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Background: High-risk pregnancies are frequently associated with elevated levels of stress, anxiety, uncertainty, and impaired prenatal bonding. Pregnant women hospitalized due to premature rupture of membranes (PROM) between 20 and 32 weeks of gestation are particularly vulnerable, facing fears of preterm birth and potential loss of the child. Maternal stress during pregnancy may negatively affect fetal development and the developing mother–child relationship. Emerging evidence suggests that art and music therapy can promote emotional stabilization, resource activation, stress reduction, and prenatal attachment. The multicenter KlangKunst project aims to evaluate a manualized art and music therapy intervention as an adjunct to inpatient prenatal care.

Methods / Study Status: KlangKunst is a multicenter, randomized controlled trial with a mixed-methods design. Pregnant women hospitalized with PROM (20+0–32+0 weeks of gestation) are randomized to either an intervention group receiving six to ten manualized art or music therapy sessions during their inpatient stay or a control group receiving creative materials without therapeutic guidance. The intervention is delivered bedside using accessible art materials and simple musical instruments and follows a standardized manual to ensure comparability across sites. The study is conducted collaboratively by University Hospital Essen, MSH Medical School Hamburg, and Alanus University of Arts and Social Sciences, involving six clinical sites across Germany. Quantitative outcomes include perceived stress (PSQ-20), anxiety (GAD-7), and prenatal attachment (MAAS), assessed at baseline, post-intervention, six weeks, and six months of follow-up. Qualitative interviews and session-based measures of well-being and physiological stress indicators complement the quantitative data.

Expected Outcomes and Significance: It is hypothesized that participation in the manualized art and music therapy program will result in clinically meaningful reductions in stress and anxiety and strengthen prenatal attachment compared with the control condition. Beyond immediate improvements in maternal well-being, the study seeks to contribute to evidence-based psychosocial care in obstetrics and to establish art and music therapy as feasible and effective components of inpatient prenatal care. Findings may inform future research on postnatal bonding, child development, and the integration of creative arts therapies into routine care for women experiencing high-risk pregnancies.