The Effect of a Gamification-Based Educational Intervention in Childbirth Preparation Classes on Maternal Adaptation Dimensions Among Pregnant Women: A Field Randomized Trial Publisher Pubmed



Zendehjan T T ; Mohammadzadeh F ; Hassanzadeh G ; Askari F
Source: BMC Pregnancy and Childbirth Published:2026

Abstract

Background: Enhancing knowledge and skills during pregnancy improves psychological and physical preparedness for childbirth. This study examined the effect of a gamification-based educational intervention on maternal adaptation and its dimensions among pregnant women. Methods: In this field randomized controlled trial with parallel groups and blinded data analysis, 80 pregnant women attending childbirth preparation classes in Gonabad were randomly assigned to intervention and control groups using permuted block randomization. The intervention group received eight weekly 90-minute gamification-based sessions integrated into standard classes, conducted from gestational weeks 20 to 28, including theoretical instruction, interactive question-and-answer sessions using a custom-designed game tool, physical exercises, and relaxation training. Topics covered anatomy and physiology of pregnancy, common complaints, labor stages, postpartum care, breastfeeding, and newborn care. The control group received routine prenatal education. Data were collected at three time points (baseline, immediately post-intervention, and four-week follow-up) using a demographic and obstetric questionnaire and the Prenatal Self-Evaluation Questionnaire. Effects were analyzed using generalized estimating equations. Results: The mean (standard deviation) of the participants was 27.44 (6.64). The generalized estimating equations results indicated no significant baseline difference in maternal adaptation between groups (group effect: B = − 8.67; 95% Confidence interval: − 24.34 to 6.99; p = 0.278), but showed a significant overall improvement over time in the intervention group (time effect: B = − 13.53; 95% Confidence interval: − 16.09 to − 10.96; p < 0.001) and a slower improvement in the control group compared to the intervention group (group × time interaction effect: B = 7.78; 95% Confidence interval: 2.98 to 12.57; p = 0.001). Significant interaction effects were also found for self and child well-being (B = 1.75, 95% Confidence interval: 0.73 to 2.77, p < 0.001), preparedness for labor (B = 2.49, 95% Confidence interval: 1.48 to 3.50, p < 0.001), and control during labor (B = 2.56, 95% Confidence interval: 1.46 to 3.66, p < 0.001), indicating stronger positive changes in these specific domains over time in favor of the intervention group. Conclusion: Gamification-based education can be used as an innovative approach in childbirth preparation classes to enhance maternal adaptation among pregnant women. Trial registration: IRCT20230510058147N1(20230612). © The Author(s) 2026.