Effect of cognitive behavioral therapy on anxiety and pregnancy outcomes in mothers with IUGR: an assessor-blinded randomized controlled trial

Cognitive Behavioral Therapy (CBT) is a non-pharmacological intervention that may reduce anxiety during pregnancy. This study aimed to evaluate the effect of CBT on maternal anxiety and fetal growth outcomes in pregnancies diagnosed with stage 1 intrauterine growth restriction (IUGR-1). This Assessor-blinded randomized controlled trial was conducted among pregnant women (gestational age 24–32 weeks) referred to clinics affiliated with Shiraz University of Medical Sciences. A total of 82 eligible women were randomly assigned to the intervention (CBT) and control groups (41 each). The intervention group received four CBT sessions, while the control group received routine care. Anxiety levels were measured using the Van den Bergh Pregnancy Anxiety Questionnaire, and fetal growth indices were assessed via sonography at baseline and after four weeks. No significant differences were observed between groups regarding baseline maternal age (32.78 ± 6.55 vs. 31.07 ± 5.45 years; p = 0.20) or gestational age (30.90 ± 1.49 vs. 30.41 ± 1.85 weeks; p = 0.09). Anxiety scores significantly decreased in the intervention group (from 44.41 ± 12.30 to 28.53 ± 7.13; p < 0.001), whereas no significant change was observed in the control group (from 41.00 ± 19.70 to 39.92 ± 17.32; p = 0.125). The prevalence of IUGR decreased to 56.1% in the intervention group (p < 0.001), while it remained high in the control group (92.7%; p = 0.25). Abdominal circumference percentiles improved significantly in the intervention group (p < 0.001), but changes were not significant in the control group. CBT effectively reduced pregnancy-related anxiety and showed promising effects on improving IUGR-1 outcomes. CBT may be considered a safe and beneficial adjunct to routine prenatal care in high-risk pregnancies. Further multicenter RCTs with larger sample sizes are recommended. Registered at irct.ir (code: IRCT20240109060656N6) with the Clinical Trial Registry at 2025-08-17.