Background
Materials and methods
Protocol
Search strategy
Selection criteria
Participants
Intervention
Comparison
Outcomes
Study design
Information retrieval and data extraction
Quality assessment and assessment of confidence in the review findings
Results
Results of the search
Study characteristics
Study ID | Country | Study type | Sample size | Gestation (weeks) | Intervention | Control | Outcome of interest | Main results | Frequency | Intensity | Timing | Type |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Babbar et al. 2016 | USA | RCT uncomplicated pregnancy | 46 (23/23) | 28–36 weeks | Yoga session | PowerPoint presentation | Mode of birth | NVB 65% yoga and 61% control | One time | One | 60 mins | Poses, breathing, shavasana |
Balaji et al. 2017 | India | RCT gestational diabetes | 151 (75/76) | 24 weeks | Yoga sessions | Routine treatment | Mode of birth | NVB 84% yoga 26% control | Daily | 3 months taught if practiced daily availability of 91 sessions | 60 mins | Loosening exercises, postures, deep relaxation technique, pranayama |
Bershadsky et al. 2014 | USA | Non-randomised control trial normal pregnancy | 50 (38/12) | 12–19 weeks | Yoga sessions | Usual activity | Depression Physiological stress | Cortisol levels lower post yoga and fewer depressive symptoms in yoga group | No information | No information taught sessions | 90 mins | Hatha yoga |
Bhartia et al. 2019 | India | RCT low risk pregnant women | 78 (38/40) | 18–20 weeks | Yoga therapy | Routine physical activity | Perceived stress Mode of birth | Perceived stress reduced 31.75% in yoga group and increased 6.60% in control (p < 0.001). NVB 92% yoga and 90% control | Tri-weekly | 36 sessions – 12 taught & 24 self-practice | 50 mins | Loosening exercises, breathing, postures, deep relaxation |
Bolanthakodi et al. 2018 | India | RCT normal pregnancy | 150 (75/75) | 30 weeks | Yoga therapy | Standard antenatal care | Mode of birth Pain management | More NVB in yoga group (p < 0.037), duration of labour was significantly shorter (p < 0.001) Significant reduction in intravenous analgesic in yoga group (p < 0.045) and tolerance of pain was higher as shown by NPIS (p < 0.001) and PBOS scores (p < 0.0001) | Bi-weekly for 4 sessions and weekly for three sessions and self-practice tri-weekly | 7 taught sessions & availability of 24–36 self- practice sessions | 30 mins | Integrated approach to yoga therapy (IAYT) |
Chen et al. 2017 | China | RCT healthy pregnant women | 94 (48/46) | 16 weeks | Yoga sessions | Routine prenatal care | Physiological stress | Prenatal yoga significantly reduced cortisol (p < 0.001) | Bi-weekly | 40 taught sessions | 70 mins | Postures, deep breathing, guided imagery, deep relaxation |
Chuntharapat et al. 2008 | Thailand | RCT normal pregnancy | 74 (37/37) | 26–28 weeks | Yoga sessions | Routine nursing care | Pain management Duration of labour | No differences between groups for pethidine usage. Shorter duration of labour in yoga group | Bi-weekly taught and tri-weekly self-practice | 6 taught sessions & 30–36 available self-practice sessions | 60 mins | Education, postures, chanting om, breath awareness, dhyana, yoga nidra |
Davis et al. 2015 | USA | RCT symptoms anxiety/depression | 46 (23/23) | 28 weeks | Yoga sessions | TAU | Depression Anxiety | Prenatal yoga was associated with reductions in symptoms of anxiety and depression | Weekly | 8 taught sessions and self-practice DVD | 75 mins | Ashtanga Vinyasa system of yoga modified for pregnancy |
Deshpande et al. 2013 | India | RCT high-risk pregnancies | 68 (30/38) | 12 weeks | Yoga therapy | Standard antenatal care/prenatal stretching exercises | Perceived stress | RMANOVA showed a significant decrease (P = 0.02) in the PSS scores of the yoga group compared to the control group | No information | 16 weeks | No information | No information |
Field et al. 2012 | USA | RCT depression | 56 (28/28) | 20 weeks | Yoga postures | Standard prenatal care | Depression Anxiety | Decreased depression scores (F = 82.40,p < 0.001) and decreased anxiety scores (F = 26.23, p < 0.001) in the yoga group | Bi-weekly | 24 taught sessions | 20 mins | Postures |
Field et al. 2013 | USA | RCT depression | 92 (46/46) | 22 weeks | Yoga postures | Social support | Depression Anxiety Physiological stress | Reduced anxiety and depression in both groups with no significant group difference and reduced cortisol pre/post yoga and pre/post social support | Weekly | 12 taught sessions | 20 mins | Postures |
Gallagher et al. 2020 | USA | RCT high-risk pregnancy on bedrest | 79 (48/31) | 23–31 weeks | Yoga sessions | Standard care and no yoga | Depression Anxiety | Perceived anxiety and depression overall scores lower in yoga group than in control group (p < 0.001) | Bi-weekly taught, video self-practice | Average of 7.46 (3–16) taught sessions, and 2 (0–24) self-practice video sessions | 30 mins | Breathing, visulisation, adapted yoga moves, yoga nidra |
Hayase et al. 2018 | Japan | Non-randomised control trial uncomplicated pregnancy | 91 (38/53) | 20–23 weeks | Yoga sessions | Standard antenatal care | Perceived stress Physiological stress | PSS scores lower in yoga group at 20–23 & 28–31 weeks’ gestation. Salivary α-amylase levels in yoga group significantly decreased immediately after yoga | Weekly taught and daily self- practice | Average of 4 to 19 taught sessions and all women practiced yoga for > 15 min at home, at least three times a week based on the self-report | 60 mins taught session and 15 mins self- practice | Warm-up, breathing exercises, postures, meditation |
Jahdi et al. 2017 | Iran | RCT normal pregnancy | 60 (30/30) | 26 weeks | Yoga sessions | Routine midwifery care | Mode of birth Duration of labour Pain management | Duration of the second and third stages of labour significantly shorter in yoga group (p = 0.04 and 0.01 respectively). Caesarean section rate 13.3% in yoga group compared to 50% in control group. Analgesic use during first stage of labour showed no difference between groups (p = 0.2) | Tri-weekly taught & daily self-practice | 33 taught sessions and possibility of 44 self- practice sessions | 60 mins | Postures, chanting om, breath awareness, yoga nidra, dhyana |
Kundarti et al. 2020 | Indonesia | RCT normal pregnancy | 59 (30/29) | 20–32 weeks | Yoga sessions | Standard antenatal care | Anxiety Physiological stress | Average anxiety in the intervention and control group after intervention (M = 13.16) vs (M = 35.30) and average cortisol levels (M = 16.50) vs (M = 9.91) | Weekly | 8 taught sessions | 90 mins | Postures, breathing, meditation shavasana |
Makhija et al. 2021 | India | RCT mild hypertensive disorder pregnancy | 60 (30/30) | Third trimester | Integrated yoga | Routine care | Duration of labour Mode of birth | Reduction in total duration of labour in yoga group (p = 0.011). 22 (73.3%) yoga group had vaginal delivery compared to 18 (60%) in control group | Tri-weekly | At least 4 weeks (12 sessions) | 40 mins | Postures, breathing, meditation |
Mitchell et al. 2012 | USA | RCT depression | 24 (12/12) | 20 weeks | Yoga postures | Parenting education sessions | Depression | Depressive symptoms reduced to subclinical levels in 55% of yoga group compared to 11% of control group | Bi-weekly | 24 taught sessions | 20 mins | Postures |
Mohyadin et al. 2020 | Iran | RCT normal pregnancy | 84 (42/42) | 26–37 weeks | Yoga sessions | Routine midwifery care | Anxiety Pain management Duration of labour Mode of birth | Anxiety lower in yoga group (p = 0.003). less pain at 4-5 cm in yoga group (p = 0.001). Shorter duration of labour in yoga group (p = 0.003) | Bi-weekly taught and tri-weekly home practice | 6 sessions | 60 mins | Postures, breathing, meditation |
Munirekha et al. 2019 | India | True-experimental post-test only control group design - uncomplicated pregnancy | 30 (15/15) | 24–32 weeks | Yoga sessions | Health education on antenatal care and future lactation | Mode of birth | NVB 80% yoga group compared to 40% control group | Weekly | Taught from 24 to 32 weeks until delivery | No information | Yogasanas |
Narendran et al. 2005 | India | Non-randomised control trial normal pregnancy | 335 (169/166) | 18–20 weeks | Yoga therapy | Walking 30 mins twice daily | Mode of birth | NVB 54% yoga group compared to 49% control group | Daily | Mean GA at delivery 38 weeks allowing for availability of 126 sessions | 60 mins | Integrated approach of yoga therapy (IAYT) Taught then self-practice |
Newham et al. 2014 | UK | RCT healthy pregnant women | 59 (31/28) | 20–24 weeks | Yoga sessions | TAU | Anxiety Depression Physiological stress | Greater reduction in both anxiety and depression in the yoga group. Significant decrease in cortisol after yoga (0.15 [0.11]μg/dL vs. 0.13[0.10]μg/dL P = 0.003) | Weekly | 8 taught sessions | 1.5 h | Hatha yoga |
Rakhshani et al. 2010 | India | RCT normal pregnancy | 102 (51/51) | 18–20 weeks | Integrated yoga | Standard antenatal exercises | Quality of life | Between groups analysis showed significant improvements in the yoga group in the physical (P = 0.001), psychological (P = 0.001), social (P = 0.003) environmental domains (P = 0.001) of the WHOQOL-100 | Tri-weekly | If until delivery estimated between 54 and 66 available taught sessions | 60 mins | Lectures, breathing exercises, postures, meditation, deep relaxation |
Rakhshani et al. 2012 | India | RCT high-risk pregnancy | 68 (30/38) | 12 weeks | Integrated yoga | Standard care plus walking for half an hour mornings and evenings | Mode of birth | Lower rate of emergency c-section in yoga group 51.7% compared to 57.9% in control | Tri-weekly | 28 taught sessions | 60 mins | Breathing exercises, yogic postures, meditative exercises |
Rong et al. 2021 | China | RCT normal healthy pregnancy | 64 (32/32) | 18–27 weeks | Yoga sessions | Routine prenatal care | Anxiety Depression Duration of labour Mode of birth | No statistically significant difference in post anxiety and depressions scores. Higher rate of vaginal birth (p = 0.039) and shorter duration of labour (p = 0.002) in yoga group | Tri-weekly | 12 weeks (up to 36 sessions) | 60 mins | Warm-up, postures, meditation |
Ruqaiyah et al. 2020 | India | Quasi-experimental pre/post with control | 24 (12/12) | Third trimester | No information | No information | Anxiety | Lower anxiety in the yoga group post intervention (p = 0.002) | No information | No information | No information | No information |
Satyapriya et al. 2009 | India | RCT normal pregnancy | 90 (45/45) | 18–20 weeks | Integrated yoga | Standard prenatal exercise | Perceived stress | Perceived stress decreased by 31.57% in the yoga group and increased by 6.60% in the control group (P = 0.001) | Tri-weekly for first month then daily self- practice | 1 month taught then self- practice, refresher every 4 weeks until 28 weeks then 2 weeks until 36 weeks. 16-week programme with availability of up to 92 sessions | 120 mins taught, 60 mins self-practice | Lectures, breathing exercises, poses, meditation, deep relaxation |
Satyapriya et al. 2013 | India | RCT normal pregnancy | 96 (51/45) | 18–20 weeks | Integrated yoga | Standard antenatal exercises | Anxiety Depression Perceived stress | Anxiety and Depression reduced with improvement in pregnancy experience in the yoga group (P < 0.001) | Tri-weekly for first month then daily self- practice | 16-week programme estimated up to 92 available sessions | 120 mins taught, 60 mins self-practice | Lectures, breathing exercises, poses, deep relaxation, meditation |
Uebelacker et al. 2016 | USA | RCT depression | 20 (12/8) | 12–26 weeks | Yoga sessions | Mom-baby wellness workshops | Depression | Although both groups had reduced depression scores, yoga was preferred. | Weekly | 9 taught sessions & self- practice | 75 mins | Breathwork, warm-up, poses, relaxation, homework |
Yekefallah et al. 2021 | Iran | RCT normal pregnancy | 70 (35/35) | 26–37 weeks | Yoga sessions | Routine prenatal care | Duration of labour Mode of birth | Mean duration of labour was shorter in yoga group (p < 0.0001). 82.9% of the women in the yoga group and 65.7% in the control group had a natural delivery | Bi-weekly | Attended for 9–11 weeks (up to 22 sessions) | 75 mins | Hatha yoga |
Yulianti et al. 2018 | Indonesia | RCT normal pregnancy | 102 (51/51) | 22–32 weeks | Yoga sessions | Not treated | Depression Anxiety | Mean level of anxiety and depression were lower in the yoga group at both two- and four-weeks post intervention (p < 0.001) | No information | 1 month | No information | No information |
Yuvarani et al. 2020 | India | Quasi-experimental pre/pots with control depression and anxiety | 30 (15/15) | 16–20 weeks | Yoga sessions | Aerobic exercise | Depression | Aerobic exercise and yoga showed significant effect for reducing the symptoms of depression (P ≤ 0.001) | Weekly | 3 months (up to 13 sessions) | 20 mins | Breathing, postures |
Characteristics of pregnancy yoga interventions
Risk of bias
Assessment of the quality of the evidence - GRADE
Yoga for pregnancy
| ||||||
Patient or population: pregnant women
Settings: Any
Intervention: yoga
Comparison: treatment as usual or any other active treatment | ||||||
Outcomes
|
Illustrative comparative risks* (95% CI)
|
Relative effect
(95% CI)
|
No of Participants
(studies)
|
Quality of the evidence
(GRADE)
|
Comments
| |
Assumed risk | Corresponding risk | |||||
Treatment as usual or any other active treatment
|
Yoga
| |||||
Anxiety
STAI, HADS-A, Hamilton Follow-up: 2-18 weeks | The mean anxiety in the intervention groups was
0.91 standard deviations lower
(1.49 to 0.33 lower) | 733 (11 studies) | ⊕⊕⊝⊝
low
1,2,3,4,5
| SMD -0.84 (-1.64 to -0.03) | ||
Depression
CES-D, HADS-D, Hamilton, EPDS Follow-up: 2-18 weeks | The mean depression in the intervention groups was
0.47 standard deviations lower
(0.90 to 0.04 lower) | 679 (12 studies) | ⊕⊕⊝⊝
low
1,2,3,4,5,6,7
| SMD -0.53 (-1.04 to -0.02) | ||
Perceived stress
PSS-10; Pregnancy experiences questionnaire (PEQ) Follow-up: 12-24 weeks | The mean perceived stress in the intervention groups was
1.03 standard deviations lower
(1.55 to 0.52 lower) | 423 (5 studies) | ⊕⊕⊝⊝
low
1,2,5
| |||
Physiological stress
Salivary cortisol Follow-up: 4-20 weeks | The mean physiological stress in the intervention groups was
0.69 standard deviations lower
(1.50 lower to 0.13 higher) | 279 (4 studies) | ⊕⊝⊝⊝
very low
1,2,3,4,5,6,8,9
| |||
Total duration of labour
medical records Follow-up: 10-24 weeks | The mean total duration of labour in the intervention groups was
117.75 lower
(153.80 to 81.71 lower) | 472 (6 studies) | ⊕⊕⊝⊝
low
1,2,3,8
| |||
Normal vaginal birth
medical records Follow-up: 10-28 weeks |
Study population
|
OR 2.58
(1.46 to 4.56) | 1195 (12 studies) | ⊕⊝⊝⊝
very low
1,2,3,5,6,10
| ||
51 per 100
|
73 per 100
(61 to 83) | |||||
Moderate
| ||||||
49 per 100
|
72 per 100
(59 to 82) | |||||
Quality of life
WHOQoL100 Follow-up: mean 16 weeks | The mean quality of life in the intervention groups was
1.73 higher
(0.79 to 2.67 higher) | 102 (1 study) | ⊕⊕⊝⊝
low
1,2,8
|