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. 2011 Jul 6;2011(7):CD007559.
doi: 10.1002/14651858.CD007559.pub2.

Mind-body interventions during pregnancy for preventing or treating women's anxiety

Isabelle Marc  1 , Narimane Toureche, Edzard Ernst, Ellen D Hodnett, Claudine Blanchet, Sylvie Dodin, Merlin M Njoya
Affiliations

Mind-body interventions during pregnancy for preventing or treating women's anxiety

Isabelle Marc et al. Cochrane Database Syst Rev. .

Abstract

Background: Anxiety during pregnancy is a common problem. Anxiety and stress could have consequences on the course of the pregnancy and the later development of the child. Anxiety responds well to treatments such as cognitive behavioral therapy and/or medication. Non-pharmacological interventions such as mind-body interventions, known to decrease anxiety in several clinical situations, might be offered for treating and preventing anxiety during pregnancy.

Objectives: To assess the benefits of mind-body interventions during pregnancy in preventing or treating women's anxiety and in influencing perinatal outcomes.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 November 2010), MEDLINE (1950 to 30 November 2010), EMBASE (1974 to 30 November 2010), the National Center for Complementary and Alternative Medicine (NCCAM) (1 December 2010), ClinicalTrials.gov (December 2010) and Current Controlled Trials (1 December 2010), searched the reference lists of selected studies and contacted professionals and authors in the field.

Selection criteria: Randomized controlled trials, involving pregnant women of any age at any time from conception to one month after birth, comparing mind-body interventions with a control group. Mind-body interventions include: autogenic training, biofeedback, hypnotherapy, imagery, meditation, prayer, auto-suggestion, tai-chi and yoga. Control group includes: standard care, other pharmacological or non-pharmacological interventions, other types of mind-body interventions or no treatment at all.

Data collection and analysis: Three review authors independently assessed trials for inclusion all assessed risk of bias for each included study. We extracted data independently using an agreed form and checked it for accuracy.

Main results: We included eight trials (556 participants), evaluating hypnotherapy (one trial), imagery (five trials), autogenic training (one trial) and yoga (one trial). Due to the small number of studies per intervention and to the diversity of outcome measurements, we performed no meta-analysis, and have reported results individually for each study. Compared with usual care, in one study (133 women), imagery may have a positive effect on anxiety during labor decreasing anxiety at the early and middle stages of labor (MD -1.46; 95% CI -2.43 to -0.49; one study, 133 women) and (MD -1.24; 95% CI -2.18 to -0.30). Another study showed that imagery had a positive effect on anxiety and depression in the immediate postpartum period. Autogenic training might be effective for decreasing women's anxiety before delivering.

Authors' conclusions: Mind-body interventions might benefit women's anxiety during pregnancy. Based on individual studies, there is some but no strong evidence for the effectiveness of mind-body interventions for the management of anxiety during pregnancy. The main limitations of the studies were the lack of blinding and insufficient details on the methods used for randomization.

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Conflict of interest statement

Isabelle Marc and Sylvie Dodin received a grant from the Canadian Institute of Health Research and conducted a clinical trial to investigate the benefits of hypnosis for pain and anxiety management in pregnancy termination.

Figures

1
1
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
2
2
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1 Imagery versus non imagery lesson: Korol 1992, Outcome 1 Anxiety state (STAI‐S) after the last prenatal class.
1.2
1.2. Analysis
Comparison 1 Imagery versus non imagery lesson: Korol 1992, Outcome 2 Knowledge of labor and delivery after the last prenatal class.
2.1
2.1. Analysis
Comparison 2 Imagery versus usual care: Ip 2009, Outcome 1 Anxiety at early stages of labor.
2.2
2.2. Analysis
Comparison 2 Imagery versus usual care: Ip 2009, Outcome 2 Anxiety at middle stages of labor.
2.3
2.3. Analysis
Comparison 2 Imagery versus usual care: Ip 2009, Outcome 3 Anxiety at late stages of labor.
2.4
2.4. Analysis
Comparison 2 Imagery versus usual care: Ip 2009, Outcome 4 Pain at early stage of labor.
2.5
2.5. Analysis
Comparison 2 Imagery versus usual care: Ip 2009, Outcome 5 Pain at middle stages of labor.
2.6
2.6. Analysis
Comparison 2 Imagery versus usual care: Ip 2009, Outcome 6 Pain at late stages of labor.
2.7
2.7. Analysis
Comparison 2 Imagery versus usual care: Ip 2009, Outcome 7 Coping behaviours during labor.
2.8
2.8. Analysis
Comparison 2 Imagery versus usual care: Ip 2009, Outcome 8 Outcome expectancy on OE‐16.
2.9
2.9. Analysis
Comparison 2 Imagery versus usual care: Ip 2009, Outcome 9 Efficacy expectancy on EE‐16.
4.1
4.1. Analysis
Comparison 4 Imagery versus music: Rees 1995, Outcome 1 Anxiety state (STAI‐S) 28 days postpartum.
4.2
4.2. Analysis
Comparison 4 Imagery versus music: Rees 1995, Outcome 2 Depression 28 days postpartum.
4.3
4.3. Analysis
Comparison 4 Imagery versus music: Rees 1995, Outcome 3 Self‐esteem score.
5.1
5.1. Analysis
Comparison 5 Imagery versus passive relaxation plus progressive relaxation: Uresh 2009, Outcome 1 Anxiety level.
5.2
5.2. Analysis
Comparison 5 Imagery versus passive relaxation plus progressive relaxation: Uresh 2009, Outcome 2 Serum cortisol.
5.3
5.3. Analysis
Comparison 5 Imagery versus passive relaxation plus progressive relaxation: Uresh 2009, Outcome 3 Serum ACTH.
5.4
5.4. Analysis
Comparison 5 Imagery versus passive relaxation plus progressive relaxation: Uresh 2009, Outcome 4 Serum norepinephrine (NE).
5.5
5.5. Analysis
Comparison 5 Imagery versus passive relaxation plus progressive relaxation: Uresh 2009, Outcome 5 Serum epinephrine.
5.6
5.6. Analysis
Comparison 5 Imagery versus passive relaxation plus progressive relaxation: Uresh 2009, Outcome 6 Heart rate.
5.7
5.7. Analysis
Comparison 5 Imagery versus passive relaxation plus progressive relaxation: Uresh 2009, Outcome 7 Systolic blood pressure.
5.8
5.8. Analysis
Comparison 5 Imagery versus passive relaxation plus progressive relaxation: Uresh 2009, Outcome 8 Diasystolic blood pressure.
5.9
5.9. Analysis
Comparison 5 Imagery versus passive relaxation plus progressive relaxation: Uresh 2009, Outcome 9 Level of relaxation.
6.1
6.1. Analysis
Comparison 6 Yoga versus wait‐list intervention: Vieten 2008, Outcome 1 Anxiety state.
6.2
6.2. Analysis
Comparison 6 Yoga versus wait‐list intervention: Vieten 2008, Outcome 2 Depression.
6.3
6.3. Analysis
Comparison 6 Yoga versus wait‐list intervention: Vieten 2008, Outcome 3 Perceived stress.
6.4
6.4. Analysis
Comparison 6 Yoga versus wait‐list intervention: Vieten 2008, Outcome 4 Negative affect.
6.5
6.5. Analysis
Comparison 6 Yoga versus wait‐list intervention: Vieten 2008, Outcome 5 Positive affect.
6.6
6.6. Analysis
Comparison 6 Yoga versus wait‐list intervention: Vieten 2008, Outcome 6 Affect regulation.
7.1
7.1. Analysis
Comparison 7 Autogenic training versus traditional psycho‐prophylaxis: Zimmermann 1979, Outcome 1 Anxiety self reported before entering labor room.
7.2
7.2. Analysis
Comparison 7 Autogenic training versus traditional psycho‐prophylaxis: Zimmermann 1979, Outcome 2 Use of a spasmolytic medication.
7.3
7.3. Analysis
Comparison 7 Autogenic training versus traditional psycho‐prophylaxis: Zimmermann 1979, Outcome 3 Use of oxytocin in early stage of labor.
7.4
7.4. Analysis
Comparison 7 Autogenic training versus traditional psycho‐prophylaxis: Zimmermann 1979, Outcome 4 Length of dilatation period.
7.5
7.5. Analysis
Comparison 7 Autogenic training versus traditional psycho‐prophylaxis: Zimmermann 1979, Outcome 5 Expulsion time.
See this image and copyright information in PMC

Update of

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