Psychological Interventions for Pregnant Women in Chemical, Biological, Radiological, and Nuclear Incidents: A Systematic Review

BACKGROUND AND AIMS: Chemical, Biological, Radiological, and Nuclear (CBRN) incidents increasingly threaten public health, especially with the rise of unconventional weapons. Pregnant women are particularly vulnerable to psychological impacts. Psychological First Aid (PFA) is a key supportive intervention. This study explores current psychological strategies and aims to improve mental health outcomes for pregnant women in CBRN emergencies. METHODS: In this systematic review, four electronic databases-PubMed, Embase, Web of Science, and Scopus-were initially searched up to November 4, 2023 and subsequently updated in July 2025; no additional eligible studies were identified in the updated search. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 7228 records were identified. After removing 2633 duplicates, 4595 records remained for screening. Following title and abstract screening, 103 full-text articles were assessed for eligibility, of which 25 studies met the inclusion criteria and were included in the final analysis. RESULTS: This study emphasized the importance of psychological responses and support during CBRN incidents, especially for pregnant women. Interventions at individual, organizational, and social levels may help reduce psychological distress. Individually, these include PFA, counseling, and stress management. Organizational interventions involve planning mental health services and necessary support in hospitals and medical centers. Socially, they include promoting support networks and helping pregnant women cope with incidents. CONCLUSION: This review emphasized that in CBRN incidents, supporting the mental health of pregnant women at individual, organizational, and social levels was critical. The study supported a three-pronged intervention framework aiming to reduce the psychological impact of CBRN incidents and empower individuals and communities to rebuild and thrive afterward. These results emphasized that joint efforts of healthcare providers, policymakers, and community organizations were essential to provide psychosocial care that is comprehensive, accessible, and sensitive to the distinct needs of affected individuals.