Advertisement

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

  • Cynthia L. Battle
    Correspondence
    Correspondence to: Cynthia L. Battle, PhD, Butler Hospital Psychosocial Research Program, 345 Blackstone Blvd., Providence, RI 02906. Phone: +1-401-455-6371; fax: 401-455-6235.
    Affiliations
    Alpert Medical School of Brown University, Department of Psychiatry & Human Behavior, Providence, Rhode Island

    Butler Hospital, Psychosocial Research Program, Providence, Rhode Island

    Women & Infants' Hospital of Rhode Island, Center for Women's Behavioral Health, Providence, Rhode Island
    Search for articles by this author
  • Lisa A. Uebelacker
    Affiliations
    Alpert Medical School of Brown University, Department of Psychiatry & Human Behavior, Providence, Rhode Island

    Butler Hospital, Psychosocial Research Program, Providence, Rhode Island

    Memorial Hospital of Rhode Island, Department of Family Medicine, Pawtucket, Rhode Island
    Search for articles by this author
  • Susanna R. Magee
    Affiliations
    Alpert Medical School of Brown University, Department of Psychiatry & Human Behavior, Providence, Rhode Island

    Memorial Hospital of Rhode Island, Department of Family Medicine, Pawtucket, Rhode Island
    Search for articles by this author
  • Kaeli A. Sutton
    Affiliations
    The Motion Center, Yoga and Dance Studio, Providence, Rhode Island
    Search for articles by this author
  • Ivan W. Miller
    Affiliations
    Alpert Medical School of Brown University, Department of Psychiatry & Human Behavior, Providence, Rhode Island

    Butler Hospital, Psychosocial Research Program, Providence, Rhode Island
    Search for articles by this author

      Highlights

      • We evaluated feasibility of prenatal yoga as a treatment for antenatal depression.
      • Thirty-four depressed pregnant women were enrolled in a 10-week open trial of prenatal yoga.
      • Findings suggested that the yoga intervention was feasible, acceptable, and safe.
      • In addition, women had significant reductions in depressive symptoms.
      • 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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Women's Health Issues
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Baer R.A.
        • Smith G.T.
        • Hopkins J.
        • Krietemeyer J.
        • Toney L.
        Using self-report assessment methods to explore facets of mindfulness.
        Assessment. 2006; 13: 27-45
        • Battle C.L.
        • Salisbury A.L.
        • Schofield C.A.
        • Ortiz-Hernandez S.
        Perinatal antidepressant use: understanding women's preferences and concerns.
        Journal of Psychiatric Practice. 2013; 19: 443-453
        • Battle C.L.
        • Uebelacker L.A.
        • Howard M.
        • Castaneda M.
        Prenatal yoga and depression during pregnancy.
        Birth. 2010; 37: 353-354
        • Battle C.L.
        • Uebelacker L.A.
        • Magee S.R.
        Patient-centered care for antenatal depression.
        American Journal of Obstetrics & Gynecology. 2012; 207 (author reply e11): e10-e11
        • Beebe B.
        • Jaffe J.
        • Buck L.
        • Chen H.
        • Cohen P.
        • Feldstein S.
        • et al.
        Six-week postpartum maternal depressive symptoms and 4-month mother-infant self- and interactive contingency.
        Infant Mental Health Journal. 2008; 29: 442-471
        • Chaudron L.H.
        Complex challenges in treating depression during pregnancy.
        American Journal of Psychiatry. 2013; 170: 12-20
        • Chuntharapat S.
        • Petpichetchian W.
        • Hatthakit U.
        Yoga during pregnancy: effects on maternal comfort, labor pain and birth outcomes.
        Complementary Therapies in Clinical Practice. 2008; 14: 105-115
        • Cohen J.
        Statistical power analysis for the behavioral sciences.
        2nd ed. Lawrence Erlbaum Associates, Hillsdale, NJ1988
        • Cox J.L.
        • Holden J.M.
        • Sagovsky R.
        Detection of postnatal depression: Development of the Edinburgh Postnatal Depression Scale.
        British Journal of Psychiatry. 1987; 150: 782-786
        • Craig C.L.
        • Marshall A.L.
        • Sjostrom M.
        • Bauman A.E.
        • Booth M.L.
        • Ainsworth B.E.
        • et al.
        International physical activity questionnaire: 12-country reliability and validity.
        Medicine and Science in Sports and Exercise. 2003; 35: 1381-1395
        • Cripe S.M.
        • Frederick I.O.
        • Qiu C.
        • Williams M.A.
        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. 2011; 25: 116-123
        • Curtis K.
        • Weinrib A.
        • Katz J.
        Systematic review of yoga for pregnant women: Current status and future directions.
        Evidence-Based Complementary and Alternative Medicine. 2012; 2012: 715942
        • Davalos D.
        • Yadon C.A.
        • Tregellas H.C.
        Untreated prenatal maternal depression and the potential risks to offspring; A review.
        Archives of Women's Mental Health. 2012; 15: 1-14
        • Devilly G.J.
        • Borkovec T.D.
        Psychometric properties of the credibility/expectancy questionnaire.
        Journal of Behavior Therapy and Experimental Psychiatry. 2000; 31: 73-86
        • Field T.
        • Diego M.
        • Delgado J.
        • Medina L.
        Yoga and social support reduce prenatal depression, anxiety and cortisol.
        Journal of Bodywork and Movement Therapies. 2013; 17: 397-403
        • Field T.
        • Diego M.
        • Hernandez-Reif M.
        • Medina L.
        • Delgado J.
        • Hernandez A.
        Yoga and massage therapy reduce prenatal depression and prematurity.
        Journal of Bodywork and Movement Therapies. 2012; 16: 204-209
        • First M.B.
        • Spitzer R.L.
        • Gibbon M.
        • Williams J.B.W.
        Structured clinical interview for DSM-IV-TR Axis I disorders, Research version, Patient edition with Psychotic Screen (SCID-I/P W/PSY SCREEN).
        Biometrics Research, New York State Psychiatric Institute, New York2001
        • Flynn H.A.
        • Blow F.C.
        • Marcus S.M.
        Rates and predictors of depression treatment among pregnant women in hospital-affiliated obstetrics practices.
        General Hospital Psychiatry. 2006; 28: 289-295
        • Freeman M.P.
        Antidepressant medications treatment during pregnancy: prevalence of use, clinical implications, and alternatives.
        Journal of Clinical Psychiatry. 2011; 72: 7
        • Gavin N.I.
        • Gaynes B.N.
        • Lohr K.N.
        • Meltzer-Brody S.
        • Gartlehner G.
        • Swinson T.
        Perinatal depression: Systematic review of prevalence and incidence.
        Obstetrics and Gynecology. 2005; 106: 1071-1083
        • Goodman J.H.
        Women's attitudes, preferences, and perceived barriers to treatment for perinatal depression.
        Birth: Issues in Perinatal Care. 2009; 36: 60-69
        • Grigoriadis S.
        • VonderPorten E.H.
        • Mamisashvili L.
        • Tomlinson G.
        • Dennis C.L.
        • Koren G.
        • et al.
        The impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta-analysis.
        Journal of Clinical Psychiatry. 2013; 74: e321-e341
        • Grote N.K.
        • Bridge J.A.
        • Gavin A.R.
        • Melville J.L.
        • Iyengar S.
        • Katon W.J.
        A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction.
        Archives of General Psychiatry. 2010; 67: 1012-1024
        • Jayashree R.
        • Malini A.
        • Rakhshani A.
        • Nagendra H.
        • Gunasheela S.
        • Nagarathna R.
        Effect of the integrated approach of yoga therapy on platelet count and uric acid in pregnancy: A multicenter stratified randomized single-blind study.
        International Journal of Yoga. 2013; 6: 39-46
        • Kim J.J.
        • La Porte L.M.
        • Corcoran M.
        • Magasi S.
        • Batza J.
        • Silver R.K.
        Barriers to mental health treatment among obstetric patients at risk for depression.
        American Journal of Obstetrics & Gynecology. 2010; 202: 312.e1-312.e5
        • Kroenke K.
        • Spitzer R.L.
        • Williams J.B.W.
        The PHQ-9: Validity of a brief depression severity measure.
        Journal of General Internal Medicine. 2001; 16: 606-613
        • Larsen D.L.
        • Attkisson C.C.
        • Hargreaves W.A.
        • Nguyen T.D.
        Assessment of client/patient satisfaction: Development of a general scale.
        Evaluation and Program Planning. 1979; 2: 197-207
        • Martins R.F.
        • Pinto e Silva J.L.
        Treatment of pregnancy-related lumbar and pelvic girdle pain by the yoga method: A randomized controlled study.
        Journal of Alternative and Complementary Medicine. 2014; 20: 24-31
        • Murray L.
        • Cooper P.J.
        • Wilson A.
        • Romaniuk H.
        Controlled trial of the short- and long-term effect of psychological treatment of postpartum depression. 2. Impact on the mother-child relationship and child outcome.
        British Journal of Psychiatry. 2003; 182: 420-427
        • Muzik M.
        • Hamilton S.E.
        • Lisa Rosenblum K.
        • Waxler E.
        • Hadi Z.
        Mindfulness yoga during pregnancy for psychiatrically at-risk women: Preliminary results from a pilot feasibility study.
        Complementary Therapies in Clinical Practice. 2012; 18: 235-240
        • Nguyen T.D.
        • Attkisson C.C.
        • Stegner B.L.
        Assessment of patient satisfaction: Development and refinement of a service evaluation questionnaire.
        Evaluation and Program Planning. 1983; 6: 299-313
        • O'Mahen H.A.
        • Flynn H.A.
        Preferences and perceived barriers to treatment for depression during the perinatal period.
        Journal of Women's Health. 2008; 17: 1301-1309
        • Palladino C.L.
        • Flynn H.A.
        • Richardson C.
        • Marcus S.M.
        • Johnson T.R.
        • Davis M.M.
        Lengthened predelivery stay and antepartum complications in women with depressive symptoms during pregnancy.
        Journal of Womens Health (Larchmont). 2011; 20: 953-962
        • Posternak M.A.
        • Young D.
        • Sheeran T.
        • Chelminski I.
        • Franklin C.L.
        • Zimmerman M.
        Assessing past treatment history: Test-retest reliability of the Treatment Response to Antidepressant Questionnaire.
        Journal of Nervous and Mental Disorders. 2004; 192: 95-102
        • Rakhshani A.
        • Maharana S.
        • Raghuram N.
        • Nagendra H.R.
        • Venkatram P.
        Effects of integrated yoga on quality of life and interpersonal relationship of pregnant women.
        Quality of Life Research. 2010; 19: 1447-1455
        • Rakhshani A.
        • Nagarathna R.
        • Mhaskar R.
        • Mhaskar A.
        • Thomas A.
        • Gunasheela S.
        The effects of yoga in prevention of pregnancy complications in high-risk pregnancies: A randomized controlled trial.
        Preventative Medicine. 2012; 55: 333-340
        • Rush A.J.
        • Bernstein I.H.
        • Trivedi M.H.
        • Carmody T.J.
        • Wisniewski S.
        • Mundt J.C.
        • et al.
        An evaluation of the Quick Inventory of Depressive Symptomatology and the Hamilton Rating Scale for Depression: A sequenced treatment alternatives to relieve depression trial report.
        Biological Psychiatry. 2006; 59: 493-501
        • Rush A.J.
        • Trivedi M.H.
        • Ibrahim H.M.
        • Carmody T.J.
        • Arnow B.
        • Klein D.N.
        • et al.
        The 16-item Quick Inventory of Depressive Symptomatology (QIDS) Clinician Rating (QIDS-C) and Self-Report (QIDS-SR): A psychometric evaluation in patients with chronic major depression.
        Biological Psychiatry. 2003; 54: 573-583
        • Satyapriya M.
        • Nagendra H.R.
        • Nagarathna R.
        • Padmalatha V.
        Effect of integrated yoga on stress and heart rate variability in pregnant women.
        International Journal of Gynaecology & Obstetrics. 2009; 104: 218-222
        • Segre L.S.
        • Losch M.E.
        • O'Hara M.W.
        Race/ethnicity and perinatal depressed mood.
        Journal of Reproductive and Infant Psychology. 2006; 24: 99-106
        • Shankardass K.
        • O'Campo P.
        • Dodds L.
        • Fahey J.
        • Joseph K.
        • Morinis J.
        • et al.
        Magnitude of income-related disparities in adverse perinatal outcomes.
        BMC Pregnancy and Childbirth. 2014; 14: 96
        • Sherman K.J.
        Guidelines for developing yoga interventions for randomized trials.
        Evidence-Based Complementary and Alternative Medicine. 2012; 2012: 143271
        • Sockol L.E.
        • Epperson C.N.
        • Barber J.P.
        A meta-analysis of treatments for perinatal depression.
        Clinical Psychology Review. 2011; 31: 839-849
        • Spinelli M.G.
        • Endicott J.
        Controlled clinical trial of interpersonal psychotherapy versus parenting education program for depressed pregnant women.
        American Journal of Psychiatry. 2003; 160: 555-562
        • Sugiura-Ogasawara M.
        • Furukawa T.A.
        • Nakano Y.
        • Hori S.
        • Aoki K.
        • Kitamura T.
        Depression as a potential causal factor in subsequent miscarriage in recurrent spontaneous aborters.
        Human Reproduction. 2002; 17: 2580-2584
        • Trivedi M.H.
        • Rush A.J.
        • Ibrahim H.M.
        • Carmody T.J.
        • Biggs M.M.
        • Suppes T.
        • et al.
        The Inventory of Depressive Symptomatology, Clinician Rating (IDS-C) and Self-Report (IDS-SR), and the Quick Inventory of Depressive Symptomatology, Clinician Rating (QIDS-C) and Self-Report (QIDS-SR) in public sector patients with mood disorders: a psychometric evaluation.
        Psychological Medicine. 2004; 34: 73-82
        • Uebelacker L.A.
        • Epstein-Lubow G.
        • Gaudiano B.A.
        • Tremont G.
        • Battle C.L.
        • Miller I.W.
        Hatha yoga for depression: Critical review of the evidence for efficacy, plausible mechanisms of action, and directions for future research.
        Journal of Psychiatric Practice. 2010; 16: 22-33
        • Wang S.
        • DeZinno P.
        • Fermo L.
        • William K.
        • Caldwell-Andrews A.A.
        • Bravemen F.
        • et al.
        Complementary and alternative medicine for low-back pain in pregnancy: A cross-sectional survey.
        Journal of Alternative and Complementary Medicine. 2005; 11: 459-464

      Biography

      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.

      Biography

      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.

      Biography

      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.

      Biography

      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.

      Biography

      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.