Research: MARC and COLLEAGUES,

Listed in Issue 213

Abstract

MARC and COLLEAGUES, Departement de pediatrie, Universite Laval, Centre Hospitalier Universitaire de Quebec, 2705 boulevard Laurier, Quebec, Quebec, Canada, G1V 4G2 assessed the benefits of mind-body interventions during pregnancy in preventing or treating women's anxiety and in influencing perinatal outcomes.

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 behavioural 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.

Methodology

Search Strategy: The authors 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. The authors extracted data independently using an agreed form and checked it for accuracy.

Results

The authors 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 labour decreasing anxiety at the early and middle stages of labour (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.

Conclusion

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.

References

Marc I, Toureche N, Ernst E, Hodnett ED, Blanchet C, Dodin S and Njoya MM. Mind-body interventions during pregnancy for preventing or treating women's anxiety. [Review]  Cochrane Database of Systematic Reviews. (7): CD007559. 2011.

Comment

I fear that the randomized controlled trial model on mind-body interventions render it difficult to assess results; natural therapies are holistic and individualized so other methods of assessment would be preferable. Until other methods are adopted, there will continue to be weaknesses of the research methodology.

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