Psychological Impact of High-Risk Pregnancy and the Role of Nursing Interventions-An integrative review
DOI:
https://doi.org/10.35654/ijnhs.v9i2.919Keywords:
Psychological wellbeing, Nursing interventions, High-risk pregnancy, Coping, AnxietyAbstract
Pregnancy is widely perceived as a positive and transformative life event; however, when complications categorise a pregnancy as high-risk, women often experience substantial psychological distress alongside physical challenges. Emotional responses such as anxiety, fear, uncertainty, and depressive symptoms may adversely influence maternal wellbeing, foetal health, and the overall pregnancy experience. Despite advancements in obstetric care, the psychological needs of women with high-risk pregnancies remain insufficiently integrated into routine antenatal services. This integrative review aimed to examine the psychological impact of high-risk pregnancy and evaluate the effectiveness of nursing interventions in supporting emotional wellbeing and coping. A comprehensive literature search was conducted across major electronic databases for studies published between 2010 and 2025. Both qualitative and quantitative evidence were considered, and methodological quality was assessed using established appraisal frameworks. Data were analysed through thematic synthesis to identify recurring patterns and key findings. The review demonstrated that women with high-risk pregnancies commonly report elevated levels of anxiety, depression, fear of adverse outcomes, and feelings of emotional vulnerability. Socioeconomic challenges, inadequate social support, and limited psychological care were identified as important contributing factors. Positive coping was strongly associated with family involvement, supportive healthcare interactions, and effective communication. Nurse-led interventions, including counselling, relaxation techniques, mindfulness-based strategies, structured education, and telehealth support, were consistently associated with improvements in psychological wellbeing and maternal–foetal attachment. High-risk pregnancy should therefore be recognised as both a psychological and physiological experience. Integrating structured psychosocial support within antenatal care is recommended to enhance coping, emotional resilience, and maternal outcomes.
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References
Bjelica A, Cetkovic N, Trninic-Pjevic A, Mladenovic-Segedi L. The phenomenon of pregnancy: a psychological view. Ginekol Pol. 2018;89(2):102–6. doi:10.5603/GP.a2018.0017. PMID: 29512815.
Kuppusamy P, Prusty RK, Kale DP. High-risk pregnancy in India: prevalence and contributing risk factors—a national survey-based analysis. J Glob Health. 2023;13:04116. doi:10.7189/jogh.13.04116.
Zhang Y, Ding W, Wu T, et al. Pregnancy with multiple high-risk factors: a systematic review and meta-analysis. J Glob Health. 2025;15:04027. doi:10.7189/jogh.15.04027.
World Health Organization. Maternal mortality [Internet]. Geneva: World Health Organization; 2023 [cited 2025 Nov 11]. Available from: https://www.who.int/news-room/fact-sheets/detail/maternal-mortality
Ministry of Health and Family Welfare (India). High-risk conditions in pregnancy [Internet]. New Delhi: Government of India; 2016 [cited 2025 Nov 11]. Available from: https://pmsma.mohfw.gov.in/wp-content/uploads/2016/10/High-Risk-Conditions-in-preg-modified-Final.pdf
Albarqi MN. The impact of prenatal care on the prevention of neonatal outcomes: a systematic review and meta-analysis of global health interventions. Healthcare (Basel). 2025;13(9):1076. doi:10.3390/healthcare13091076.
Alderdice F, Lynn F, Lobel M. A review of the emotional and psychological impact of high-risk pregnancy. J Reprod Infant Psychol. 2012;30(1):2–24.
Isaacs NZ, Andipatin MG. A systematic review regarding women's emotional and psychological experiences of high-risk pregnancies. BMC Psychol. 2020;8(1):45. doi:10.1186/s40359-020-00410-8.
Modak A, Ronghe V, Gomase KP, Mahakalkar MG, Taksande V. A comprehensive review of motherhood and mental health: postpartum mood disorders in focus. Cureus. 2023;15(9):e46209. doi:10.7759/cureus.46209.
Al-Mutawtah M, Campbell E, Kubis HP, Erjavec M. Women's experiences of social support during pregnancy: a qualitative systematic review. BMC Pregnancy Childbirth. 2023;23(1):782. doi:10.1186/s12884-023-06089-0.
Vine SJ, Moore LJ, Wilson MR. An integrative framework of stress, attention, and visuomotor performance. Front Psychol. 2016;7:1671. doi:10.3389/fpsyg.2016.01671.
Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs. 2005;52(5):546–53.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
Critical Appraisal Skills Programme (CASP). CASP qualitative checklist [Internet]. Oxford: CASP UK; 2024 [cited 2025 Nov 11]. Available from: https://casp-uk.net/casp-checklists/CASP-checklist-qualitative-2024.pdf
Joanna Briggs Institute. JBI critical appraisal tools for use in JBI systematic reviews: checklist for analytical cross-sectional studies. Adelaide: JBI; 2020.
Hong QN, Pluye P, Fàbregues S, Bartlett G, Boardman F, Cargo M, et al. The mixed methods appraisal tool (MMAT) version 2018 for information professionals and researchers. Educ Inf. 2018;34(4):285–91.
McNestry C, Killeen SL, Crowley RK, McAuliffe FM. Pregnancy complications and later life women's health. Acta Obstet Gynecol Scand. 2023;102(5):523–31. doi:10.1111/aogs.14523.
Schiele C, Goetz M, Hassdenteufel K, et al. Acceptance, experiences, and needs of hospitalized pregnant women toward an electronic mindfulness-based intervention: a pilot mixed-methods study. Front Psychiatry. 2022;13:939577. doi:10.3389/fpsyt.2022.939577.
Ekelöf K, Tangen GA, Nyström CD, Löf M, Thomas K. Mental wellbeing during pregnancy and the transition to motherhood: an explorative study through the lens of healthcare professionals. BMC Pregnancy Childbirth. 2025;25(1):803. doi:10.1186/s12884-025-07894-5.
Ahmad M, Sechi C, Vismara L. Advanced maternal age: a scoping review about the psychological impact on mothers, infants, and their relationship. Behav Sci (Basel). 2024;14(3):147. doi:10.3390/bs14030147.
Kotimäki S, Härkönen J, Karlsson L, Karlsson H, Scheinin NM. Educational differences in prenatal anxiety and depressive symptoms and the role of childhood circumstances. SSM Popul Health. 2020;12:100690. doi:10.1016/j.ssmph.2020.100690.
Fisher JR, Tran HT, Tran T. Relative socioeconomic advantage and mood during advanced pregnancy in women in Vietnam. Int J Ment Health Syst. 2007;1:3. doi:10.1186/1752-4458-1-3.
Hildingsson I, Nordin-Remberger C, Wells MB, Johansson M. Cluster analysis of fear of childbirth, anxiety, depression, and childbirth self-efficacy. J Obstet Gynecol Neonatal Nurs. 2024;53(5):522–33. doi:10.1016/j.jogn.2024.04.004.
Amegavluie REA, Ani-Amponsah M, Naab F. Women's experiences of surviving severe obstetric complications: a qualitative inquiry in southern Ghana. BMC Pregnancy Childbirth. 2022;22(1):212. doi:10.1186/s12884-022-04538-w.
Cleveland Clinic. Pregnancy bed rest [Internet]. Cleveland, OH: Cleveland Clinic; 2023 [cited 2025 Nov 11]. Available from: https://my.clevelandclinic.org/health/articles/9757-pregnancy-bed-rest
Ucar N, Pinar SE. The hospital stressors and depression, anxiety levels in pregnant women hospitalized due to preterm delivery: a follow-up study. Perspect Psychiatr Care. 2020;56(2):290–6. doi:10.1111/ppc.12426.
Jackson L, O'Donoghue E, Helm J, Gentilcore R, Hussain A. 'Some days are not a good day to be a mum': exploring lived experiences of guilt and shame in the early postpartum period. Eur J Investig Health Psychol Educ. 2024;14(12):3019–38. doi:10.3390/ejihpe14120198.
Constantinou G, Varela S, Buckby B. Reviewing the experiences of maternal guilt – the "Motherhood Myth" influence. Health Care Women Int. 2021;42(1):1–25. doi:10.1080/07399332.2020.1835917.
Khanna T, Patel R, Akhtar F, Mehra S. Relationship between partner support and psychological distress among young women during pregnancy: a mixed-method study from a low- and middle-income country. J Affect Disord Rep. 2023;14:100672. doi:10.1016/j.jadr.2023.100672.
Maurya VK, Baranwal A, Gupta RP. Domestic violence during pregnancy and its interaction with hormonal changes and abuse: a review of suicide risk factors. Int J Indian Psychol. 2024;13(2):49–58. doi:10.25215/1302.004.
Sheikh J, Allotey J, Kew T, Khalil H, Galadanci H, Hofmeyr GJ, Abalos E, Vogel JP, Lavin T, Souza JP, Kaur I, Ram U, Betran AP, Bohren MA, Oladapo OT, Thangaratinam S. Vulnerabilities and reparative strategies during pregnancy, childbirth, and the postpartum period: moving from rhetoric to action. eClinicalMedicine. 2024;67:102264. doi:10.1016/j.eclinm.2023.102264.
Syeda R, Hakeem N, Aziz S. Coping strategies in women with anxiety and depression during prenatal period. Ann Abbasi Shaheed Hosp Karachi Med Dent Coll. 2017;22(3):191–9. doi:10.58397/ashkmdc.v22i3.128.
Mróz M, Stobnicka D, Marcewicz A, Szlendak B, Iwanowicz-Palus G. Stress and coping strategies among women in late motherhood. J Clin Med. 2024;13(7):1995. doi:10.3390/jcm13071995.
Burayu ET, Bekele GG, Shifaw ZK. Exploring coping strategies for perinatal bereaved mothers with loss and its associated factors in public health facilities in Southwest Ethiopia. SAGE Open Med. 2025;13:20503121251376262. doi:10.1177/20503121251376262.
Mohammadi S, Shojaei K, Maraghi E, Motaghi Z. Explaining the psychological distress of women with high-risk pregnancies in Iran: a qualitative study. Iran J Nurs Midwifery Res. 2022;27(6):560–6. doi:10.4103/ijnmr.ijnmr_321_21.
Cebekhulu G, Andipatin M. Women’s experiences of high-risk pregnancy care in resource constrained Cape Town communities. Health SA Gesondheid. 2025;30:a2890. doi:10.4102/hsag.v30i0.2890.
Li L, Xiao L, Yuan X, et al. Partner involvement and emotional and informational support gaps as predictors of postpartum birth trauma symptoms: a multi-center cross-sectional study of 230 women at 42 days postpartum. BMC Pregnancy Childbirth. 2025;25(1):918. doi:10.1186/s12884-025-08084-z.
Jin Y, Wu Y, Li J. Midwife empathy and its association with the childbirth experience: a cross-sectional study. BMC Pregnancy Childbirth. 2022;22(1):960. doi:10.1186/s12884-022-05309-3.
Souto SPA, Silva RCGD, Prata AP, Guerra MJ, Couto C, Albuquerque RSD. Midwives’ interventions for reducing fear of childbirth in pregnant women: a scoping review. JBI Evid Synth. 2022;20(12):2867–935. doi:10.11124/JBIES-21-00382.
Callanan F, Tuohy T, Bright AM, Grealish A. The effectiveness of psychological interventions for pregnant women with anxiety in the antenatal period: a systematic review. Midwifery. 2022;104:103169. doi:10.1016/j.midw.2021.103169.
Patel A, Dinesh N, Sharma PVN, Kumar P, Binu V. Outcomes of structured psychotherapy for emotional adjustment in a childless couple diagnosed with recurrent pregnancy loss: a unique investigation. J Hum Reprod Sci. 2018;11(2):202. doi:10.4103/jhrs.JHRS_127_17.
Muzik M, Hamilton SE, Rosenblum KL, Waxler E, Hadi Z. Mindfulness yoga during pregnancy for psychiatrically at-risk women: preliminary results from a pilot feasibility study. Complement Ther Clin Pract. 2012;18(4):235–40. doi:10.1016/j.ctcp.2012.06.006.
Mohammed HH, Hamed AAAE, Afefy NAE, Sherif NA, Ibrahim SM. The effectiveness of nurse-led antenatal education on maternal self-efficacy: an evidence-based approach. BMC Nurs. 2025;24(1):895. doi:10.1186/s12912-025-03471-5.
Rehman S, Sarwar H, Fatima E, Hussain K, Batool A. Effect of nurse-led educational intervention on knowledge and practice of self-care during the intrapartum and postpartum period in a private hospital. J Health Wellness Community Res. 2025;321e. doi:10.61919/72pcm920.
ElShabory NEHMES, Abdel-Gawad RAAA, Mohammed HSS, Shehata AAFM, Ibrahim EMAEA. Effectiveness of nursing intervention session on health locus of control and self-efficacy for women with preeclampsia. BMC Pregnancy Childbirth. 2025;25(1):468. doi:10.1186/s12884-025-07447-w.
Noor S, Mukhtar M, Kaleem A. Effects of nurse-led group-based education on knowledge and utilization of antenatal care services among pregnant women. J Neonatal Surg [Internet]. 2025 May 22 [cited 2025 Nov 11];14(26S):473–7. Available from: https://www.jneonatalsurg.com/index.php/jns/article/view/6309
Ramadan OME, Alshammari AM, Alruwaili AN, Elsharkawy NB, Alhaiti A, Baraka NIM. Nurse-led telemedicine versus in-person lactation support for breastfeeding initiation in mothers of low-birth-weight infants: a non-inferiority randomized controlled trial. BMC Pregnancy Childbirth. 2025;25(1):1066. doi:10.1186/s12884-025-08236-1.
Evans C, Clancy G, Evans K, Booth A, Nazmeen B, Sunney C, Clowes M, Jones N, Timmons S, Spiby H. Optimising digital clinical consultations in maternity care: a realist review and implementation principles. BMJ Open. 2024;14(10):e079153. doi:10.1136/bmjopen-2023-079153.
Toosi M, Akbarzadeh M, Ghaemi Z. The effect of relaxation on mother’s anxiety and maternal–fetal attachment in primiparous IVF mothers. J Natl Med Assoc. 2017;109(3):164–71. doi:10.1016/j.jnma.2017.03.002.
Dai L, Shen Q, Redding SR, Ouyang YQ. Simulation-based childbirth education for Chinese primiparas: a pilot randomized controlled trial. Patient Educ Couns. 2021;104(9):2266–74. doi:10.1016/j.pec.2021.02.036.
Desmawati, Kongsuwan W, Chatchawet W. Effect of nursing intervention integrating an Islamic praying program on labor pain and pain behaviors in primiparous Muslim women. Iran J Nurs Midwifery Res. 2019;24(3):220–226. doi:10.4103/ijnmr.IJNMR_36_18
Calpbinici P, Özçirpan ÇY. The effect of the training program provided to primiparous pregnant women through the motivational interview method on their fear of childbirth, childbirth self-efficacy, and delivery mode: a randomized controlled trial. Curr Psychol. 2023;42(1):21609–21623. doi:10.1007/s12144-022-03285-7
Aksoy Derya Y, Altiparmak S, Akça E, Gökbulut N, Yilmaz AN. Pregnancy and birth planning during COVID-19: The effects of tele-education offered to pregnant women on prenatal distress and pregnancy-related anxiety. Midwifery. 2021;92:102877. doi:10.1016/j.midw.2020.102877
Çankaya S, ?im?ek B. Effects of antenatal education on fear of birth, depression, anxiety, childbirth self-efficacy, and mode of delivery in primiparous pregnant women: a prospective randomized controlled study. Clin Nurs Res. 2021;30(6):818–829. doi:10.1177/1054773820916984
Mirzakhani K, Shoorab NJ, Akbari A, Khadivzadeh T. High-risk pregnant women's experiences of receiving prenatal care in the COVID-19 pandemic: a qualitative study. BMC Pregnancy Childbirth. 2022;22(1):363. Published 2022 Apr 26. doi:10.1186/s12884-022-04676-1
Nurseslabs. High-risk pregnancy [Internet]. Available from: https://nurseslabs.com/high-risk-pregnancy/#google_vignette
Murugalakshmi PL. Role of nurse and crisis intervention during pregnancy. Asian J Nurs Educ Res. 2018;8(2):298–300. doi:10.5958/2349-2996.2018.00058.7
Ayers S, Crawley R, Webb R, Button S, Thornton A, HABiT Collaborative Group. What are women stressed about after birth? Birth. 2019;46(4):678–685. doi:10.1111/birt.12455
Le Bas GA, Youssef GJ, Macdonald JA, Mattick R, Teague SJ, Honan I, et al. Maternal bonding, negative affect, and infant social-emotional development: a prospective cohort study. J Affect Disord. 2021;281:926–934. doi:10.1016/j.jad.2020.11.031
Rehbein E, Moyer A, Lobel M. Ways of coping with stress during pregnancy: differences revealed through meta-analysis. Womens Reprod Health (Phila). 2024;11(2):296–312. doi:10.1080/23293691.2023.2237968
Williamson SP, Moffitt RL, Broadbent J, Neumann DL, Hamblin PS, et al. Coping, wellbeing, and psychopathology during high-risk pregnancy: a systematic review. Midwifery. 2023;116:103556.
Yoo H, Ahn S. Effects of nonpharmacological interventions on the psychological health of high-risk pregnant women: a systematic review and meta-analysis. Korean J Women Health Nurs. 2021;27(3):180–195.
Yu X, Liu Y, Huang Y, Zeng T. The effect of nonpharmacological interventions on the mental health of high-risk pregnant women: a systematic review. Complement Ther Med. 2022;64:102799.
Alizadeh-Dibazari Z, et al. The effect of non-pharmacological prenatal interventions on fear of childbirth: an overview of systematic reviews and meta-analysis. BMC Psychiatry. 2024.
Zeng G, et al. Effects of nonpharmacological interventions on depressive and anxiety symptoms during pregnancy: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2024.
Mirzakhani K, et al. Well-being in high-risk pregnancy: an integrative review. J Reprod Infant Psychol. 2020.
Keshavarz M, et al. Psychosocial adaptation in high-risk pregnancy: a systematic review. BMC Pregnancy Childbirth
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