Keyword: yoga, pregnancy, prenatal yoga

Question Research Answer

Definition yoga 1. Meg Haye. Sam Chase prescribing Yoga. 2010

The word yoga derives from the Sanskrit word yuj,

meaning ‘‘to yoke, or unite,’’ a root that gives rise to the
popular translation of yoga as ‘‘union.’’ More broadly
understood in a modern context, yoga is a set of principles
and practices designed to promote health and well-being
through the integration of body, breath, and mind.

How does yoga actually 2. Babbar, Shilpa. Shyken, Jaye. Yoga in Pregnancy. 2016
work
A prenatal yoga practice has been shown to benefit
women who suffer from anxiety, depression, stress, low
back pain, and sleep disturbances. A small number of
studies have been performed in high-risk pregnancies that
also demonstrate an improvement in outcomes. The
safety of performing yoga for the first time in pregnancy
and fetal tolerance has been demonstrated.

But how does yoga actually work? Several theories have

been proposed. Pranayamic breathing, also known as
deep breathing, is defined as a voluntary manipulation of
breath movement and serves as the cornerstone of any
yoga practice. Slow, deliberate, deep breathing activates
the parasympathetic nervous system mainly by stretching
of lung tissue and the vagal nerves. This leads to a
physiological response characterized by a decrease in
heart rate, blood pressure, metabolic rate, and oxygen
consumption. Deep breathing also increases
 neuroplasticity, defined as the reorganization of neural
pathways as an adaptive response. Studies reveal an
increase in neuroplasticity in those who perform yoga,
thereby improving concentration, intelligence quotient
scores, and motor control.

Yoga safe for woman 3. Davis, Kyle. Goodman, Sherryl H. Leiferman, Jenn.
pregnancy Taylor, Mary. Dimidjian, Sona. A randomized controlled
trial of yoga for pregnant women with symptoms of
depression and anxiety. Journal Complementary
Therapies in Clinical Practice. 2015

Prenatal yoga was found to be a feasible and acceptable

intervention and was associated with reductions in
symptoms of anxiety and depression; however, prenatal
yoga only significantly outperformed TAU on reduction
of negative affect.

4. Polis, Rachael L. Gussman, Debra. Kuo, Yen Hong.

Yoga in pregnancy: An examination of maternal and fetal
responses to 26 yoga postures. Obstetrics and
Gynecology. 2015

Results: Twenty-five healthy pregnant women were

evaluated. Ten reported regular yoga practice, eight were
familiar with yoga, and seven had no yoga experience.
Yoga groups were similar in age, race, body mass index,
gestational age, and parity. Presession and postsession
nonstress tests were reactive. Presession and postsession
data showed no change in maternal heart rate, temper-
ature, pulse oximetry, or fetal heart rate. During the 26
yoga postures, vital signs, pulse oximetry, and uterine
tocometry remained normal in all women and in all
 postures. The fetal heart rate across all 26 postures was
normal. There were no falls or injuries during the total
cumulative 650 poses. No participants reported decreased
fetal movement, contractions, leakage of fluid, or vaginal
bleeding in the 24-hour follow-up.

Conclusion: All 26 yoga postures were well-tolerated

with no acute adverse maternal physiologic or fetal heart
rate changes. Yoga is increasing in popularity in the
United States and has become a mainstream form of
exercise practiced by more than 20 million Americans in
2012 as compared with approximately 16 million in 2008.
1 Women are interested in participating in yoga during
their pregnancy. 2 The American College of Obstetri-
cians and Gynecologists recommends pregnant women
should be encouraged to engage in regular moderate
intensity physical activity in the absence of
contraindications. 3 Research supports moderate-
intensity physical activity during pregnancy. 4 In 2008,
the U.S. Department of Health and Human Services
provided physical activity guidelines including those for
pregnant women. 5 Yoga was listed as an example of a
health-enhancing physical activity and has been
described as a moderate-intensity exercise.

5. Jiang, Qinxian. Wu, Zhengguo. Zhou, Li. Dunlop, Jenae

Chen, Peijie. Effects of Yoga Intervention during
Pregnancy: A Review for Current Status. American
Journal of Perinatology. 2015

Results Ten randomized controlled trials were evaluated.

The findings consistently indicate that yoga intervention
presented with lower incidences of prenatal disorders (p<
 0.05), and small gestational age (p < 0.05), lower levels
of pain and stress (p < 0.05), and higher score of
relationship (p < 0.05). In addition, yoga can be safely
used for pregnant women who are depressed, at high-risk,
or experience lumbopelvic pain. Moreover, yoga is a
more effective exercise than walking or standard prenatal
exercises.

Conclusion: The findings suggest that yoga is a safe and

more effective intervention during pregnancy.

The health improvements from prenatal yoga program

were observed not only for infants but also for mothers
during pregnancy, as well as throughout labor and after
delivery. Moreover, it was also found that yoga may be
more beneficial than walking and standard prenatal
exercises. Overall, the evidence suggests that yoga is
well-suited to pregnancy. These results are positive.
However, further RCTs are needed to provide firmer
evidence regarding the utility and validity of yoga
intervention, particularly in relation to maternal and fetal
outcomes or physical variables for pregnant women.

Benefits prenatal yoga 6. Satyapriya, M. Nagarathna, R. Padmalatha, V. Nagendra,

for mother H. R. Effect of integrated yoga on anxiety, depression &
well being in normal pregnancy. Journal Complementary
Therapies in Clinical Practice. 2013

Yoga reduces anxiety, depression and pregnancy related

uncomfortable experiences.
7. Battle, Cynthia L. Uebelacker, Lisa A. Magee, Susanna
R. Sutton, Kaeli A. Miller, Ivan W. Potential for prenatal
yoga to serve as an intervention to treat depression during
pregnancy. Journal Women's Health Issues. 2015.

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.

8. Kusaka, Momoko. Matsuzaki, Masayo. Shiraishi, Mie.

Haruna, Megumi. Immediate stress reduction effects of
yoga during pregnancy: One group pre–post test. Journal
Women and Birth. 2016

This study indicated the immediate stress reduction

effects of yoga during pregnancy. This study revealed
that pregnant women experienced immediate reductions
in salivary cortisol and aamylase concentrations after
yoga classes. Their subjective mood also improved by
yoga.

9. Davison, Kirsten Krahnstoever. Birch, Leann L. The

effect of prenatal Hatha yoga on affect, cortisol and
depressive symptoms. NIH Public Access. 2008

Reduce stressors and increase relaxation.

10. Davison, Kirsten Krahnstoever Birch, Leann L. Yoga and

massage therapy reduce prenatal depression and
prematurity. NIH Public Access. 2008
 These data highlight the benefits of these cost-effective
therapies for prenatally depressed women and their
offspring. Inasmuch as depressed pregnant women are
often reluctant to use antidepressants because of their
potential side effects (Field, 2010; Van Shaick et al.,
2004), massage and yoga may be cost-effective
alternatives for the treatment of depression during
pregnancy (Gaudiano & Epstein-Lubow, 2007), most
especially if they can decrease prematurity and low
birthweight, as they did in this study.

11. Pamela J. Reis and Martha R. Alligood. Prenatal Yoga

in Late Pregnancy and Optimism, Power, and Well-
Being. Journal Nursing Science Quarterly. 2014

Increases in mean scores for optimism, power, and well-

being were statistically significant from baseline to
completion of the prenatal yoga program.

12. Patricia Kinser and Saba Masho. “Yoga Was My Saving

Grace”: The Experience of Women Who Practice
Prenatal Yoga. Journal of the American Psychiatric
Nurses Association. 2015

Pregnant women with stress and depressive symptoms

may be drawn to prenatal yoga for the psychological and
physical benefits.

13. Campbell, Virginia R. Nolan, Mary. A qualitative study

exploring how the aims, language and actions of yoga for
pregnancy teachers may impact upon women’s self-
efficacy for labour and birth. Journal Women and Birth.
2016
 As a holistic intervention affecting the physical,
psychosocial and spiritual domains, yoga appears to be
ideally placed to influence women’s ability to manage
labour pain. This study adds to the debate around how
yoga may facilitate an increase in women’s self-efficacy
for labour and birth and highlights the need for further
research into whether yoga can be ‘dismantled’ and if so,
which underlying mechanisms are effective. Findings
suggest any changes to women’s self-efficacy beliefs
after yoga classes may not be due purely to yoga practice
but also to time spent with other women in a safe
environment where hopes, fears and practical aspects of
managing labour and birth can be discussed in a positive
way. A follow-on study will explore women’s experience
of yoga classes to ascertain which aspects they find
helpful in labour. Their lived experiences will be
compared with the teachers’ understanding of how yoga
classes enhance women’s self-efficacy for labour and
birth.

14. Babbar, Shilpa. Chauhan, Suneet P. Exercise and yoga

during pregnancy : a survey. Exercise and yoga during
pregnancy : a survey. 2015

In conclusion, this pilot study identified a large number

of women who believed that exercise and yoga are
beneficial and they report being active during their
pregnancy. There was a knowledge gap between obese
and non-obese women with regard to knowing the
appropriate frequency and duration of exercise.
Additional studies are necessary to verify the self-
reported responses to exercise and if peripartum
 outcomes are improved among those compliant with
ACOG recommendations.

15. Martins, Roseny Flávia. Pinto e Silva, João Luiz.

Treatment of Pregnancy-Related Lumbar and Pelvic
Girdle Pain by the Yoga Method: A Randomized
Controlled Study. The Journal of Alternative and
Complementary Medicine. 2014

The yoga method was more effective at reducing

lumbopelvic pain intensity compared with postural
orientation.

16. Patricia Anne Kinser, Jena Pauli, Nancy Jallo, Mary

Shall, Kailee Karst, Michelle Hoekstra, and Angela
Starkweather. Physical Activity and Yoga-Based
Approaches for Pregnancy-Related Low Back and Pelvic
Pain. 2017

Benefits to women for pain and other symptoms, ranging

from stress and depression to childbirth self-efficacy

17. Fereshteh Jahdi, Fatemeh Sheikhan, Hamid Haghani,

Bahare Sharifi, Azizeh Ghaseminejad, Mahshad
Khodarahmian, Nicole Rouhana. Yoga during
pregnancy: The effects on labor pain and delivery
outcomes (A randomized controlled trial). Journal
Complementary Therapies in Clinical Practice. 2017

Yoga during pregnancy may contribute to a reduction

pain of labor and improved adequacy of childbirth.
Benefits yoga for fetus 18. Rakhshani, Abbas. Nagarathna, Raghuram. Mhaskar,
Rita. Mhaskar, Arun. Thomas, Annamma. Gunasheela,
Sulochana. Effects of Yoga on Utero-Fetal-Placental
Circulation in High-Risk Pregnancy : A Randomized
Controlled Trial. 2015

The results of this first randomized study of yoga in high-

risk pregnancy suggest that guided yogic practices and
visualization can improve the intrauterine fetal growth
and the utero-fetal-placental circulation. The result of this
randomized controlled trial of yoga in high-risk
pregnancy has shown that yogic visualization and guided
imagery can significantly reduce the impedance in the
uteroplacental and fetoplacental circulation. This pilot
data can be used to power larger studies to confirm these
results and elaborate on the mechanism of action.

19. Wiebe, Henry W. Boulé, Normand G. Chari, Radha.

Davenport, Margie H. The Impact of Prenatal Exercise on
Fetal Growth: A Meta-Analysis. 2014

Prenatal exercise reduces excessive fetal growth thereby

potentially mitigating the longer-term risk of developing
obesity in the offspring.

20. Sussman, Dafna. Lye, Stephen J. Wells, Greg D. Impact

of maternal physical activity on fetal breathing and body
movement-A review. Early Human Development. 2016

One of the postulated mechanisms underlying the change

in fetal breathing movement following maternal exercise
is mild fetal hypoxia. Such mild hypoxia is consistent
with the transient increase in fetal HR that is reported
 immediately after exercise however, the accuracy of this
speculated mechanism has yet to be determined. Another
possible mechanism is the rise in maternal
norepinephrine during exercise, which could cross the
placenta and decrease fetal breathing frequency

Is yoga more effective 21. Beddoe, Amy E. Paul Yang, Chin Po Kennedy, Holly
for pregnant women in Powell Weiss, Sandra J. Lee, Kathryn A. The effects of
second trimester than mindfulness-based yoga during pregnancy on maternal
third trimester? psychological and physical distress. Journal of Obstetric,
Gynecologic, and Neonatal Nursing. 2009

Result: Women practicing mindful yoga in their second

trimester reported significant reductions in physical pain
from baseline to postintervention compared with women
in the third trimester whose pain increased. Women in
their third trimester showed greater reductions in
perceived stress and trait anxiety.

Conclusions: Preliminary evidence supports yoga’s

potential efficacy in these areas, particularly if started
early in the pregnancy.

As a holistic intervention affecting the physical,

psychosocial and spiritual domains, yoga appears to be
ideally placed to influence women’s ability to manage
labour pain. This study adds to the debate around how
yoga may facilitate an increase in women’s self-efficacy
for labour and birth and highlights the need for further
research into whether yoga can be ‘dismantled’ and if so,
which underlying mechanisms are effective. Findings
suggest any changes to women’s self-efficacy beliefs
after yoga classes may not be due purely to yoga practice
 but also to time spent with other women in a safe
environment where hopes, fears and practical aspects of
managing labour and birth can be discussed in a positive
way. A follow on study will explore women’s experience
of yoga classes to ascertain which aspects they find
helpful in labour. Their lived experiences will be
compared with the teachers’ understanding of how yoga
classes enhance women’s self-efficacy for labour and
birth.

Contraindication 22. Reyes, Laura M. Davenport, Margie H.. Exercise as a

prenatal yoga therapeutic intervention to optimize fetal weight.
Pharmacological Research. 2018

There are some contraindications for exercise during

pregnancy (i.e. preeclampsia, restrictive lung disease,
placenta previa after 26 weeks of gestation).
Interestingly, exercise decreases a plethora of risk
factors associated with the development of
preeclampsia. In fact, a recent meta-analysis suggests
that increasing levels of physical activity before and
early during