The role of antenatal education on maternal self-efficacy, fear of childbirth, and birth outcomes: A systematic review and meta-analysis

Abstract

INTRODUCTION Antenatal education programs aim to prepare expectant mothers for childbirth and early parenthood. This meta-analysis assessed the impact of these programs on maternal psychological outcomes and birth experiences, focusing on childbirth selfefficacy, fear of childbirth, and maternal and neonatal outcomes, including rates of vaginal delivery, cesarean section, Apgar scores, and birth weight. METHODS A systematic search was conducted in PubMed, Web of Science, SCOPUS, and Cochrane Library until July 2024. Randomized controlled trials (RCTs) comparing antenatal education to standard care were included. Data were synthesized using meta-analysis with standardized mean differences (SMD) for continuous outcomes and risk ratios (RR) for dichotomous outcomes. RESULTS Forty studies were reviewed, with 31 eligible for meta-analysis. Among 1116 pregnant women, antenatal education significantly increased childbirth self-efficacy (SMD=2.00; 95% CI: 1.06–2.95, p<0.0001) and decreased fear of childbirth (SMD= -1.26; 95% CI: -1.79 – -0.74, p<0.00001). Maternal outcomes showed higher vaginal delivery rates (RR=1.10; 95% CI: 1.04–1.16, p=0.0004) and lower cesarean rates (RR=0.80; 95% CI: 0.70–0.92, p=0.001). No significant differences were found in episiotomy rates, Apgar scores, or birth weight. CONCLUSIONS Antenatal education improves maternal psychological outcomes and promotes vaginal delivery. However, high heterogeneity and potential bias in the studies limit generalizability. More research is needed on long-term impacts and effectiveness in low-resource settings.