Online-based antenatal education and its effects on maternal mental health and selected neonatal outcomes: a systematic review and meta-analysis

BACKGROUND: Online antenatal education is increasingly used to improve maternal psychological outcomes and preparedness for childbirth. However, evidence regarding its effectiveness remains inconsistent, particularly due to heterogeneity in intervention types and outcome measures. METHODS: This systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines. PubMed, EMBASE, Scopus, Web of Science, CINAHL, and the Cochrane Library were searched from inception to March 2026. Randomized controlled trials and observational studies evaluating digital antenatal interventions in pregnant women were included. Outcomes included maternal depression, anxiety, fear of childbirth, self-efficacy, and small-for-gestational-age (SGA) incidence. Random-effects models were used, and standardized mean differences (SMDs) and odds ratios (ORs) were calculated. Heterogeneity was assessed using I² statistics. RESULTS: Twelve studies involving 4,982 participants were included. No significant effects were observed for depression (SMD = - 0.18; 95% CI: -0.45 to 0.09; I² = 86.5%; p = 0.188), anxiety (SMD = - 0.10; 95% CI: -0.66 to 0.46; I² = 92.8%; p = 0.723), or self-efficacy (SMD = 0.56; 95% CI: -0.11 to 1.23; I² = 90.6%; p = 0.102). A reduction in fear of childbirth did not reach statistical significance (SMD = - 0.53; 95% CI: -1.06 to 0.003; p = 0.051. No significant association was found for SGA (OR = 0.73; 95% CI: 0.17-3.14; p = 0.670). Substantial heterogeneity was present across outcomes, limiting the interpretability of pooled estimates. CONCLUSION: Current evidence, characterized by substantial heterogeneity, does not demonstrate statistically significant effects of online-based antenatal education on maternal depression, anxiety, or fear, nor on improving self-efficacy or preventing SGA infants. However, the high heterogeneity (I² >85% for most outcomes) indicates that these pooled estimates are exploratory, and clinically meaningful effects for specific intervention types cannot be ruled out. Findings should be interpreted cautiously.