What is the clinical evidence from this study?

Study design: RCT. Population: Risk of Gestational Hypertension (n=234). Intervention: Yoga therapy (asanas and slow pranayamas) vs. Standard antenatal care alone. Primary outcome: Incidence of gestational hypertension (RR 2.65, 95% CI 1.42-4.95, p=<0.001).

July 12, 2022Open Access

Effects of yoga on cardiometabolic risks and fetomaternal outcomes are associated with serum nitric oxide in gestational hypertension: a randomized control trial

Q: What are the key findings of this study?

Yoga practice for 20 weeks significantly reduced the risk of developing gestational hypertension (RR 2.65) compared to standard care in pregnant women at high risk for the condition.

Key Result

Yoga practice for 20 weeks significantly reduced the risk of developing gestational hypertension (RR 2.65) compared to standard care in pregnant women at high risk for the condition.

Study Design

Type

RCT (n=234)

Blinding

Single-blinded

Randomization

Block randomization

Multicenter

Structured PICO

Does a 20-week structured yoga therapy program reduce the incidence of new-onset hypertension in pregnant women at risk for gestational hypertension?

Population

234 normotensive pregnant women before 16 weeks of gestation with risk factors for gestational hypertension (e.g., family history, extremes of reproductive age, first pregnancy, multiple pregnancy), BMI > 35, DBP < 90 mmHg, and SBP < 140 mmHg.

Intervention

Structured module of yoga therapy (30 minutes twice daily) added to standard antenatal care for 20 weeks, starting at the 16th week of gestation.

Comparator

Standard antenatal care alone (including aspirin 75 mg, folate, iron, calcium, vitamin C, and antihypertensives like labetalol or nifedipine if indicated).

Outcome

Incidence of new-onset hypertension following twenty weeks of intervention.hard clinical

A 20-week yoga intervention significantly reduced the incidence of gestational hypertension and improved fetomaternal outcomes in high-risk pregnant women.

Main Result

Effect estimate: RR 2.65 (95% CI 1.42-4.95)

Absolute Event Rate: 6.61% vs 25.66%

p-value: p=<0.001

Limitations

Yoga could not be instituted prior to the 16th week of gestation.
Cannot conclude that yoga alone was effective in reducing blood pressure in patients who developed HDP, as they were placed on antihypertensive medications.
Single-blinded design.

Abstract

Gestational hypertension (GH) is associated with adverse cardiometabolic and pregnancy outcomes. Though yoga is known to be beneficial in pregnancy, the effects of yoga rendered for twenty weeks starting from 16th week of gestation in pregnant women having risk of GH on the incidence of hypertension, cardiometabolic risks and fetomaternal outcomes have not been studied. A randomized control trial was conducted on 234 pregnant women having risk of GH receiving standard antenatal care (Control group, n = 113), and receiving standard care + yoga (Study group, n = 121). Interventions were given for twenty weeks starting at 16th week of gestation. Baroreflex sensitivity (BRS), heart rate variability (HRV), insulin resistance, lipid-risk factors, and markers of inflammation, oxidative stress and vascular endothelial dysfunction (VED) were assessed before and after intervention. Incidence of new-onset hypertension, level of cardiometabolic risks at 36th week, and fetomaternal-neonatal outcomes in the perinatal period, were noted. The link of hypertension, pregnancy outcomes and cardiometabolic risks with nitric oxide (NO), the marker of VED was assessed by analysis of covariance, Pearson's correlations, and multilinear and logistic regressions. In study group, 6.61% women developed hypertension compared to 38.1% in the control group following 20-week intervention and there was significant decrease in risk of developing GH (RR, 2.65; CI 1.42-4.95). There was less-painful delivery, decreased duration of labor, increased neonatal birthweight and Apgar score in study group. Increase in total power of HRV (β = 0.187, p = 0.024), BRS (β = 0.305, p < 0.001), and decrease in interleukin-6 (β = - 0.194, p = 0.022) had significant association with increased NO. Twenty weeks of practice of yoga during pregnancy decreases the incidence of hypertension, improves fetomaternal outcomes, and reduces cardiometabolic risks in pregnant women having risk of GH. Decreased blood pressure, increased HRV, BRS and birth weight and decreased inflammation were associated with improved endothelial function. Trial registration: Clinical Trials Registry of India (CTRI), registration number: CTRI/2017/11/010608, on 23.11.2017.

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