Interventions to reduce maternal anxiety in pregnancy

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Abstract

Background: Maternal anxiety in pregnancy has been associated with an increased risk of poor obstetric outcome, including preterm delivery, low birth weight and emergency caesarean delivery. Furthermore, mothers suffering from antenatal anxiety are more likely to experience delivery complications and develop postnatal depression. Consequently, the National Institute of Clinical and Health Excellence (NICE) in the UK have emphasised the need for non-pharmacological interventions to help reduce antenatal anxiety. Yoga may be a suitable intervention as it incorporates relaxation techniques with physical exercise that can be customised for pregnant women. Furthermore, it has been shown to be as effective as cognitive behavioural therapy in reducing anxiety in non-pregnant women.Aim: To develop and pilot a randomised controlled trial that tests a yoga-based relaxation therapy designed to help reduce maternal anxiety in pregnancy.Method: This thesis is divided into two sections. The first details the methodology, results and implications of pilot work conducted to develop the design for the larger RCT. This pilot work entailed (1) a survey of yoga instructors to examine the usual structure of yoga classes and the features of a class that make it beneficial, (2) a pilot study with the preliminary design for the larger RCT applied to women already attending antenatal yoga sessions, (3) a discussion group with yoga instructors who took part in the pilot study and (4) service user feedback on study design. The second section focuses on the implementation and findings of the RCT where pregnant women were recruited through an ultrasound department and community midwives. Pregnant women were subsequently randomised to either treatment-as-usual (TAU) or an 8-week programme of antenatal yoga to test whether a single session of yoga significantly lowered maternal anxiety and levels of the stress hormone cortisol, and whether multiple sessions help to reduce maternal anxiety, specifically fear of childbirth. Results Participants who attended antenatal yoga showed a significant decrease in fear of childbirth compared to at baseline. Furthermore, the decrease in scores was significantly greater than that observed for the control group. In contrast the control group showed significantly elevated depression scores post-intervention when compared to those that received yoga. A single session of yoga was shown to reduce both subjective ratings of anxiety and stress hormone levels. This effect remained at the final session of the intervention.Conclusion: These preliminary data suggest yoga to be a potentially useful intervention, both in the short and long term, in helping to reduce women’s anxieties towards labour and delivery. However further research is required to identify ways to research complementary therapies, which are readily available within the community, to help maintain the fidelity of comparison groups in scientific research.

Keyword(s)

Anxiety; Pregnancy

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