Psychological and psychosocial interventions for the treatment of antenatal maternal depression: systematic review and network meta-analysis

BACKGROUND: Antenatal depression is a common and disabling condition associated with adverse maternal, obstetric and offspring outcomes. Concerns about fetal exposure and acceptability limit pharmacological treatment during pregnancy, and guidelines recommend non-pharmacological interventions as first-line care for mild-to-moderate cases. However, comparative evidence for clinically diagnosed antenatal depression remains limited. AIMS: The aim of this network meta-analysis was to compare and rank the efficacy and acceptability of non-pharmacological interventions for the treatment of clinically diagnosed antenatal depression. METHOD: We conducted a systematic review and network meta-analysis of randomised controlled trials including pregnant women diagnosed with depressive disorders according to DSM or ICD criteria. Databases were searched from inception to September 2025. Interventions were grouped into predefined nodes and compared with treatment-as-usual (TAU). Depressive symptom severity was synthesised as standardised mean differences and acceptability was assessed using all-cause dropout rates. Risk of bias and confidence in the evidence were formally assessed. RESULTS: Ten trials comprising 1853 participants were included. Cognitive-behavioural therapy (CBT) showed the largest and most consistent reduction in depressive symptoms (standardised mean difference -0.83, 95% CI -1.38 to -0.28) compared with TAU and outperformed other active interventions. Other interventions showed smaller and more uncertain effects. Acceptability did not differ meaningfully across interventions. Certainty of evidence was very low across network comparisons. CONCLUSIONS: CBT appears to be the most effective and acceptable non-pharmacological intervention for antenatal depression, supporting current guideline recommendations and underscoring the need for further high-quality trials.