Effect of relaxation interventions in pregnant women on maternal and neonatal outcomes: A systematic review and meta-analysis

Abstract

Background: Maternal stress during pregnancy has been associated with adverse pregnancy and birth outcomes. Aiming to reduce maternal stress and to improve pregnancy and birth outcomes, different relaxation interventions have been tested during pregnancy. This systematic review and meta-analysis was conducted on studies that have tested relaxation interventions to improve maternal wellbeing, and pregnancy and birth outcomes in various settings. Method: A systematic search of PubMed, EMBASE Classic + EMBASE (Ovid), MEDLINE In-Process and Non-Indexed Citations, MEDLINE Daily, and MEDLINE (Ovid), Cumulative Index to Nursing & Allied Health Plus (CINAHL via EBSCO) and Cochrane library databases was conducted to identify studies on stress reduction relaxation interventions in pregnant women. The outcomes of interest were maternal mental health (stress, anxiety, and depression), pregnancy outcomes (gestational age, labor duration and mode of delivery) and birth outcomes (birth weight, APGAR score and term or preterm delivery). Randomized controlled trials or quasi-experimental studies with stress reduction relaxation interventions during pregnancy and ever published in English globally were eligible for inclusion. Studies with interventions in high-risk pregnancies, those including psychotropic medications, or interventions at the onset of labor and delivery were excluded. All studies were screened for quality and risk of bias. We conducted meta-analyses, using random-effects models, for three outcomes for which there was sufficient information: maternal depressive symptoms, perceived maternal stress; and birth weight. Result: Nineteen studies were eligible for analysis. The studies sampled 2395 pregnant women, mostly aged between 18 and 39 years. The interventions applied were yoga therapy, music therapy, progressive muscular relaxation (PMR)/guided imagery/deep breathing exercises, mindfulness or hypnosis. The meta-analyses showed that the interventions were effective in improving maternal depressive symptoms (-2.5 points, [95% confidence interval (CI) -3.6, -1.3]) and stress symptoms (-4.1 points, [95% CI -8.1, -0.1]) during pregnancy. There was no effect of the interventions overall on birth weight (45 g, 95% CI -56, 146); however, PMR in two studies increased birth weight (181 g, 95% CI 25, 338) whereas music therapy and yoga had no benefit. Narrative syntheses of outcomes that were not amenable to meta-analysis indicated beneficial effects of music interventions on APGAR score (n=4 studies) and gestational age at birth (n=2 studies). Interventions were also reported to significantly increase spontaneous mode of delivery (n=3 studies) and decrease the rate of instrumental virginal delivery by 5%, caesarean section by 20% and duration of labor (n=2 study). Discussion: Adverse life experience during pregnancy impairs the normal adaptive changes supposed to maintain normal homeostasis during pregnancy and results in increased risk of stress, anxiety and depression. This imbalance results in increased stress hormone in the maternal-fetal circulation which is harmful to the mother and her fetus leading for adverse pregnancy and birth outcomes. Stress reduction relaxation intervention restores the normal homeostasis in pregnancy and improves normal biological and psychological wellbeing and consequently improves pregnancy and birth outcomes. Conclusion: In addition to benefits for mothers, relaxation interventions hold some promise for improving newborn outcomes; therefore, this approach strongly merits further research.