Effects of prenatal yoga on birth outcomes in nulliparous women: a systematic review and meta-analysis of randomized controlled trials

Background Prenatal yoga uniquely integrates moderate aerobic activity with mindfulness‑based stress reduction, diaphragmatic breathing, and targeted pelvic‑floor conditioning. This study aimed to investigate whether yoga could influence the rates of cesarean section, episiotomy, perineal laceration, vaginal midwifery, preterm birth, and total labor time during delivery compared to standard nursing care. Method Searches were conducted in MEDLINE, OVID, Scopus, PubMed, China Biology Medicine (CBM), Wiley, BMJ, JAMA, The Cochrane Library, Web of Science, VIP database, Wanfang database, CNKI, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials, using a combination of keywords related to “prenatal yoga,” “pregnancy yoga,” “yoga birth RCT,” “pregnant woman yoga,” and pregnancy outcomes from database inception until December 2023. Bias assessment followed the Cochrane Handbook guidelines. The random-effects model calculated relative risk or mean differences with confidence intervals. Randomized controlled trials comparing yoga practice with general nursing exclusively during labor were included. Primary outcomes were rates of cesarean section, episiotomy, perineal laceration, vaginal midwifery, and preterm birth. Secondary outcomes included total labor time during delivery. Statistical analysis was performed using RevMan 5.4. Results The meta-analysis included 14 randomized controlled trials with 3637 women. The control group received general nursing, while the experimental group underwent yoga classes and practice in addition to general nursing. The risk of bias was generally low. The rates of cesarean section (RR = 0.45, 95%CI: 0.38, 0.54, P < 0.01), vaginal delivery (RR = 0.66, 95%CI: 0.47, 0.93, P = 0.02), premature birth (RR = 0.29, 95%CI: 0.15, 0.56, P < 0.01), and perineal laceration (RR = 0.41, 95%CI: 0.25, 0.69, P < 0.0007) in the experimental group were lower than in the control group. Additionally, the total labor time for the experimental group was shorter than for the control group [MD=-2.10, 95%CI: -2.42, -1.79, P < 0.0001]. Conclusions Combining yoga practice with general nursing contributes to lower cesarean rates, shortened delivery times, reduced perineal lacerations, episiotomies, and preterm births.