O impacto da prática de meditação Mindfulness durante a gestação sobre a saúde materna e desfecho obstétrico e perinatal: uma revisão sistemática de literatura

Abstract

Introduction: Pregnancy represents a period of intense biological, psychological, and social transformations, often accompanied by increased emotional vulnerability. Evidence indicates that symptoms of stress, anxiety, and depression are common during this period and are associated with adverse obstetric and neonatal outcomes, as well as repercussions on child development. In this context, non-pharmacological interventions, such as those based on mindfulness, have been proposed as safe and potentially effective strategies to promote maternal mental health and improve perinatal outcomes. Objective: To comprehensively map and synthesize the available evidence on the impact of Mindfulness-Based Intervention (MBIs) during pregnancy on maternal, obstetric, and perinatal health outcomes. Methods: A Systematic review was conducted according to the recommendations of the Joanna Briggs Institute and PRISMA guidelines. The search was performed in six databases (MEDLINE, Embase, Cochrane Library, Web of Science, Scopus, and LILACS), without language or date restrictions. Quantitative studies involving pregnant women undergoing MBI initiated during the prenatal period were included. In total, 152 studies were included, most of which were randomized clinical trials. Due to methodological heterogeneity, the data were synthesized in narrative form. Results: The findings revealed a consistent trend toward beneficial effects of MBIs, particularly in the domain of maternal mental health. Approximately 72% of the included studies reported clear positive outcomes, while an additional 20% identified partial benefits, indicating a robust—albeit heterogeneous—pattern of effect. Significant reductions in depressive and anxiety symptoms were widely observed, and longitudinal evidence suggests that these benefits may persist for several years, especially among participants who maintain regular mindfulness practice over time. Stress reduction was further supported by physiological markers, including decreased cortisol levels and improved heart rate variability, suggesting modulation of neuroendocrine pathways. In addition, improvements were observed in positive dimensions of mental health, such as emotional regulation, self-compassion, and enhanced childbirth self-efficacy. Within the obstetric domain, although evidence remains limited, findings pointed to reduced fear of childbirth, lower preference for cesarean delivery, and increased rates of vaginal birth. Some studies also reported shorter labor duration, reduced use of analgesia, and improvements in clinical parameters such as blood pressure and glycemic control. Regarding perinatal outcomes, emerging evidence suggests a reduction in the incidence of small-for-gestational-age infants and improvements in composite adverse outcomes, as well as higher APGAR scores. Enhanced maternal–fetal bonding was another consistent finding, with potential implications for the child’s socioemotional development. Despite these encouraging results, interpretation should be approached with caution. The methodological quality of the included studies was frequently limited by biases inherent to behavioral interventions, including lack of blinding, predominant reliance on self-reported measures, high attrition rates, and relatively small sample sizes. These limitations, combined with heterogeneity in intervention protocols and study populations, reduce confidence in the magnitude of the observed effects and raise the possibility of benefit overestimation. Conclusion: MBTs represent a promising, safe, and potentially scalable strategy for promoting maternal mental health during pregnancy, with possible downstream benefits for obstetric and neonatal outcomes. However, the current body of evidence remains of low certainty. High-quality, adequately powered randomized controlled trials employing standardized protocols and objective outcome measures are urgently needed to definitively establish their efficacy and clinical applicability.