"Warrior who transcends adversity": A qualitative examination of resilience among mothers caring for adolescents with congenital heart disease.

PURPOSE: Parenting resilience is essential for the well-being and development of children with chronic illnesses. Given the importance of parenting resilience in this context, this study explored the nature of parenting resilience among mothers caring for adolescents with congenital heart disease (CHD). DESIGN AND METHODS: We adopted Husserl's phenomenological approach and conducted semistructured in-depth interviews. In addition, we conducted purposive sampling at the pediatric cardiology outpatient departments of 2 medical centers in Taiwan to recruit 11 mothers of adolescents with CHD; all of these adolescents had received open-heart surgery. Furthermore, we analyzed data by using Colaizzi's approach, and we adhered to the COnsolidated criteria for REporting Qualitative research checklist. RESULTS: Mothers caring for adolescents with CHD was a dynamic process involving problem solving. The 11 mothers in this study employed resilience to remain strong, provided a sense of normalcy for their children, and approached challenges calmly and bravely. We uncovered three major themes among these mothers: "providing support for the child, "facing challenges with equanimity," and "overcoming adversity through positivity and gratitude." CONCLUSIONS: The present results provide a deeper understanding of how mothers caring for adolescents with CHD can cultivate resilience. PRACTICE IMPLICATIONS: The study's findings can inform transitional programs for adolescents with CHD and their families, with nursing professionals supporting mothers' resilience.

The lived experience of mothers caring for school-age children with Pompe disease: A qualitative study.

PURPOSE: To explore the lived experiences of mothers caring for school-age children with Pompe disease. DESIGN AND METHODS: A qualitative study using a descriptive phenomenology approach. Semi-structured interviews were conducted from October to December 2022 with 10 mothers of school-age children diagnosed with Pompe disease, which were identified through the Taiwan Pompe Disease Association. Colaizzi's phenomenological method was employed for data analysis. RESULTS: The study identified five themes in the caregiving experiences of mothers: 1. unwavering parenting beliefs; 2. child-centric approach; 3. focus on peer relationships and coping strategies; 4. integration of learning, treatment, and rehabilitation; and 5. embracing and navigating life's challenges. Mothers balanced education, treatment, and rehabilitation for their children with Pompe disease, offering perspectives into the caregiving experience. CONCLUSIONS: This study highlights the complex experiences of mothers caring for children with Pompe disease, emphasizing the importance of comprehensive support. PRACTICE IMPLICATIONS: Insights into the perspectives of mothers can aid health-care professionals in understanding the challenges faced by families with children diagnosed with Pompe disease and can enable the development of strategies for providing comprehensive psychological support to improve mental health outcomes for these children and their families. Increased awareness among health-care professionals and in the society leads to an informed and empathetic approach to addressing the unique challenges faced by children with Pompe disease and their families.

Children's perceptions of interactive virtual-reality interventions implemented before and after intravenous cannulation.

BACKGROUND: Although some studies have reported evidence of the effectiveness of virtual-reality interventions implemented for children undergoing intravenous (IV) cannulation, children's perceptions of virtual-reality interventions implemented during IV cannulation warrant further exploration. AIMS: To explore the school-aged children's perceptions of interactive virtual-reality interventions implemented before and after IV cannulation. METHODS: A qualitative descriptive study was adopted. Sixty-nine children aged 6-12 years from two medical centers were recruited and interviewed from June to September 2020. After the completion of the immersive virtual-reality scene of IV cannulation before undergoing actual IV cannulation and the emotionally cathartic virtual-reality play after the placement process, individual interviews were conducted with the children in the paediatric wards. Inductive content analysis was performed to analyse children's perceptions. The study complied with the Consolidated Criteria for Reporting Qualitative Research. RESULTS: Three categories related to children's perception of interactive virtual-reality interventions implemented before and after IV cannulation were identified: (1) feelings towards and coping strategies employed during IV cannulation; (2) mental preparation through immersion in the virtual-reality scene; and (3) healing effects of immersive cathartic play. CONCLUSIONS: The findings indicate that interactive virtual-reality interventions can help hospitalised children mentally prepare for medical procedures, obtain knowledge regarding such procedures, and overcome their fear of needles. The children's reported perceptions of the virtual-reality interventions indicated that the interventions were age-appropriate, safe and fun. The results of this study highlight the need to more thoroughly understand the perceptions of hospitalised children and may serve as a reference for designing child-friendly care interventions for nursing practice.

Gender differences in cognitive function and its associated factors among older adults with type 2 diabetes.

Diabetes is widely prevalent among older people and can influence accelerated cognitive decline. Gender-based disparities may contribute to variations in cognitive decline. This study examined gender differences in cognitive function and associated factors among older adults with diabetes. A cross-sectional study was conducted involving 318 Taiwanese older adults with type 2 diabetes. Demographic, health, and diabetes-related data were collected, and cognitive neuropsychological tests were evaluated. Compared to men, women with diabetes showed significantly poorer performance in global cognitive function and executive function. Age, years of education, sleep quality, and HbA1c were correlated with domains of cognitive function in men, whereas age, years of education, depressive symptoms, HbA1c, and duration of diabetes were associated with domains of cognitive function among women. Nurses should recognize gender differences in factors associated with cognitive function in older adults with diabetes and should develop individualized interventions to improve patients' cognitive function.

Association between cognitive function and self-reported antihypertensive medication adherence among middle-aged and older hypertensive women.

DESIGN: This study applied a cross-sectional, descriptive correlational design. AIMS AND OBJECTIVES: The purpose of the study was to examine the relationship between cognitive function and self-reported antihypertensive medication adherence in middle-aged and older hypertensive women. BACKGROUND: Although medication adherence is an essential key for preventing complications from hypertension, poor medication adherence is common among middle-aged and older hypertensive women. Taking medications involves a cognitive process. Little is known about the contribution of cognitive function to adherence to antihypertensive medication in middle-aged and older women. METHODS: This study used a convenience sample of 137 women aged ≥50 years recruited from a medical centre in southern Taiwan. Participants completed a survey of demographic and clinical information and self-reported medication adherence, and received cognitive function tests. Hierarchical regression analyses were used to evaluate the association between cognitive function and medication adherence. This study followed the STROBE guidelines. RESULTS: More than one-fourth of the women (27%) reported poor adherence. Women with poor adherence appeared to have a significantly lower memory than women with good adherence. Memory was positively associated with antihypertensive medication adherence after controlling for age, blood pressure and duration of hypertension. Working memory, executive function and psychomotor speed were not significantly related to antihypertensive medication adherence. CONCLUSIONS: Reduced memory function was associated with poorer antihypertensive medication adherence among middle-aged and older women. Middle-aged and older women with hypertension and poor memory performance are at risk of poor medication adherence. Future prospective studies examining the causal relationship between cognitive function and antihypertensive medication adherence are warranted. RELEVANCE TO CLINICAL PRACTICE: Nurses could evaluate the memory of middle-aged and older hypertensive women when assessing antihypertensive medication adherence in clinical practice and provide relevant interventions.

A mini-flipped, game-based Mediterranean diet learning program on dietary behavior and cognitive function among community-dwelling older adults in Taiwan: A cluster-randomized controlled trial.

The Mediterranean diet has been recommended to delay cognitive decline, but adherence to the diet among older adults remain poor, and research on interventions that effectively promote the diet has been inconclusive. This study examined the effects of a mini-flipped, game-based Mediterranean diet learning program in improving dietary behavior and cognitive function in community-dwelling older adults in Taiwan. A cluster randomized controlled trial was conducted. The experimental group completed an 8-week, mini-flipped, game-based learning program. Data were collected at baseline and 8 weeks after intervention. Outcome measures included dietary behavior, global cognitive function, and subjective cognitive dysfunction. Compared with the control group, the experimental group exhibited significantly improved Mediterranean diet behavior and global cognitive function after the intervention, although there was no significant difference in subjective cognitive function. Future research should be conducted with larger populations and longer-term follow-up to evaluate the effect of this learning program.

Cognitive function and associated factors among postmenopausal women with hypertension and natural menopause in Taiwan.

Hypertension is prevalent among postmenopausal women worldwide and is a risk factor for cognitive impairment. This study examined the cognitive differences between Taiwanese postmenopausal women with and without hypertension after natural menopause and identified factors associated with cognitive function in hypertensive postmenopausal women. A two-group comparative design study of 171 Taiwanese postmenopausal participants (mean age = 64.8±6.6) was conducted in southern Taiwan. Cognitive performance on neuropsychological tests was evaluated, and demographic, health, menopausal, and disease related variables were assessed. Compared to the non-hypertensive group, women with hypertension showed significantly worse performance and a higher percentage of impairment in global cognitive functioning and memory. Fewer years of education and longer duration of hypertension were associated with lower global cognitive function, and increased age was associated with lower scores in delayed memory. Cognitive screening as well as training on global cognitive functioning and memory are needed for postmenopausal hypertensive women. (148 words).

Comparison of group vs self-directed music interventions to reduce chemotherapy-related distress and cognitive appraisal: an exploratory study.

PURPOSE: The purpose of this study was to determine effects of group music intervention and self-directed music intervention on anxiety, depression, and cognitive appraisal among women with breast cancer. METHODS: A quasi-experimental design randomly assigned 60 women undergoing chemotherapy to 3 groups: group music intervention, self-directed music intervention, or a control group. The Hospital Anxiety and Depression Scale and the Mini-Mental Adjustment to Cancer Scale were administered before, after the 8-week interventions, and at 3-month follow-up. RESULTS: Of the 52 women completing the study, results indicated that group music intervention had a significant (p < .01) immediate effect to decrease helplessness/hopelessness and anxious preoccupation and significant effects for reducing anxiety, depression, helplessness/hopelessness, and cognitive avoidance compared to the other two groups at 3-month follow-up. CONCLUSIONS: Group music intervention can be considered an effective supportive care in alleviating the chemotherapy-related distress and enhancing cognition modification of women with breast cancer. Further research is needed to determine the role of cognitive appraisal in the illness trajectory.

Factors predicting emotional cue-responding behaviors of nurses in Taiwan: An observational study.

OBJECTIVE: Responding to emotional cues is an essential element of therapeutic communication. The purpose of this study is to examine nurses' competence of responding to emotional cues (CRE) and related factors while interacting with standardized patients with cancer. METHODS: This is an exploratory and predictive correlational study. A convenience sample of registered nurses who have passed the probationary period in southern Taiwan was recruited to participate in 15-minute videotaped interviews with standardized patients. The Medical Interview Aural Rating Scale was used to describe standardized patients' emotional cues and to measure nurses' CRE. The State-Trait Anxiety Inventory was used to evaluate nurses' anxiety level before the conversation. We used descriptive statistics to describe the data and stepwise regression to examine the predictors of nurses' CRE. RESULTS: A total of 110 nurses participated in the study. Regardless of the emotional cue level, participants predominately responded to cues with inappropriate distancing strategies. Prior formal communication training, practice unit, length of nursing practice, and educational level together explain 36.3% variances of the nurses' CRE. CONCLUSIONS: This study is the first to explore factors related to Taiwanese nurses' CRE. Compared to nurses in other countries, Taiwanese nurses tended to respond to patients' emotional cues with more inappropriate strategies. We also identified significant predictors of CRE that show the importance of communication training. Future research and education programs are needed to enhance nurses' CRE and to advocate for emotion-focused communication.

Validation of the Chinese version of the CogState computerised cognitive assessment battery in Taiwanese patients with heart failure.

AIMS AND OBJECTIVES: To evaluate the validity of the Chinese version of the CogState battery, a computerised cognitive testing among patients with heart failure in Taiwan. BACKGROUND: Cognitive deficits are common in patients with heart failure and a validated Chinese measurement is required for assessing cognitive change for this population. The CogState computerised battery is a measurement of cognitive function and has been validated in many languages, but not Chinese. DESIGN: A cross-sectional study. METHODS: A convenience sample consisted of 76 women with heart failure and 64 healthy women in northern Taiwan. Women completed the Chinese version of the CogState battery and the Montreal Cognitive Assessment. Construct validity of the Chinese version of the battery was evaluated by exploratory factor analysis and known-group comparisons. Convergent validity of the CogState tasks was examined by Pearson correlation coefficients. RESULTS: Principal components factor analysis with promax rotation showed two factors reflecting the speed and memory dimensions of the tests. Scores for CogState battery tasks showed significant differences between the heart failure and healthy control group. Examination of convergent validity of the CogState found a significant association with the Montreal Cognitive Assessment. CONCLUSION: The Chinese CogState Battery has satisfactory construct and convergent validity to measure cognitive deficits in patients with heart failure in Taiwan. RELEVANCE TO CLINICAL PRACTICE: The Chinese CogState battery is a valid instrument for detecting cognitive deficits that may be subtle in the early stages, and identifying changes that provide insights into patients' abilities to implement treatment accurately and consistently. Better interventions tailored to the needs of the cognitive impaired population can be developed.

Predictors of memory performance among Taiwanese postmenopausal women with heart failure.

BACKGROUND: There are no studies describing the nature of memory deficits among women with heart failure (HF). OBJECTIVES: The aims of this study were to examine memory performance among Taiwanese women with HF compared with age- and education-matched healthy women, and to evaluate factors that explain memory performance in women with HF. METHODS AND RESULTS: Seventy-six women with HF and 64 healthy women were recruited in Taiwan. Women completed working, verbal, and visual memory tests; HF severity was collected from the medical records. Women with HF performed significantly worse than healthy women on tests of working memory and verbal memory. Among women with HF, older age explained poorer working memory, and older age, higher HF severity, more comorbidities, and systolic HF explained poorer verbal memory. Menopausal symptoms were not associated with memory performance. CONCLUSIONS: Results of the study validate findings of memory loss in HF patients from the United States and Europe in a culturally different sample of women. Working memory and verbal memory were worse in Taiwanese women with HF compared with healthy participants. Studies are needed to determine mechanisms of memory deficits in these women and develop interventions to improve memory.

Exploring barriers to physical activity participation among female nursing students adhering to specific social-cultural norms in Indonesia: A qualitative study.

Background: The prevalence of insufficient physical activity is common among nursing students and impacts their academic performance. Research on obstacles to physical activity (PA) among religious women, notably Muslims, is limited. Objectives: This study aimed to explore barriers to PA among Indonesian Muslim female nursing students and gather suggestions for overcoming those barriers. Methods: This study used a qualitative descriptive design. Two focus groups were conducted with 12 Muslim female nursing students in Makassar, Indonesia. Interviews were audio-recorded and transcribed verbatim. The data were collected from May and July 2019. Inductive thematic analysis was used to identify core themes and sub-themes. Results: Thematic analysis identified barriers to PA across four main themes: intrapersonal, interpersonal, institutional, and social-cultural related to religious context. Each theme included two to three sub-themes, totaling nine categories of PA participation barriers. Intrapersonal barriers consisted of low motivation, emotional states, and a sedentary lifestyle. Interpersonal challenges included a lack of family or friend support and family obligations. Institutional barriers involved academic workload prioritization, school environment inaccessibility, and absence of athletic curriculum policy. Socio-cultural barriers posed by religious expectations included gender-related concerns and modest dressing. Drawing from their perspectives as Muslim female nursing students, study participants proposed six strategies to address these barriers. Proposed solutions include promoting PA through Apps, forming female team-up clubs, providing designated exercise spaces, and implementing mandatory athletic courses for nursing students at the institutional level. Additionally, offering female instructors and private exercise rooms could reduce the barriers from a socio-cultural perspective caused by religious expectations. Conclusions: The study found that Muslim female nursing students with dual roles face increased barriers to PA participation, driven by intrapersonal and interpersonal levels, nursing learning load, and religious norms. Schools could build environments to meet the religious expectations within Indonesian society to promote PA for Muslim female nursing students. For example, the practical strategies include offering private rooms or female instructors when they physically exercise in school.

Effects of Aerobic Walking on Memory, Subjective Cognitive Complaints, and Brain-Derived Neurotrophic Factor Among Older Hypertensive Women.

Background:Hypertension is prevalent in older women and is associated with increased cognitive impairment. Exercise has demonstrated beneficial effects on cognitive function, but the impact of exercise on older hypertensive women remains unclear. We investigated the effects of an aerobic walking program on memory, subjective cognitive complaints, and brain-derived neurotrophic factor in older hypertensive women. Methods: A quasi-experimental study with a pretest-posttest design was conducted. Older hypertensive women were randomly assigned to the aerobic walking group or a control group with routine care. The intervention group received a 24-week aerobic walking program. Data were collected at baseline and 24 weeks after enrollment. Participants' characteristics, memory, subjective cognitive complaints, and plasma brain-derived neurotrophic factor were analyzed. Results: The aerobic walking group (n = 30) reported improvements in total recall, delayed recall, and subjective cognitive impairment after 24 weeks of aerobic walking. Compared to the control group (n = 28), the aerobic walking group showed significantly greater improvement in delayed recall at 24 weeks. However, aerobic walking had no significant effect on subjective cognitive complaints or brain-derived neurotrophic factor. Conclusion: The aerobic walking training significantly improved memory performance among older women with hypertension. A longer randomized controlled trial with a larger sample is necessary to confirm and further explore the effects of this intervention.

Nurse-Enhanced Memory Intervention in Heart Failure: the MEMOIR study.

BACKGROUND: Many patients with heart failure (HF) have cognitive deficits, including memory loss. OBJECTIVES: The aim of this study was to evaluate the efficacy of a cognitive training intervention on memory (primary outcome), working memory, psychomotor speed, executive function, and performance of cognitive activities and instrumental activities of daily living (IADLs). METHODS AND RESULTS: Forty patients with HF were randomly assigned to the computerized plasticity-based cognitive training intervention called Brain Fitness or to the health education active control intervention. Advanced practice nurses made weekly home visits to assess symptoms and monitor intervention adherence. Patients completed demographic and clinical data (baseline), neuropsychologic tests (baseline and 8 and 12 weeks), and measures of cognitive and IADLs performance (baseline and 12 weeks) and satisfaction (12 weeks). Linear mixed models analyses indicated a significant group by time interaction for delayed recall memory (P = .032) and a significant time effect for total (list learning) (P < .001) and delayed (P = .015) recall memory, psychomotor speed (P = .029), and performance of IADLs (P = .006). Intervention adherence and patient satisfaction were high. CONCLUSIONS: To our knowledge, this was the first test of Brain Fitness in HF. Although it was a preliminary study with limitations, results support the need for a larger randomized controlled trial to determine whether the memory loss of HF is amenable to plasticity-based interventions.

Using a Socio-Environmental Approach to Explore the Determinants for Meeting the Recommended Physical Activity among Adults at Risk of Diabetes in Rural Indonesia.

Moderate-to-vigorous physical activity (PA) is recommended to mitigate the risk of diabetes. This study explored the PA of adults at risk for diabetes in rural Indonesia and determined the requirements for meeting the recommended PA level. In total, 842 adults were screened using a diabetes risk test in a rural health centre; among them, 342 were at risk of diabetes. The level of PA was assessed using the International Physical Activity Questionnaire, whereas the associated factors underlying the three domains -individual, support, and environment-were determined by the Influences on Physical Activity Instrument. The data analysis included a three-step multiple linear regression (MLR) and logistic regression (LR). Overall, 40.6% of the participants met the recommended PA. According to the MLR analysis, among males, individuals who gave PA a higher priority and had enough time to perform PA were predicted to have a higher activity energy expenditure (MET-minutes per week). According to the LR analysis, men were more likely to meet the recommended PA, and people who gave PA a lower priority and had less access to space for PA were less likely to meet the recommended PA level. Strategies for promoting PA in rural Indonesia include focusing on women, people who prioritize PA less, and those who have less time and space in which to be physically active.

Effects of a Case Management Program for Women With Pregnancy-Induced Hypertension.

BACKGROUND: Pregnancy-induced hypertension (PIH) is a leading cause of maternal and fetal morbidity and mortality. Although case management programs have been proposed to improve maternal and fetal outcomes in high-risk pregnancies, limited data are available regarding the effect of case management on women with PIH. PURPOSE: The aim of this study was to evaluate the effect of an antepartum case management program on stress, anxiety, and pregnancy outcomes in women with PIH. METHODS: A quasi-experimental research design was employed. A convenience sample of women diagnosed with PIH, including preeclampsia, was recruited from outpatient clinics at a medical center in southern Taiwan. Sixty-two women were assigned randomly to either the experimental group (n = 31) or the control group (n = 31). The experimental group received case management for 8 weeks, and the control group received routine clinical care. Descriptive statistics, independent t or Mann-Whitney U tests, chi-square or Fisher's exact tests, paired t test, and generalized estimating equations were used to analyze the data. RESULTS: The average age of the participants was 35.1 years (SD = 4.5). No significant demographic or clinical differences were found between the control and experimental groups. The results of the generalized estimating equations showed significantly larger decreases in stress and anxiety in the experimental group than in the control group. No significant differences were identified between the two groups with respect to infant birth weeks, infant birth weight, average number of medical visits, or frequency of hospitalization. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The nurse-led case management program was shown to have short-term positive effects on the psychosocial outcomes of a population of Taiwanese patients with PIH. These results have important clinical implications for the healthcare administered to pregnant women, particularly in terms of improving the outcomes in those with PIH.

To Develop Indonesian Version of The Influence on Physical Activity Instrument for Community-Based Obese Adults: Cross-Cultural Validation and Psychometric Testing.

PURPOSE: Insufficient physical activity is a public health concern in Indonesia, but there are no valid Indonesian tools for exploring the influences. Due to cultural and contextual differences, the Indonesian version of the Influence on Physical Activity Instrument (IPAI-I) was developed and tested the psychometric properties in community obese-adults. METHODS: The cross-sectional study enrolled 846 obese-adults in Indonesian community health-centre. The IPAI was translated with culturally appropriate Indonesian. Using Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) assessed the psychometric properties. The scale reliability was tested by Cronbach's α for internal consistency and intra-class correlation coefficient (ICC) for stability. RESULTS: Through EFA via Principal Axis Factoring with Oblimin rotation, the 21-item IPAI-I exhibited cross-cultural appropriateness, readability with three factors in the individual domain, one factor in the support domain, and two factors in the environment domain. The indices of good fit model for three domains testing by a second-order CFA was achieved at χ2/df=1.5, goodness of fit index = .93, root mean square error of approximation = .039 (p < .001). Furthermore, a high correlation (r = .52; p < .001) was between the support domain and the environment domain, but the two domains had a very low correlation with the individual domain, respectively. The test-retest reliability was by ICC with .73 - .92 and Cronbach's α with .82 - .91 among six-factor, respectively. CONCLUSIONS: The IPAI-I is a valid, reliable instrument to assess in Indonesian context. Enhancing ecological effects are high-priority to increase physical activity for community obese-individual.

Effects of Aromatherapy Massage on Pregnant Women's Stress and Immune Function: A Longitudinal, Prospective, Randomized Controlled Trial.

OBJECTIVES: This study's aims are to examine the effects of aromatherapy massage on women's stress and immune function during pregnancy. METHODS: This longitudinal, prospective, randomized controlled trial recruited 52 healthy pregnant women from a prenatal clinic in Taipei using convenience sampling. The participants were randomly assigned to the intervention (n = 24) or control (n = 28) group using Clinstat block randomization. The intervention group received 70 min of aromatherapy massage with 2% lavender essential oil every other week (10 times in total) for 20 weeks; the control group received only routine prenatal care. In both groups, participants' salivary cortisol and immunoglobulin A (IgA) levels were collected before and after the intervention group received aromatherapy massage (every month from 16 to 36 weeks gestation) and were analyzed using enzyme-linked immunosorbent assay. RESULTS: The pregnant women in the intervention group had lower salivary cortisol (p < 0.001) and higher IgA (p < 0.001) levels immediately after aromatherapy massage than those in the control group, which did not receive massage treatment. Comparing the long-term effects of aromatherapy massage on salivary IgA levels between groups at different times, the study found that the pretest salivary IgA levels at 32 (p = 0.002) and 36 (p < 0.001) weeks gestational age (GA) were significantly higher than the pretest IgA at 16 weeks GA (baseline). CONCLUSIONS: This study presented evidence that aromatherapy massage could significantly decrease stress and enhance immune function in pregnant women. The findings can guide clinicians or midwives in providing aromatherapy massage to women throughout the pregnancy.

Effects of prenatal yoga on women's stress and immune function across pregnancy: A randomized controlled trial.

OBJECTIVE: The effects of prenatal yoga on biological indicators have not been widely studied. Thus, we compared changes in stress and immunity salivary biomarkers from 16 to 36 weeks' gestation between women receiving prenatal yoga and those receiving routine prenatal care. DESIGN: For this longitudinal, prospective, randomized controlled trial, we recruited 94 healthy pregnant women at 16 weeks' gestation through convenience sampling from a prenatal clinic in Taipei. Participants were randomly assigned to intervention (n=48) or control (n=46) groups using Clinstat block randomization. INTERVENTION: The 20-week intervention comprised two weekly 70-min yoga sessions led by a midwife certified as a yoga instructor; the control group received only routine prenatal care. MAIN OUTCOME MEASURES: In both groups, participants' salivary cortisol and immunoglobulin A levels were collected before and after yoga every 4 weeks from 16 to 36 weeks' gestation. RESULTS: The intervention group had lower salivary cortisol (p<0.001) and higher immunoglobulin A (p<0.001) levels immediately after yoga than the control group. Specifically, the intervention group had significantly higher long-term salivary immunoglobulin A levels than the control group (p=0.018), and infants born to women in the intervention group weighed more than those born to the control group (p<0.001). CONCLUSION: Prenatal yoga significantly reduced pregnant women's stress and enhanced their immune function. Clinicians should learn the mechanisms of yoga and its effects on pregnant women. Our findings can guide clinicians to help pregnant women alleviate their stress and enhance their immune function.