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Background Perinatal mental illness is prevalent and can be associated with poorer health outcomes for mother and fetus if untreated. Mindfulness is a contemporary approach to managing mental health concerns; however, little is known about the effectiveness of Mindfulness-based Interventions during pregnancy, especially within the context of peer support. Methods A systematic review was undertaken. Randomised controlled trials and quasi-experimental studies were included. All articles were critically appraised using the Critical Appraisal Skills Program checklist. Results Of the 2053 records initially identified, 21 studies met inclusion criteria. Studies demonstrated modest improvements in perinatal mental illness, particularly when interventions were adapted to meet the unique needs of women in the prenatal period. Comparison was difficult, due to high heterogeneity and methodological limitations. No studies explored peer support as a therapeutic mechanism and maternal-fetal bonding was not a measured in any studies. Conclusion Mindfulness-based group interventions designed to meet the needs of perinatal women require further research, with larger sample sizes, more rigorous methodology and greater demographic diversity required. Additionally, value could be afforded in exploration of how group support affects any change mechanisms within the participants and include maternal fetal bonding as a measured outcome.