands and practical circumstances. Therefore, to examine whether digital CBT interventions are more effective when delivered during pregnancy, after childbirth, or across both periods, we conducted a systematic review and meta-analysis of 16 randomized controlled trials involving 7,577 participants. Our results indicate that digital CBT delivered after childbirth is significantly more effective in reducing depressive symptoms than interventions delivered during pregnancy (b=-1.99, 95%CI [-3.90, -0.08], p=0.04). Interventions spanning both periods did not show additional benefit. These findings can inform the design and implementation of future digital CBT interventions targeting perinatal populations.