Mind-body interventions on stress management in pregnant women: A systematic review and meta-analysis of randomized controlled trials.

AIM: To quantify the effect of mind-body interventions on stress in pregnant women. DESIGN: A systematic review and meta-analysis of randomized controlled trials was performed. DATA SOURCES: PubMed, Embase, CENTRAL, Web of Science and PsycINFO were searched from each database inception to January 2020. REVIEW METHODS: Randomized controlled trials regarding mind-body interventions for stress in pregnant women were included. Methodological quality was evaluated using the Cochrane Collaboration 'Risk of Bias' tool and meta-analysis was performed via RevMan 5.3. Subgroup analysis and publication bias assessment were conducted. Post hoc sensitivity analysis was performed to investigate the source of heterogeneity. RESULTS: In total, 28 studies comprising 1944 participants were included. The overall meta-analysis showed that antenatal stress of pregnant women in the mind-body interventions groups showed significant high improvements (SMD=-0.94; 95% CI [-1.25, -0.63]; p < .00001) compared with the control groups. Results of subgroup analyses indicated that all types of mind-body interventions including mindfulness intervention, cognitive behavioural therapy, relaxation techniques and yoga were beneficial to antenatal stress. Both groups and individual formats mind-body interventions were effective. 4-8 weeks mind-body interventions were seemed as the optimal choice. Moreover, mind-body interventions were concomitant with reducing antenatal anxiety and depression. CONCLUSION: Mind-body interventions are promising approaches for stress reduction in pregnant women. Nevertheless, the results should be interpreted with caution because of high heterogeneity and publication bias. Further high-quality studies are needed to verify the findings. IMPACT: Mind-body interventions have been widely implemented to ameliorate antenatal stress, but conflicting results were found across studies. This systematic review and meta-analysis suggested that mind-body interventions are relatively safe and convenient and can successfully promote antenatal stress. The suggestions proposed in this review may be useful for developing a scientific mind-body interventions regimen and encouraging the application of mind-body interventions in pregnant women, thereby managing antenatal stress effectively.

The effectiveness of massage on peri-operative anxiety in adults: A meta-analysis of randomized controlled trials and controlled clinical trials.

BACKGROUND AND PURPOSE: and purpose: Massage has gained increasing attention for reducing peri-operative anxiety. We aimed to investigate the effectiveness of massage for peri-operative anxiety in adults. METHODS: Six English electronic databases were comprehensively searched from their inception to February 2020. Subgroup analysis, quality assessment, sensitivity analysis, meta-regression and publication bias assessment were performed. RESULTS: Twenty-five controlled trials comprising 2494 participants were included. The meta-analysis indicated that massage could significantly reduce peri-operative anxiety for most types of surgical patients. Specifically, it was effective for pre-, intra- and post-operative anxiety. Acupoint or specific body reflex area massage showed a larger effect than general massage did. Massage delivered by professionals and non-professionals were both effective. Massage lasting 10-20 min per session was the most worthy of recommendation. Massage was concomitant with the improvement of peri-operative vital signs and post-operative pain. CONCLUSION: Massage is a promising complementary therapy for ameliorating peri-operative anxiety in adults.

Complementary and alternative medicine for natural and treatment-induced vasomotor symptoms: An overview of systematic reviews and meta-analyses.

BACKGROUND AND PURPOSE: Vasomotor symptoms (VMS) are very common in menopausal populations and cancer patients and can cause physical and mental discomfort. We aim to summarize the findings of systematic reviews and meta-analyses (SRs/MAs) that assessed the effectiveness of complementary and alternative medicines(CAMs)on VMS to provide solid evidence for future practice. METHODS: PubMed, Embase, the Cochrane Library, and Web of Science were searched from inception to May 2019 to identify relevant SRs/MAs. The methodological quality of SRs/MAs and evidence levels of the outcomes were assessed. RESULTS: A total of 29 SRs/MAs were reviewed. Evidence has shown that acupuncture, hypnosis, paced respiration, cognitive behavioural therapy, genistein, soy isoflavones, S-equol, combined preparations of black cohosh, and omega-3 supplements could significantly reduce VMS. The methodological quality of the SRs/MAs was moderate or high. CONCLUSION: CAMs might be beneficial for reducing VMS, but the evidence levels were not high. Several priorities for future practice were identified.

Effects of exercise on pregnant women's quality of life: A systematic review.

OBJECTIVES: Exercise is a promising approach to improve the health of pregnant women. However, data from studies investigating exercise and the quality of life of pregnant women are inconsistent and, to date, no systematic review on this topic has been published. The aim of this review was to comprehensively assess the effects of exercise on pregnant women's quality of life, and to determine whether exercise positively affects quality of life in this population. STUDY DESIGN: Literature was retrieved from electronic databases, namely PubMed, EMBASE, Web of Science and the Cochrane Library, from inception to 30 October 2018. Clinical trials published in English evaluating the effects of exercise on pregnant women's quality of life were included. The authors assessed the risk of bias in all eligible studies using the Effective Public Health Practice Project, and used a qualitative synthesis method to identify the effects of exercise on pregnant women's quality of life. RESULTS: Thirteen studies were included. Exercise was divided into the following four modes: aerobic exercise, resistance exercise, a combination (aerobic and resistance exercises), and yoga or physical activity. Aerobic and resistance training had a mixed effect on pregnant women's quality of life, while the combination of aerobic and resistance exercises and yoga or physical activity resulted in significant improvements. CONCLUSIONS: This systematic review is the first to suggest that group-based combined exercise and yoga or physical activity are associated with significant benefits related to improvements in pregnant women's quality of life. Furthermore, aerobic or resistance exercise could potentially improve pregnant women's quality of life. Therefore, it is recommended that medical service providers should pay more attention to the importance of exercise, and develop tailored exercise programmes to promote improvements in pregnant women's quality of life.

Effects of nonpharmacological interventions on depressive symptoms and depression among nursing students: A systematic review and meta-analysis.

OBJECTIVES: We aim to examine whether nonpharmacological interventions could effectively improve depressive symptoms and depression to provide more treatment options for nursing students. METHODS: PubMed, the Cochrane Library, EMBase, Web of Science, PsycINFO, and three Chinese electronic databases were comprehensively searched for papers that were published from January 1990 through March 2018. Quality assessment, sensitivity analysis and heterogeneity were performed. RESULTS: In our review, 13 controlled trials met the inclusion criteria. The meta-analysis indicated that the depressive symptoms and depression of nursing students in the intervention groups showed significantly moderate improvements compared with the control groups. Three subgroup analyses showed that mindfulness interventions and stress management programs were common and effective, short-term interventions were beneficial to depression, nonpharmacological interventions had great improvements for Asian nursing students and more rigorous researches on methodological quality are recommended. CONCLUSION: Nonpharmacological interventions can serve as promising complementary and alternative approaches in reducing the depressive symptoms and depression of nursing students.

Panax quinquefolium saponin attenuates cardiac remodeling induced by simulated microgravity.

BACKGROUND: Cardiac atrophy and reduced cardiac distensibility have been reported following space flight. Cardiac function is correspondingly regulated in response to changes in loading conditions. Panax quinquefolium saponin (PQS) improves ventricular remodeling after acute myocardial infarction by alleviating endoplasmic reticulum stress and Ca2+overload. However, whether PQS can ameliorate cardiac atrophy following exposure to simulated microgravity remains unknown. PURPOSE: To explore the protective role of PQS in cardiac remodeling under unloading conditions and its underlying mechanisms. METHODS: Hindlimb unloading (HU) model was used to simulate unloading induced cardiac remodeling. Forty-eight male rats were randomly assigned to four groups, including control, PQS, HU and HU + PQS. At 8 weeks after the experiment, cardiac structure and function, serum levels of Creatine Kinase-MB (CK-MB), Cardiactroponin T (cTnT), ischemia modified albumin (IMA), and cardiomyocyte apoptosis were measured. Network pharmacology analysis was used to predict the targets of the six major constituents of PQS, and the signaling pathways they involved in were analyzed by bioinformatics methods. Changes in the key proteins involved in the protective effects of PQS were further confirmed by Western Blot. RESULTS: Simulated microgravity led to increases in serum levels of CK-MB, cTnT and IMA, remodeling of cardiac structure, impairment of cardiac function, and increased cardiomyocyte apoptosis as compared with control. PQS treatment significantly reduced serum levels of CK-MB, cTnT and IMA, improved the impaired cardiac structure and function, and decreased cardiomyocyte apoptosis induced by unloading. The activation of AMPK and inhibition of Erk1/2 and CaMKII/HDAC4 were demonstrated in the cardiocytes of HU rats after PQS treatment. CONCLUSION: PQS provides protection against cardiac remodeling induced by simulated microgravity, partly resulting from changes in the signaling pathways related to energy metabolism reduction, calcium overloading and cell apoptosis.

Association between vitamin D deficiency and antepartum and postpartum depression: a systematic review and meta-analysis of longitudinal studies.

PURPOSE: The two previous reviews performed on the association of vitamin D deficiency in pregnancy with antepartum and postpartum depression were limited in reporting forms as they were both systematic reviews and the conclusions were also deemed to be inconclusive. Considering the high prevalence of vitamin D deficiency and depression during and after pregnancy as well as their numerous hazards to pregnancy outcomes, it is of great need to synthesize existing evidence in a more accurate statistical method, so that reliable guidance related to vitamin D supplementation during pregnancy could be provided for clinical decision making. METHODS: We performed a systematic review and meta-analysis to investigate the association of vitamin D deficiency with antepartum and postpartum depression. RESULTS: Nine longitudinal studies with 8470 participants were included in the meta-analysis. We found serum 25(OH)D levels < 50 nmol/l was associated with 2.67 times (OR 3.67; 95% CI 1.72-7.85) increased risk of postpartum depression than those 25(OH)D levels ≥ 50 nmol/l, but we did not find a significant association between low vitamin D levels and depressive symptoms during pregnancy with a serum 25(OH)D cut-off level of 30 nmol/l (OR 1.47; 95% CI 0.92-2.36). CONCLUSIONS: The low status of maternal vitamin D could be an adverse factor for postpartum depression, but the available evidence suggested no association between vitamin D deficiency and depressive symptoms during pregnancy. However, this result should be interpreted with caution owning to the small number of studies. Well-designed intervention studies are also needed to further evaluate the benefits of vitamin D supplementation during pregnancy.