Does Yoga impact during Pregnancy: Systematic Review

doi:10.21203/rs.3.rs-2951187/v1

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Does Yoga impact during Pregnancy: Systematic Review

https://doi.org/10.21203/rs.3.rs-2951187/v1

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Background: Pregnancy-related stress will lead to many complications and it will affect the health of pregnant women. Many complementary therapies have a positive effect on the health of the mother and unborn child. RCTs were utilized to investigate the advantages of yoga for expectant mothers and their unborn children. High levels of stress especially between 25 to 28 weeks of pregnancy may also be connected to autism in children.

Aim The aim of this systematic review was to investigate all Randomized Control trials [RCT] that have a potential impact of yoga on pregnancy-related stress and pregnancy outcome.

MethodsA systematic search in PubMed, Web of Science, EMBASE, and CINAHL databases was undertaken from 2012 to 2022. Randomized Control Trial studies on pregnant women with yoga intervention especially in the second trimester, reporting either pregnancy or neonatal outcomes were included.

Results: The search resulted in potentially relevant studies; 16 were included. The majority of research studies found that pregnant women who practiced yoga had lower stress levels (p<0.001) as well as normal platelet counts and pregnancy outcomes (p<0.001), and had a positive impact of yoga during pregnancy.

Conclusion: In this systematic review shows that a prenatal yoga program gives pregnancy benefits well as well-planned labour and birth outcomes. Improvements in psychological, physical, and biological health of mother and child.

Pregnancy causes biological changes in a pregnant woman's body as her body adjusts to support the developing fetus. It has distinct physical, psychological, and social manifestations. Pregnancy health is a holistic approach to health that addresses physical, mental, emotional, social, and spiritual well-being. It is comprehensive care, also known as a holistic approach to full care because it addresses pregnant women's medical, emotional, social, economic, and spiritual needs. An outline of the frame postures, or asanas and pranayama, purportedly authored by Patanjali, are where the term "yoga" originated [1]. For pregnant women, it must become a commonplace workout. Its more comprehensive approach to mental health, including mental, physical, and non-secular well-being, maybe the reason for its notoriety. Numerous aspects of yoga practices are integrated into specific physical exercises such as asanas (postures), pranayama (deep breathing), and savasana [2, 3].

Yoga has been shown to improve stamina through improved sleep and a decrease in stress levels. as well as to promote mental health through a decrease in chronic headaches and depression. It also enables the relief of chronic pain conditions like arthritis and severe back pain. While pregnant, practicing yoga assists individuals to maintain a unique connection to their unbreakable link to mental and non-secular well-being. Yoga treatments have been shown in studies to improve both physical and mental health by boosting muscle strength, memory, and sleep. It is quite satisfactory in terms of pain, despondency, and serum cortisol levels [4, 5]. Yoga, in particular, has a favorable influence location along the hypothalamic-pituitary-adrenal axis linked with the cortisol stage inside the blood due to stress. The stress of being pregnant may also influence serum levels at some point cortisol stage [6], within the blood, and its causes and purposes detrimental to being pregnant results and modifications in fetal neuro-development. Yoga remedies may also be a resource in lowering strain stage and desirable being pregnant final results [7]. Yoga treatment has been shown in studies to enhance muscle power, memory, and sleep quality while decreasing pain, depression, and serum cortisol levels. Yoga has a profound influence on the hypothalamic-pituitary-adrenal axis, which has been related to an increase in blood pressure and cortisol levels as a result of stress [8]. Stress during pregnancy can affect serum cortisol levels in the blood, which can lead to a poor pregnancy outcome and damage embryonic neurodevelopment. Yoga therapy may aid in stress relief and the maintenance of a healthy pregnancy. They built a bond with their unborn child during their pregnancy.

A systematic review was conducted on the benefits of yoga during pregnancy; however, the conclusions were confined and narrow. The main goal of the gift story overview was to provide a comprehensive, up-to-date evaluation of yoga efficacy. RCTs were utilized to investigate the advantages of yoga for expectant mothers and their unborn children, and the findings were summarized using criteria that are not commonly used in health-related research themes. When compared to other pregnancy workouts. Is yoga therapy more beneficial than other types of regular exercise?

Search Strategy methods

An electronic search of publications published in various journals from 2012 to 2022 was done. The search was limited to databases in English from PubMed, Web of Science, EMBASE, and CINAHL. A search approach was used to discover studies. Subject headings and keywords were utilized in conjunction. In PubMed, the following subject heading phrases were used: "yoga" [Mesh], "pregnancy" [Mesh], "perinatal care" [Mesh], "prenatal care" [Mesh], "Pregnancy Outcome" [Mesh], "Treatment Outcome" [Mesh] The Boolean operator “and” are linked to search the articles. A manual search of the pertinent studies was investigated based on the references. The studies comprised randomized control trials in which the intervention was expressly declared to be yoga or yoga-based activities throughout pregnancy.

Inclusion/exclusion criteria

Articles full-text RCT published between 2012 to 2022 are identified. The excluded studies are non-randomized, qualitative, observational, descriptive studies and one group pre and post-intervention group, and all types of review studies.

Intervention type

Pregnant women and the intrusion includes yoga therapy studies. The control group is similar to typical prenatal, standard treatment, and counseling.

Outcome measurement

Primary research evaluating the effects of pregnant yoga against standard care on stress, anxiety, depression, immunoglobulin, platelet count, and non-specific delivery outcomes was very convincing.

Literature search

An electronic search of publications published in various journals from 2012 to 2022 was conducted, with the search limited to the English language. The original search yielded 1731 items, with 1707 preserved after duplicates were deleted, as shown in Fig. 1. Following title and abstract screening based on inclusion and exclusion criteria, a total of 1663 papers were excluded. There were 16 full-text publications reviewed. If an article was an uncontrolled trial, it was excluded.

Description of included studies

India contributed eight studies on yoga therapy, three from the United States, four from Iran, and one each from Brazil and Taiwan. Three studies on high-risk pregnant women have been done [10–12], and one study on pregnant women who suffered pelvic pain [14]. During pregnancy, two studies on hypertension [23, 24], were conducted. The rest of the studies focused on normal pregnant women.

The study comprised three types of yoga postures: integrated yoga [10, 13, 22–24], hatha yoga [14, 21], and remaining traditional yoga (yoga and pranayama). Therapies like integrated yoga and hatha yoga especially combined postures (asanas) with breathing (pranayama) technique, meditation (Dhyana), and yoga nidra relaxation. The yoga program began in the second trimester and continued till the baby was born. One trial featured a one-time week of instruction followed by a 12-week intervention. The frequency of practice ranged from once per week to every day. The list of yoga poses employed in the intervention was provided by eight studies. Twelve trials with routine nursing care were included in the control group [11, 12, 14–23]. Two studies [10, 13], compared yoga to traditional stretching exercises, one on massage⁹, and one on antenatal counseling [24].

Table 1

Summary of the efficacy of yoga on pregnancy studies
Author & Place	Objective	Sample size and intervention.	Results and conclusion
Field et al (2012, United States) [9].	Effectiveness of massage and yoga therapy on depression among pregnant women.	N = 84 (yoga therapy 12 weeks twice-weekly yoga and massage session 20 minutes for the control group)	The yoga group experienced a larger reduction in anxiety, anger, and back pain (p < 0.001). the intervention group had increased gestational age (p < 0.005) as well as birth weight (p < 0.001).
Rakshani et al, (2012, India) [10].	Efficacy of yoga on prevention of pregnancy-related complications in high-risk pregnant women.	n = 68 (30 yoga and 38 control group) The yoga group got integrated yoga three times per week from the 12-28th week of gestation. The control group got standard prenatal exercise.	The pregnant women in the yoga group had a lower rate of pregnancy-induced hypertension(p < 0.018), preeclampsia (p < 0.042), and FGR (p < 0.05). A good neonatal outcome like decreased small for gestational age (p < 0.006) and increased Apgar scores (p < 0.033).
Deshpande et al (2013, India) [11].	Effectiveness of yoga therapy maternal stress levels in high-risk pregnancies.	n = 68 (30 yoga and 38 control group) yoga group received yoga therapy for 16 weeks and the control group revived standard antenatal care.	The perceived stress level was reduced in the yoga group at 28 weeks of follow-up when compared to the control group (p = 0.02).
Jayashree et al (2013, India) [12].	Efficacy of yoga therapy on serum uric acid and platelet counts in high-risk pregnancy	n = 68 (30 yoga and 38 control group) yoga group received yoga therapy for 16 weeks and the control group revived standard antenatal care.	The yoga group had a reduction in healthy platelet count at the 12th and 20th week of gestation (p < 0.001). Significantly fewer numbers in the yoga group (n = 3) developed PIH/Preeclampsia when compared to the control group (n = 12).
Sathyapriya et al (2013, India)[13].	To study the effect of integrated yoga on pregnancy experience, anxiety, and depression in normal pregnancy.	n = 96 (51 yoga and 45 control group) yoga group received integrated yoga therapy for one hour daily for 16 weeks and the control group received standard prenatal exercise.	Pregnancy-related experience (PEQ), anxiety as well as depression was reduced in the yoga group (p < 0.001).
Martins et al (2014, Brazil)[14].	To assess Hatha yoga’s effectiveness in reducing lumbopelvic pain in pregnancy.	n = 60 (30 yoga and 30 control group) yoga group received Hatha yoga therapy one hour per week for 10 weeks and the control group received routine nursing care.	Pregnant women who performed yoga therapy had less pain score (p < .0058) than those in the postural orientation group. The intensity of pain gradually decreased throughout ten yoga sessions (p < 0.024).
Devis K. et.al (2015, United States) [15].	Efficacy of yoga on pregnant women suffering from depression.	N = 46 (30 yoga and 30 control group) 75 minutes of yoga sessions once a week total of eight weeks received by the intervention group and standard prenatal treatment received by the control group.	Yoga is a satisfactory intervention for depression and anxiety over time. Significantly yoga has a greater reduction in negative affect as compared to treatment as usual (β = -0.53, SE = 0.20, p = .011).
Chen PJ, (2017, Taiwan) [16].	To assess the effectiveness of prenatal yoga on stress and immune function among pregnant women.	n = 94 (48 intervention and 46 control group) intervention group received 70 minutes of yoga class once a week for 20 weeks and the control group received routine prenatal care.	The intervention group had lower stress and salivary cortisol levels (p < 0.001) and greater immunoglobulin levels (p < 0.001) than the control group. The birth weight of children born to the intervention group was greater than that of the control group (p < 0.001).
Jahdi F, et al (2017, Iran) [17].	To investigate the effects of an antenatal yoga program on perceived maternal labor pain and delivery outcomes.	n = 60 (30 intervention and 30 control group) intervention group received a yoga 60 minutes workout three times a week from the 26th to 37th week of gestation and the control group received routine midwifery care.	If pregnant women perform yoga during pregnancy may reduce pain intensity during labor in the yoga group (p = 0.01), and improve the adequacy and shorter duration of childbirth, when compared to the control group.
Bolanthakodi C, et al (2018, India) [18].	Assess prenatal yoga's effectiveness in alleviating labor pain and birth outcomes.	n = 150 (75 intervention and 75 control group) intervention group received 30 minutes yoga sessions from 30th weeks of gestation and routine care is given to the control group.	The tolerance of labor pain was better in the yoga group (p < 0.001). The number of low birth-weight babies was significantly less in the yoga group (p < 0.042), yoga is effective in improving birth outcomes.
Holden SC, et.al (2019, USA) [19].	To assess the effectiveness of prenatal yoga for back pain, balance, and maternal wellness	n = 20 (11 intervention and 9 control group) intervention group received weekly yoga sessions once time for a week total12 of weeks and educational support was received by the control group.	There were no variations in back pain disability across groups. Significant impacts were identified on biomechanical evaluations, including a percentage change in gait speed (p = 0.04), and it was determined that yoga enhances a pregnant woman's overall well-being.
Mohyadin E et.al (2020), Iran[20].	To determine the impact of yoga practice on labor stage length, anxiety, and pain throughout pregnancy.	n = 84 Nulliparous women underwent a yoga program consisting of 60-minute training sessions that began in week 26 of pregnancy and continued through 37 weeks of gestation. The control group received standard care.	The intervention group experienced less pain during dilatation (4–5 cm) than the control group (p = 0.001). The intervention group also had less anxiety than the control group (p = 0.003). In addition, the intervention group's overall duration of the two stages of labour was shorter than the control group's (p = 0.003).
Yekefallah L et al. (2021), Iran [21].	The primary goal is to determine how yoga affected delivery and neonatal outcomes in nulliparous pregnant women.	n = 70 (35 intervention and 35 control group) From 26 to 37 weeks, the intervention group attended a 75-minute Hatha yoga class twice a week, while the control group received regular prenatal care.	The intervention group had a substantial effect on nulliparous women's normal delivery (p = 0.044). Women in the intervention group had a birth at a later gestational age (p = 0.001). Neonatal Apgar scores (p < 0.0001) and birth weight (p = 0.001) were considerably higher in the intervention arm.
Pais M, et al 2021, India [22].	To assess the effect of integrated yoga on pregnancy outcomes.	n = 124 (61 intervention and 63 control group) From 18 weeks until birth, the intervention group received 45 minutes of yoga therapy every day, while the control group received standard routine care.	The intervention arm had a decreased incidence of preeclampsia (p0.009) and premature delivery (p < 0.001). Women in the intervention group had a birth at a later gestational age (p = 0.011). Apgar scores (p < 0.001) and birth weight (p = 0.001) increased in the intervention group, but the need for NICU admission decreased.
Makhija A, et al, 2021, India [23].	Effects of integrated yoga on blood pressure and pregnancy outcome among hypertensive pregnant women.	n = 60 (30 intervention and 30 control group) the intervention group received integrated yoga for 4 weeks and the control group received routine care.	Reduction in systolic blood pressure in the yoga group (p = 0.002) as well as diastolic blood pressure (p = 0.001), increased maternal comfort during labor in the hypertensive pregnant women.
Karthiga, K et. al 2022, India [24].	In pregnant hypertension, the effects of integrated yoga on cardiometabolic risks and fetal outcomes are linked to serum nitric oxide levels.	n = 256 (138 intervention group and 118 control group) the intervention group received integrated yoga for 20 weeks and counseling and the control group received antenatal counseling.	Integrated yoga effectively reduced hypertension and significantly decreased the risk of developing (RR, 2.65; CI 1.42–4.95) pregnancy-induced hypertension. Labour pain was less as well as the duration of labour time. The women who performed yoga had increased birth weight as well as Apgar score (p < 0.001), and significant association with increased nitric oxide and risk of gestational hypertension.

The Compensatory Carry-Over-Action Model

This model establishes the mechanisms of various behavioral modifications to one's health needed during pregnancy. It explains how changing one health behavior can lead to changes in numerous other behaviors in various facets of life and how these behaviors are connected. The CCAM [25], differs significantly from the other models in that it assumes that different behaviors (such as maintaining fitness and having a healthy baby) can lead to achieving higher-level goals. Therefore, it is essential for women who are expecting to intend, plan, and carry out the necessary behaviors, such as practicing integrated yoga while pregnant. The model is characterized by a healthy behavior that can lead to another or by a behavior that can start another one. For instance, practicing integrated yoga can start and maintain a healthy lifestyle during pregnancy (healthy posture, a balanced diet, and meditation). Pregnancy can be treated with the CCAM [a schematic overview is shown in Fig. 2]. A greater goal in this situation would be the desire to have a healthy baby. This objective is supported by a variety of healthy behaviors, including a balanced diet and regular exercise. Risky practices include drug use and the consumption of unhealthy diet beverages. Pregnant women suffer negative consequences as a result of the multifactorial impact, particularly stress, social isolation, financial hardship, and maternal disease conditions.

Yoga intervention effects

The studies assessed pregnancy-related stress [11, 16], back pain [9, 14], hypertension, and platelet count. Prenatal abnormalities, labour pain [17, 18, 20, 24], and neonatal outcomes. Prenatal illnesses such as fetal growth restriction (FGR), pregnancy-induced hypertension [23, 24], low immunoglobulin, and low platelet count are some of the more frequent problems that may impact pregnancies in both developing and developed nations [16, 26]. Weekly or daily yoga practice may have a substantial decrease in the frequency of preeclampsia and delivery before the term period [11, 12, 22], which aided in higher gestational age. Birth weight and Apgar score were both enhanced in the yoga group, while the need for NICU admission was reduced [13, 22].

Stress during pregnancy can cause complications such as fetal growth restriction [13, 22], preterm delivery [13, 22], PIH [10, 12], low immunoglobulin [16], lower birth weight [18], back discomfort [14, 19], impaired quality of life. For example, a lack of social support and pregnancy-related issues may lead to feelings of tension and an increased probability of engaging in unhealthy behaviors or having difficulty implementing healthier activities. During pregnancy, social support, a healthy lifestyle, a balanced diet, and meditation are all significantly linked to mental health, which can be crucial to a successful pregnancy. Furthermore, numerous studies have shown that pregnancy-related stress, anxiety, and depression are associated with low birth weight, fetal distress, poor Apgar, and a higher requirement for NICU hospitalization [5, 29].

There is evidence that poor socioeconomic status is related to low social support and encourages higher levels of compliance with health experts' advice, which can lead to improved adoption of healthy behavior [30]. Finally, social isolation/discrimination is the single most important factor influencing maternal and fetal outcomes [31]. Yoga practice during pregnancy enhances the infant's Apgar score and decreases fetal distress, minimizes the need for NICU admission, and prevents emergency caesarian delivery, induction of labor, duration, and preterm labour [14, 16–22].

As a result, they can be utilized as a part of the treatment protocol, including birthing preparation programs, to prevent pregnancy-related complications as well as delivery difficulties. Initiation of integrated yoga (Fig: 2) can help to adopt and maintain a healthy lifestyle during pregnancy by an actual positive behavior and the absence of negative behavior can adopt a greater desire to have a healthy baby.

Yoga therapy is a comprehensive holistic treatment that may be combined with regular maternity care. Since these remedies are inexpensive and immediate. All nurse-midwives and gynecologists should use this therapy for pregnant women in early preventative elements to ensure a brighter future for the country via unique care for pregnant women.

There are numerous noteworthy findings, according to the goal of this article. Yoga is a beneficial intervention for both pregnant women and their babies. Yoga intervention groups consistently had a decreased incidence of pregnancy-induced hypertension [11, 24], and preeclampsia labour [10, 11, 22], lower levels of discomfort (p = 0.001) lower levels of stress (p < 0.001) Labor anxiety and depression, scores on relationship quality and a decreased frequency of babies born at a young gestational age. Lumbopelvic discomfort, stress, anxiety, and depression as well as high-risk pregnancy can be reduced by using yoga therapy [9, 14, 17, 18].

Pregnancy-related difficulties can be avoided by encouraging pregnant women to adopt healthy habits and seek health care both before and during their pregnancy. Furthermore, initiatives to prevent unwanted pregnancies can aid in reducing unfavorable outcomes for mothers and newborns. Pregnant women who practiced yoga during their high-risk pregnancy [10.12]. had normal platelet (p < 0.001), full-term healthy infants (p < 0.033), and increased immunoglobulin and low-stress levels (p < 0.001) [12, 16]. Yoga is thought to be more effective than massage or other traditional antenatal exercises for pregnant women. And while these are healthy and popular physical activities for pregnant women, they did not affect stress levels [9, 10, 13].

Pregnancy can have an impact on the physical, and psychological well-being of pregnant women. Stress is multifactorial due to the modern competitive world. Stress and illness circumstances during pregnancy can cause a rise in cortisol levels, which can have a harmful influence on decreasing fetal growth and development [Fig:2].

In addition to that, our evaluation includes a study that demonstrated efficacy in reducing pregnancy-related stress, platelet count, and immunoglobulin. These findings are consistent with prior research that has shown the deleterious impact of increased maternal cortisol levels on fetal growth. Yet, as a result of industrialization, competitiveness, and a lack of information on a healthy diet. Some pregnant women (less than 20%) communicate their psychological distress [31]. Administrative officers are required to identify pregnant women with poor pregnancy-related health and to assess the impact of quality treatment, particularly psychological care, on preserving the healthy well-being of all pregnant women. Physicians and paramedics must interface with all aspects of the healthcare system.

Limitation

The review's biggest drawback was that just four databases were used for the review, and the researcher limited the search to publications exclusively published in English. At the same time, research on immunoglobulin, platelet count, and serum and saliva cortisol levels are contradictory. More study is needed to improve the consistency of these results. Another significant drawback is that the stress scale [11, 16], which they used to assess pregnant women's stress levels was not designed specially to detect pregnancy-related stress. To assess pregnancy-related stress, a standard perceived pregnancy stress scale or a bilingual standard perceived pregnancy stress scale is necessary.

Future directions

Considering the limitations of the systematic review, more research on psychological aspects, namely the suitable standard perceived stress scale for measuring stress, anxiety, and depression in pregnant women, is required. Furthermore, we recommend more research on the effects of yoga on urinary retention, subinvolution, postnatal weight gain, social isolation, stigma, psychological ill-health, and impaired lactation because many pregnant women are unwilling to discuss ill-health, particularly psychological ill-health, during pregnancy and postnatally. As a result, it is vital to evaluate if postnatal period yoga intervention is effective in treating and avoiding these disorders.

Aside from the impacts listed above, all have positive effects on pregnancy and neonatal health. Maternity healthcare practitioners should be aware of the long-term repercussions of antenatal stress, including autism and developmental abnormalities. However, the current generation of autistic children in India is a big source of concern. Autism affects 18 million people in the world, especially in India [31]. The soothing environment in the womb providing through yoga therapy will prevent long-term issues.

Conscious breathing may also be used as a self-soothing tool and as a possible replacement habit for other obsessive, aggressive, or self-stimulatory activities. Autism spectrum conditions cannot be prevented, however, there are therapeutic possibilities. Healthcare providers should acknowledge that each mother is unique and educate them on modern-day lifestyle adjustments associated with these health-related problems. Encourage them to seek professional assistance during this time. Future studies should incorporate pregnant women in analytical structuring and reflective practice in clinical settings, as opposed to all of the investigations that have been undertaken in simulated, classroom, and at-home settings.

In conclusion, the systematic review shows that a prenatal yoga program gives pregnancy benefits as well as well-planned labour and birth outcomes. Improvements in physical, psychological, and biological well-being were identified in the review study. Yoga therapy is a holistic way of treating pregnant women that will significantly improve the quality of their offspring. "A child is tomorrow's citizen," as the phrase goes, and every health professional is involved in providing antenatal care, particularly in the psychological dimension, and boosting the overall development of future children.

Acknowledgments

We greatly acknowledge all authors of the original research articles that were found useful to write this review. We also extend our thanks to the Manipal Academy of Higher Education’s Health science library for providing facilities to retrieve relevant studies from various online databases.

Authors’ contributions

MP and DS contributed to the conceptualization and searching of the articles and screened studies for inclusion. MP assessed the certainty of evidence and supervised. MP revised the manuscript. All authors approved the final version of this article.

Funding

Open access facility is provided by Manipal Academy of Higher Education. The authors received no specific funding for this work.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests

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Does Yoga impact during Pregnancy: Systematic Review

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Abstract

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Introduction

Methods

Inclusion/exclusion criteria

Results

Description of included studies

The Compensatory Carry-Over-Action Model

Yoga intervention effects

Discussion

Limitation

Future directions

Conclusion

Declarations

References

Additional Declarations

Supplementary Files

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