Acceptance and Commitment Therapy for Pregnant Women: A Scoping Review

Background: Pregnancy represents a period of elevated vulnerability to psychological distress. Anxiety and depression affect a large proportion of pregnant individuals, and symptoms may persist into the postpartum period. Acceptance and commitment therapy (ACT), a third-wave cognitive behavioral therapy that aims to enhance psychological flexibility, has been increasingly adopted to improve psychological well-being in pregnancy. However, the existing evidence on the scope and characteristics of ACT-based interventions for pregnant women has not been comprehensively mapped. Methods: This scoping review adopted the five-stage framework proposed by Arksey and O’Malley and was reported following the PRISMA-ScR guidelines. A comprehensive search of eight English and three Chinese databases was conducted from database inception to 30 September 2026. Studies evaluating ACT-based interventions targeting pregnant women were eligible for inclusion. Results: Fourteen studies published between 2015 and 2025, involving a total of 862 participants (mean age: 29.70 years; mean gestational age: 28.82 weeks), were included. Quasi-experimental designs were most common (n = 8), followed by randomized controlled trials (n = 4) and mixed-methods studies (n = 2). Across the included studies, 24 distinct outcomes were assessed using 37 measurements. The most frequently assessed outcomes included pregnancy-related anxiety, coping strategies, psychological flexibility, and fear of childbirth. Findings suggested that ACT-based interventions may enhance psychological flexibility and alleviate psychological symptoms. However, considerable heterogeneity was observed in intervention characteristics and outcome assessment, alongside limited reporting of intervention development and treatment fidelity. Conclusions: ACT shows promise for promoting psychological well-being during pregnancy. Nevertheless, future research should prioritize well-designed randomized controlled trials, standardized intervention and outcome reporting, longer-term follow-up assessments, and transparent documentation of intervention development and fidelity to strengthen the evidence base, enhance reproducibility, and support clinical translation.