Effects of internet-based supportive intervention on knowledge, pregnancy stress, fear of childbirth, and pregnancy outcomes in primiparas

Why clinicians should know about it

• Picked for Neonatology (paper of the day, 25 July 2026).

Abstract

BACKGROUND: The proliferation of internet-based technologies has enabled the development of supportive intervention that have proven efficacious in several health education fields. However, their specific utility for primiparas has yet to be systematically evaluated. METHODS: A total of 332 primiparas were enrolled between January 2021 and December 2023 to participate in a randomized controlled trial, and were equally assigned to two groups (166 per group). The control group received conventional health education, while the intervention group received an internet-based supportive intervention. After excluding dropouts, 141 participants in the intervention group and 137 in the control group were included for per-protocol analysis. Maternal and neonatal health knowledge, pregnancy stress, and fear of childbirth (FOC) were evaluated using the Maternal and Infant Knowledge Scale, Pregnancy Stress Rating Scale (PSRS), and Childbirth Fear Questionnaire (CAQ), respectively. Maternal and neonatal clinical outcomes were also recorded. RESULTS: After the intervention, the intervention group demonstrated significantly higher knowledge scores in nine out of ten domains, with a higher post-intervention total score (78.45 ± 5.97 vs. 67.31 ± 7.04, P < 0.001). Similarly, the intervention group reported significantly lower pregnancy stress across all four domains, with a lower post-intervention total score (31.67 ± 6.85 vs. 38.92 ± 8.76, P < 0.001). FOC was also significantly lower in the intervention group across three dimensions, with a lower post-intervention total score (23.56 ± 4.73 vs. 28.24 ± 5.81, P < 0.001). Furthermore, sensitivity analyses under the intention-to-treat (ITT) principle showed that these findings were robust to missing data, confirming the benefits of the intervention group. The intervention group had a significantly higher rate of spontaneous vaginal delivery and lower incidences of gestational diabetes, macrosomia, low birth weight, as well as lower overall incidences of adverse maternal and neonatal events (21.28% vs. 35.04%, P = 0.011; 19.86% vs. 34.31%, P = 0.007, respectively). However, sensitivity analyses showed that adverse events were not robust to missing data, and therefore these results should be interpreted with caution. CONCLUSION: The internet-based supportive intervention is associated with higher knowledge, lower stress and FOC, and potential maternal and neonatal benefits among primiparas, suggesting its value as an antenatal education strategy.

Abstract as published, via PubMed.