Immediate stress reduction effects of yoga during pregnancy: One group pre-post test.

BACKGROUND: Excessive stress during pregnancy may cause mental disorders in pregnant women and inhibit fetal growth. Yoga may alleviate stress during pregnancy. AIM: To verify the immediate effects of yoga on stress response during pregnancy. METHODS: One group pre-post test was conducted at a hospital in Japan. We recruited 60 healthy primiparas without complications and asked them to attend yoga classes twice a month and to practice yoga at their homes using DVD 3 times a week from 20 gestational weeks until childbirth. Salivary cortisol and alpha-amylase concentration were measured before and after yoga classes at time 1 (27-32 gestational weeks) and time 2 (34-37 gestational weeks). Subjective mood was assessed using the profile of mood states. Saliva values and mood scores before and after each yoga class were compared using paired t-test and Wilcoxon rank-sum test, respectively. FINDINGS: We analyzed 44 and 35 women at time 1 and time 2, respectively. The mean salivary cortisol concentration declined significantly after each yoga class [time 1: 0.36-0.26µg/dL (p<0.001), time 2: 0.32-0.26µg/dL (p=0.001)]. The mean salivary alpha-amylase concentration also decreased significantly following each class [time 1: 72.2-50.8kU/L (p=0.001), time 2: 70.6-52.7kU/L (p=0.006)]. The scores for negative dimensions of mood (Trait-Anxiety, Depression, Anger-Hostility, Fatigue, and Confusion) decreased significantly. The scores of Vigor for a positive dimension of mood significantly increased. CONCLUSION: This study indicated the immediate stress reduction effects of yoga during pregnancy.

Effects of antenatal yoga on maternal anxiety and depression: a randomized controlled trial.

BACKGROUND: Antenatal depression and anxiety are associated with adverse obstetric and mental health outcomes, yet practicable nonpharmacological therapies, particularly for the latter, are lacking. Yoga incorporates relaxation and breathing techniques with postures that can be customized for pregnant women. This study tested the efficacy of yoga as an intervention for reducing maternal anxiety during pregnancy. METHODS: Fifty-nine primiparous, low-risk pregnant women completed questionnaires assessing state (State Trait Anxiety Inventory; STAI-State), trait (STAI-Trait), and pregnancy-specific anxiety (Wijma Delivery Expectancy Questionnaire; WDEQ) and depression (Edinburgh Postnatal Depression Scale; EPDS) before randomization (baseline) to either an 8-week course of antenatal yoga or treatment-as-usual (TAU); both groups repeated the questionnaires at follow-up. The yoga group also completed pre- and postsession state anxiety and stress hormone assessments at both the first and last session of the 8-week course. RESULTS: A single session of yoga reduced both subjective and physiological measures of state anxiety (STAI-S and cortisol); and this class-induced reduction in anxiety remained at the final session of the intervention. Multiple linear regression analyses identified allocation to yoga as predictive of greater reduction in WDEQ scores (B = -9.59; BCa 95% CI = -18.25 to -0.43; P = .014; d = -0.57), while allocation to TAU was predictive of significantly increased elevation in EPDS scores (B = -3.06; BCa 95% CI = -5.9 to -0.17; P = .042; d = -0.5). No significant differences were observed in state or trait anxiety scores between baseline and follow-up. CONCLUSION: Antenatal yoga seems to be useful for reducing women's anxieties toward childbirth and preventing increases in depressive symptomatology.

Evaluation of pregabalin as an adjuvant to patient-controlled epidural analgesia during late termination of pregnancy.

INTRODUCTION: Late termination of pregnancy combines psychological distress with severe physical pain. The present study evaluated the benefit of adding oral pregabalin to epidural analgesia during this procedure. METHODS: Healthy women were randomly allocated to receive either oral pregabalin 150 mg/12 h or prazepam 10 mg/12 h at the induction of the late termination of pregnancy procedure. When they felt abdominal pain (numerical rating scale ranging from 0 [no pain] to 100 [worst pain possible]), patient-controlled epidural analgesia was activated and set to deliver ropivacaine 0.1% with sufentanil 0.25 µg/ml, 5 ml/h with a bolus dose of 5 ml/30 min. Rescue analgesia was available as needed by administration of 10 ml ropivacaine 0.1% (pain score less than 60/100) or 0.2% (at least 60/100). The primary outcome was the consumption of epidural analgesics. RESULTS: Forty-eight patients participated in the study. Demographic and obstetric data were similar. Pregabalin reduced total ropivacaine consumption 11.3 ± 3.2 mg/h (mean ± SD) versus 15.1 ± 4.9 mg/h in the prazepam group (P = 0.005), an effect related to a decrease in the need for rescue analgesia. In the pregabalin group, fewer women asked for rescue dose (75 vs. 96%; P = 0.048), and the number of rescue doses per patient was reduced (1 [0-2] vs. 2 [1-3]); median [interquartile range], P = 0.005), particularly the need for ropivacaine 0.2%. DISCUSSION: This is the first study considering the use of pregabalin for labor pain associated with late termination of pregnancy, showing that pregabalin 150 mg/12 h is a helpful adjuvant to epidural analgesia. Modulation of both visceral sensitization and affective component of pain may contribute to the benefits observed.

'This is just what you do when you are pregnant': a qualitative study of prospective parents in Iceland who accept nuchal translucency screening.

BACKGROUND: nuchal translucency (NT) screening, mainly for Down's syndrome, in the first trimester of pregnancy is becoming an established practice in many countries. However, very little is known about parents' knowledge and beliefs prior to undergoing screening. Such information is essential to form guidelines regarding informed decision-making. OBJECTIVES: to explore the influences on prospective parents' decision-making in relation to NT screening in early pregnancy, and to gain insight into how the views of prospective mothers and fathers towards the benefits and implications of screening may differ. DESIGN: a qualitative study using framework analysis based on a grounded theory approach. PARTICIPANTS: 10 couples, who had decided to have NT screening, were recruited from four community health centres in Iceland. All pregnancies were defined as 'low risk' for fetal anomaly. DATA COLLECTION: semi-structured interviews were conducted separately with each prospective mother and father at 7-11 weeks and again at 20-24 weeks of gestation. In total, 40 interviews were conducted. FINDINGS: the majority of prospective mothers in this study had already decided to accept NT screening before they entered the public antenatal care system. The decision to accept screening seemed to lie with the prospective mother and had hardly been discussed by the couple. Differences between prospective mothers and fathers were observed in relation to the expression of expectations towards the benefits of screening and the perception of disability, which is of interest in the context of information provided to prospective parents. CONCLUSIONS AND IMPLICATIONS: the findings from this study are of interest to clinicians and policy makers forming future guidelines for antenatal care both in Iceland and further afield. It highlights the need for information for prospective parents to be in the public domain prior to their contact with maternity services. Additionally, findings add to knowledge of prospective fathers in early pregnancy regarding how their perceptions of disability may contribute to the couple's decision to accept screening.