Potential for Prenatal Yoga to Serve as an Intervention to Treat Depression During Pregnancy

doi:10.1016/j.whi.2014.12.003

Women's Health Issues

Volume 25, Issue 2, March–April 2015, Pages 134-141

https://doi.org/10.1016/j.whi.2014.12.003 Get rights and content

Highlights

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We evaluated feasibility of prenatal yoga as a treatment for antenatal depression.
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Thirty-four depressed pregnant women were enrolled in a 10-week open trial of prenatal yoga.
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Findings suggested that the yoga intervention was feasible, acceptable, and safe.
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In addition, women had significant reductions in depressive symptoms.
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These data provide initial support for prenatal yoga as a viable treatment option.

Abstract

Background

When left untreated, antenatal depression can have a serious negative impact on maternal, and infant outcomes. Many affected women do not obtain treatment for depression owing to difficulties accessing care or because they do not find standard antidepressant treatments to be acceptable during pregnancy. This study examined the acceptability and feasibility of a gentle prenatal yoga intervention, as a strategy for treating depression during pregnancy.

Methods

We developed a 10-week prenatal yoga program for antenatal depression and an accompanying yoga instructors' manual, and enrolled 34 depressed pregnant women from the community into an open pilot trial. We measured change in maternal depression severity from before to after the intervention.

Results

Results suggested that the prenatal yoga intervention was feasible to administer and acceptable to the women enrolled. No study-related injuries or other safety issues were observed during the trial. On average, participants' depression severity decreased significantly by the end of the intervention based on both observed-rated and self-report depression assessment measures.

Conclusion

The current study suggests that prenatal yoga may be a viable approach to addressing antenatal depression, one that may have advantages in terms of greater acceptability than standard depression treatments. Research and policy implications are discussed.

Section snippets

Lack of Acceptable Treatments for Antenatal Depression

Although pharmacological and nonpharmacologic interventions have been developed to treat depression in the general population, fewer clinical trials have examined the efficacy and safety of depression interventions during pregnancy. Pregnant women have unique concerns that influence their treatment decisions, and the most available depression treatment in the community, antidepressant medication, is viewed by many women to be unacceptable during pregnancy (Battle, Salisbury, Schofield, &

New Treatments Are Needed

Although public awareness of perinatal mental health issues has increased, the majority of depressed pregnant and postpartum women do not receive mental health care (Flynn, Blow, & Marcus, 2006). Owing to the high public health cost of untreated antenatal depression, there is a need to develop more acceptable strategies to treat mood symptoms during pregnancy (Battle et al., 2012, Freeman, 2011).

Prenatal Yoga: A Promising Approach

Prenatal yoga, a form of yoga tailored to be safe, gentle, and particularly helpful for pregnant women, represents a promising strategy for the treatment of maternal depression. One of the ways in which prenatal yoga may have an impact on depression is by increasing mindfulness, or nonjudgmental attention to the present moment. Mindfulness is directly taught in many yoga classes. This skill may generalize beyond classes, thereby reducing (negative) self-judgment, and/or increasing focus on the

The Current Study

The goal of the current study was to develop a prenatal yoga intervention for clinically depressed women using a class structure and content that is consistent with prenatal yoga taught in the community, and to evaluate the acceptability, feasibility, and preliminary efficacy of the intervention in an open pilot trial. In addition to careful measurement of changes in depression, we examined pre–post changes in mindfulness, a possible mechanism by which yoga may potentially lower depressive

Methods

This study was approved for human subjects protections by our institution's institutional review board.

Recruitment

We recruited 34 participants over a 14-month period (Figure 1). Of 95 women who initially called, only 6 chose not to participate after hearing the study description. Ultimately one-third of women who called about the study were enrolled.

Retention

We collected at least partial follow-up assessment data from 31 of the 34 participants; 22 (65%) provided data specifically at endpoint. Overall, we were able to collect data at approximately 75% of all scheduled data collection timepoints. One woman did not

Discussion

This treatment development study sought to evaluate whether prenatal yoga could represent a viable treatment option for antenatal depression. We developed a 10-week prenatal yoga program for depressed women with no prior yoga experience, and tested the intervention in an open pilot trial with 34 women. We found that the intervention was feasible to administer and acceptable to patients, who voiced high levels of satisfaction, and to prenatal care providers, who welcomed study recruitment and

Cynthia L. Battle, PhD, is a clinical psychologist and Associate Professor (Research) of Psychiatry & Human Behavior at Alpert Medical School of Brown University. Her, research is focused on women's perinatal mental health, including development of novel, behavioral intervention approaches.

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Pregnancy yoga is a holistic practice to support the physiological and psychological changes women experience in pregnancy, with the potential to be offered by mainstream maternity services. Evidence suggests benefits of pregnancy yoga are reduced anxiety and stress, enhanced mood and sleep, with reported improvements in physical and overall wellbeing. Women report that yoga in pregnancy assists in their birth preparation and self-efficacy in labour, with improved labour and birth experience. To date, a Qualitative Evidence Synthesis (QES) of qualitative studies of women's experiences of pregnancy yoga has not been undertaken and accordingly, the literature lacks a high-level synthesis of women's first-hand accounts.
This qualitative systematic review aims to synthesise and present new evidence about women's views and experiences of pregnancy yoga. Qualitative studies reporting women's views and experiences of practising pregnancy yoga as a sole intervention, were eligible for inclusion. Systematic searches of eight academic databases, AMED, ASSIA, CINAHL, EMBASE, MEDLINE, MIDIRS, PsycInfo and Web of Science, accompanied by extensive searches of Grey Literature, and evidence libraries, took place in May 2022. The methodological quality of included studies was formally evaluated, independently, by two reviewers using an adapted quality assessment tool. Data extraction followed and thematic synthesis, using the Thomas and Harden 2008 framework, was the validated method for the development of six analytical themes.
Seven studies, providing the experiences of 92 pregnant women, were included in the review. The methodological quality of the studies was mixed, with three of the seven scoring highly and two scoring medium for weight of evidence. The three key synthesised themes were: Equilibrium; Personal Autonomy in Healthcare; and Connection. There were six analytical subthemes: intuitive knowing, embedding the practice of yoga practice, practical toolkit, holistic care, baby bonding and peer social support.
Synthesis of pregnant women's voices identified what women want - easy access to the holistic benefits of pregnancy yoga; what they recommend - pregnancy yoga provided as mainstream maternity support and what should be provided – pregnancy yoga for all women, not only those who can afford to pay; Paying attention to what women identify as important, brings us closer to a woman-centred maternity service.
Efficacy of nondrug interventions in perinatal depression: A meta-analysis
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Perinatal depression causes significant harm to mothers and unborn infants. Nondrug intervention is a common and acceptable method for reducing perinatal depression in pregnant women; however, it lacks an evidence-based basis. This study aimed to evaluate the effectiveness of nondrug interventions, such as cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT), and yoga, in reducing perinatal depression. Randomized controlled trials (RCTs) of CBT, IPT, and yoga for improving perinatal depression were searched in the Cochrane Library, PubMed, Web of Science, Embase, ProQuest, ScienceDirect, ClinicalKey, Wanfang Data (Chinese database), and China Knowledge Resource Integrated Database. The retrieval time limit was set from the establishment of the database to December 2021. Twenty-one studies involving a total of 1981 participants were included.The present meta-analysis showed that CBT and IPT could effectively alleviate depressive symptoms in perinatal women, and the curative effect of IPT was better than that of CBT. There was no significant difference in the improvement effect of yoga on participants with depressive symptoms compared with that in the controls.This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO, CRD42022307675).
Prenatal yoga and excessive gestational weight gain: A review of evidence and potential mechanisms
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Citation Excerpt :
Prenatal yoga provides the opportunity to practice mindfulness as many of the poses are to be performed with focused attention, a non-judgmental attitude, and focus on the present (e.g., awareness to sensations in the body and breath) [135]. Studies suggest that prenatal yoga increases mindfulness [136]. Mindfulness has also been suggested as a potential mechanism of change on the relationship between yoga and stress [137,138] and depression [136,139].
To review the evidence of the potential mechanisms (behavioral, psychological/emotional, and physical factors) of prenatal yoga for preventing excessive gestational weight gain (GWG) in pregnant women to guide future research.
Prenatal yoga is a common form of physical activity during pregnancy and includes a combination of physical postures, breath control and meditation. This review theorizes how combining physical activity (i.e., prenatal yoga postures) with the add-ons brought by prenatal yoga (e.g., breath control, meditation), might provide a more comprehensive and effective strategy to prevent excessive GWG than physical activity alone. This article a) summarizes the literature on potential mechanisms of prenatal yoga to prevent excessive GWG specifically focusing on behavioral (diet, physical activity, and sleep), psychological/emotional (self-awareness, emotion regulation, stress, mood, mindfulness) and physical factors (pregnancy discomforts), b) highlights limitations of current studies, and c) provides suggestions for future research. The findings demonstrate there is insufficient evidence that prenatal yoga improves behavioral, psychological/emotional and physical factors in pregnant women and more research is needed. Though these factors have been more strongly linked to improved weight outcomes in non-pregnant populations, further testing in pregnant women is necessary to draw definitive conclusions for the efficacy of prenatal yoga to prevent excessive GWG.
Effective strategies are needed to prevent excessive GWG to encourage optimal maternal and child health outcomes. More research is warranted to evaluate the impact of prenatal yoga on weight outcomes during pregnancy and design studies to test the proposed mechanisms discussed in this review.
Effects of yoga in inflammatory bowel diseases and on frequent IBD-associated extraintestinal symptoms like fatigue and depression
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In June 2020, the Indian government published a common yoga protocol comprising loosening exercises, sitting, standing, and supine postures in combination with breathing exercises and meditation to improve health and wellbeing [87], which should be considered in future interventions. Extrapolating from existing research, yoga modules to treat IBD-related fatigue and depression should put a focus on mindfulness during the yoga intervention and make use of long restorative poses as these elements seemed effective in targeting those symptoms in other studies [22,33,39,36]. Specifically tailored yoga modules for patients with IBS to target abdominal pain and distension have already been introduced [29,30,53,88].
Quality of life (QoL) of persons with inflammatory bowel diseases (IBD) is often impaired by symptoms that do not primarily relate to intestinal inflammation. Among the most challenging extraintestinal symptoms are depression and fatigue, which are also frequent in other chronic diseases like multiple sclerosis, rheumatoid arthritis and cancer. Yoga as an ancient Indian tradition containing postures, breathing exercises and meditation may positively influence those symptoms.
This review evaluates the current literature with regard to the effect of yoga-based interventions in persons with IBD and with regard to QoL, depression and fatigue in other somatic disorders. A systematic literature search yielded three trials examining the effects of yoga in patients with IBD and 37 trials addressing depressive syndromes or fatigue in somatic disorders.
In summary, both in-person and video-based yoga classes are feasible, acceptable and safe as complementary treatment in patients with IBD and significantly improve anxiety and impaired quality of life. Current literature does not provide information on the effect of yoga on depression and fatigue in patients with IBD, but research from other somatic disorders or patients with depressive disorders implies the potential of yoga in this regard for persons with IBD. This should be specifically addressed in interventional trials with standardized yoga modules including patients with IBD suffering from fatigue, depression and/or impaired QoL.
A qualitative investigation of a prenatal yoga intervention to prevent excessive gestational weight gain: A thematic analysis of interviews
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To describe pregnant women's experiences and perceived facilitators/barriers of a prenatal yoga intervention to prevent excessive gestational weight gain (EGWG).
Pregnant women (N = 13) were interviewed after participation in a 12-week prenatal yoga intervention to prevent EGWG. Interviews were summarized using thematic analysis.
Twelve themes were identified and organized into four categories: 1) experiences of prenatal yoga (positive experience/enjoyment, pain relief, connecting to body), 2) prenatal yoga and weight (increased mindfulness/self-awareness, increased physical activity, weight management), 3) barriers to prenatal yoga (physical body, commute/traffic, schedule), and 4) facilitators of prenatal yoga (healthy pregnancy, support from other pregnant women, the feeling from prenatal yoga).
Prenatal yoga may relieve pain and help women be more connected to their bodies. Prenatal yoga may also help women become more aware of their health behaviors and increases their physical activity which may have important implications for reducing EGWG.
A comprehensive review on scientific evidence-based effects (including adverse effects) of yoga for normal and high-risk pregnancy-related health problems
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Citation Excerpt :
In another study, the practice of yoga for 10 weeks [75 min per session, one day-time and one evening-time session per week] has reported to be effective in reducing depression in pregnant women (Battle et al., 2015). Evidence suggests that yoga practice could be considered as a safe (Jiang et al., 2015) (since no yoga-related injuries were observed) (Uebelacker et al., 2016; Battle et al., 2015), feasible to administer, acceptable (Battle et al., 2015), and effective treatment for pregnant women who are depressed (Jiang et al., 2015; Uebelacker et al., 2016). In a meta-analysis, integrated yoga that includes asana, pranayama, meditation, or deep relaxation has been reported to be more effective in reducing depressive symptom than purely physical exercise-based yoga (asana) in pregnant women (Gong et al., 2015).
Women undergo distinct physiological changes and stress during pregnancy that are accompanied by various physical and psychological demands. Yoga is a complementary therapy that is commonly used by pregnant women and recommended by healthcare professionals. Thus, it is very important to know its evidence based effects, including adverse effects from all types of research. A comprehensive literature search in PubMed/Medline electronic database from inception to 23 September 2017 was performed using the keywords “yoga for pregnancy”. In total, 137 articles published since 1979 were available. Of the 137 articles, 53 articles were included for the review. This comprehensive review suggests that yoga could be considered as an evidence-based complementary therapy in improving both physical and psychological wellbeing in pregnant women during pregnancy (normal and high-risk), childbirth, and post-partum. However, types, duration, and frequency of yoga practices varied among the studies and the exact mechanisms behind the effects of yoga are less understood and need to be explored.

View all citing articles on Scopus

Lisa A. Uebelacker, PhD, a clinical psychologist, is Associate Professor (Research) of Psychiatry & Human Behavior and Family Medicine at Brown University's Alpert Medical, School. Her research interests include innovative behavioral interventions for, depression and integration of behavioral interventions into primary care.

Susanna R. Magee, MD, MPH, a board-certified family physician, is Director of the Maternal-Child, Health Program at Memorial Hospital of Rhode Island, and Assistant Professor in the, Department of Family Medicine at Alpert Medical School of Brown University.

Kaeli A. Sutton, BA, is a registered yoga teacher who has extensive training and experience, with prenatal and postpartum yoga. She is founder and Co-Director of the Motion, Center, a yoga center in Providence, Rhode Island, that specializes in classes for perinatal women.

Ivan W. Miller, PhD, is a clinical psychologist and Professor of Psychiatry & Human Behavior at, Alpert Medical School of Brown University. His research involves the development and evaluation of interventions for depression and suicidal behavior.

: Funding Source: NIH/NIMH Grant no. R34 MH085053.

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Original articlePotential for Prenatal Yoga to Serve as an Intervention to Treat Depression During Pregnancy

Highlights

Abstract

Background

Methods

Results

Conclusion

Section snippets

Lack of Acceptable Treatments for Antenatal Depression

New Treatments Are Needed

Prenatal Yoga: A Promising Approach

The Current Study

Methods

Recruitment

Retention

Discussion

American Journal of Obstetrics & Gynecology

Complementary Therapies in Clinical Practice

Journal of Behavior Therapy and Experimental Psychiatry

Journal of Bodywork and Movement Therapies

Journal of Bodywork and Movement Therapies

General Hospital Psychiatry

American Journal of Obstetrics & Gynecology

Evaluation and Program Planning

Complementary Therapies in Clinical Practice

Evaluation and Program Planning

Preventative Medicine

Biological Psychiatry

Biological Psychiatry

International Journal of Gynaecology & Obstetrics

Clinical Psychology Review

Using self-report assessment methods to explore facets of mindfulness

Assessment

Perinatal antidepressant use: understanding women's preferences and concerns

Journal of Psychiatric Practice

Prenatal yoga and depression during pregnancy

Birth

Six-week postpartum maternal depressive symptoms and 4-month mother-infant self- and interactive contingency

Infant Mental Health Journal

Complex challenges in treating depression during pregnancy

American Journal of Psychiatry

Statistical power analysis for the behavioral sciences

Detection of postnatal depression: Development of the Edinburgh Postnatal Depression Scale

British Journal of Psychiatry

International physical activity questionnaire: 12-country reliability and validity

Medicine and Science in Sports and Exercise

Risk of preterm delivery and hypertensive disorders of pregnancy in relation to maternal co-morbid mood and migraine disorders during pregnancy

Paediatric and Perinatal Epidemiology

Original article
Potential for Prenatal Yoga to Serve as an Intervention to Treat Depression During Pregnancy