The safety and effectiveness of mind body interventions for women with pregnancy induced hypertension and or preeclampsia: A systematic review and meta-analysis

The effect of classical foot massage on insomnia and anxiety in preeclamptic pregnant women: a randomized controlled study

OBJECTIVE

Preeclampsia is one of the most common complaints during pregnancy. Preeclamptic pregnant women may experience insomnia and anxiety.

METHODS

This study was a randomized controlled trial with 71 preeclamptic women. In the experimental group, a foot massage was done for 3 days in a week. In the control group, any applications were not done. These groups were assessed for insomnia and anxiety levels.

RESULTS

In this study, it was found that classical foot massage significantly reduced (12.45±5.74 vs. 33.4±6.41) insomnia and anxiety compared with the control group (18.8±6.44 vs. 39.19±8.31, respectively, p<0.05).

CONCLUSION

The classical foot massage can effectively decrease insomnia and anxiety symptoms.

Effects of yoga on cardiometabolic risks and fetomaternal outcomes are associated with serum nitric oxide in gestational hypertension: a randomized control trial

Gestational hypertension (GH) is associated with adverse cardiometabolic and pregnancy outcomes. Though yoga is known to be beneficial in pregnancy, the effects of yoga rendered for twenty weeks starting from 16th week of gestation in pregnant women having risk of GH on the incidence of hypertension, cardiometabolic risks and fetomaternal outcomes have not been studied. A randomized control trial was conducted on 234 pregnant women having risk of GH receiving standard antenatal care (Control group, n = 113), and receiving standard care + yoga (Study group, n = 121). Interventions were given for twenty weeks starting at 16th week of gestation. Baroreflex sensitivity (BRS), heart rate variability (HRV), insulin resistance, lipid-risk factors, and markers of inflammation, oxidative stress and vascular endothelial dysfunction (VED) were assessed before and after intervention. Incidence of new-onset hypertension, level of cardiometabolic risks at 36th week, and fetomaternal-neonatal outcomes in the perinatal period, were noted. The link of hypertension, pregnancy outcomes and cardiometabolic risks with nitric oxide (NO), the marker of VED was assessed by analysis of covariance, Pearson’s correlations, and multilinear and logistic regressions. In study group, 6.61% women developed hypertension compared to 38.1% in the control group following 20-week intervention and there was significant decrease in risk of developing GH (RR, 2.65; CI 1.42–4.95). There was less-painful delivery, decreased duration of labor, increased neonatal birthweight and Apgar score in study group. Increase in total power of HRV (β = 0.187, p = 0.024), BRS (β = 0.305, p < 0.001), and decrease in interleukin-6 (β =  − 0.194, p = 0.022) had significant association with increased NO. Twenty weeks of practice of yoga during pregnancy decreases the incidence of hypertension, improves fetomaternal outcomes, and reduces cardiometabolic risks in pregnant women having risk of GH. Decreased blood pressure, increased HRV, BRS and birth weight and decreased inflammation were associated with improved endothelial function.

Trial registration: Clinical Trials Registry of India (CTRI), registration number: CTRI/2017/11/010608, on 23.11.2017.

Effects of nonpharmacological interventions on the psychological health of high-risk pregnant women: a systematic review and meta-analysis

Purpose

This study aimed to summarize the current evidence on the effects of nonpharmacological interventions on psychological health outcomes for women with high-risk pregnancies due to conditions such as preeclampsia, gestational diabetes, or preterm labor.

Methods

The following databases were searched from January 2000 to December 2020: PubMed, Ovid Embase, CINAHL, Web of Science, DBpia, RISS, and KISS. Two investigators independently reviewed and selected articles according to the inclusion/exclusion criteria. RoB 2 and the ROBINS-I checklist were used to evaluate study quality.

Results

Twenty-nine studies with a combined total of 1,806 pregnant women were included in the systematic review and meta-analysis. Psychological health improvements were found in women with preeclampsia (Hedges’ g=–0.67; 95% confidence interval [CI], –0.91 to –0.44), gestational diabetes (Hedges’ g=–0.38; 95% CI, –0.54 to –0.12), and preterm labor (Hedges’ g=–0.73; 95% CI, –1.00 to –0.46). The funnel plot was slightly asymmetrical, but the fail-safe N value and the trim-and-fill method showed no publication bias.

Conclusion

Nonpharmacological interventions for women with high-risk pregnancies due to conditions such as preeclampsia, gestational diabetes, and preterm labor can improve psychological parameters such as anxiety, stress, and depression. Nurses can play a pivotal role in the nursing management of pregnant women with high-risk conditions and apply various types of nonpharmacological interventions to meet their needs in uncertain and anxious times during pregnancy.

Mind-Body Techniques in Pregnancy and Postpartum

Maternal stress can perturb physiology and psychiatric health leading to adverse outcomes. This review investigates the effectiveness of several mind-body therapies-namely biofeedback, progressive muscle relaxation, guided imagery, tai chi, and yoga-as interventions in reducing maternal stress and other pregnancy-related conditions. Through randomized trials, these techniques have shown promising benefits for reducing pain, high blood pressure, stress, anxiety, depressive symptoms, labor pain and outcomes, and postpartum mood disturbances. As these interventions are easy to implement, low cost, and safe to perform in pregnancy, they should be considered as alternative, nonpharmaceutical interventions to use during pregnancy and postpartum care.

A randomized control trial to study the effect of integrated yoga on pregnancy outcome in hypertensive disorder of pregnancy

OBJECTIVE

The study aimed to evaluate the effects of integrated yoga on blood pressure and pregnancy outcome in hypertensive disorder of pregnancy.

METHODS

Seventy-nine patients were randomized into study and control groups. The study group received the intervention in the form of integrated yoga for 4 weeks. Final analysis was done on 30 patients each of study and control group.

RESULTS

The mean systolic BP declined by 7.43 ± 5.86 mmHg in the study group as compared to 2.50 ± 5.21 mm Hg in the control group (p value 0.002). The mean diastolic BP prior to delivery was 88.00 ± 3.71 mmHg in the study group and 92.20 ± 5.02 mmHg in the control group (p = 0.001). The maternal comfort in labor was significantly higher and the duration of labor significantly reduced in the study group.

CONCLUSION

Integrated yoga effectively reduced systolic and diastolic blood pressures and increased maternal comfort during labor in hypertensive disorder of pregnancy.