Stress Reduction Interventions for Pregnant Women: A Scoping Review

PURPOSE: Stress during pregnancy can lead to negative outcomes for both the mother and child. In the case of adolescent pregnancy, the adolescent experiences abnormally high levels of stress as a result of managing the dual stress of adolescent transitions and being pregnant. The negative outcomes on the mother–child dyad associated with stress mandate that evidence-based stress reduction interventions be available and integrated by practitioners into the routine care of pregnant adolescents. To gain a better understanding of the types of interventions available that could potentially be used and evaluated with pregnant adolescents and other high-risk populations, a scoping review was done on stress reduction interventions for all pregnant women. Due to the limited amount of high-quality literature available, a scoping review was done to gain knowledge about the types of stress reduction interventions that are currently being used to reduce pregnancy-related stress without being constrained by the study design or quality.

METHOD: A systematic search was performed of peer-reviewed articles published in English in the past 10 years in the following academic databases: CINAHL Plus, PubMed, OTseeker, and Web of Science. Search terms were related to pregnancy, stress, and common stress interventions (e.g., Yoga, mindfulness-based stress reduction, mindfulness, social support, aerobic, exercise, physical activity, lifestyle). Inclusion criteria were that the study must incorporate a stress reduction intervention, measure stress as an outcome, and include participants whose mean age was below 35 yr. Initially, a total of 308 article titles and abstracts were reviewed. Thirty-one of those articles met inclusion criteria and were selected for full-text review. Fourteen articles were included in the final synthesis. Methodological quality of included articles was evaluated using the American Occupational Therapy Association’s (AOTA’s) level of evidence criteria.

RESULTS: Four categories of stress reduction interventions for pregnant women were identified: Yoga, mindfulness, social support and lifestyle, and physical activity. Six of the articles were identified using AOTA’s levels of evidence as being Level I or II, three as Level III, and five as Level IV or V.

CONCLUSION: Findings from this scoping review on the use of stress reduction interventions for pregnant women offer preliminary support for their effectiveness with this population, particularly for those with additional risk factors such as low income or a complicated pregnancy, and provide an overview of the types of interventions that are currently being used. This review demonstrates the need for more rigorous studies specifically examining stress reduction interventions targeted at women with associated high-risk conditions.

IMPACT STATEMENT: No occupational therapy practitioners provided the stress reduction interventions, even though they all fell within AOTA’s (2014) Occupational Therapy Practice Framework: Domain and Process and would be appropriate for practitioners to integrate into practice. Occupational therapy practitioners across different settings work with pregnant women and should incorporate stress reduction techniques as part of their intervention plan as their clients transition into the new role of becoming a mother.

References

American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1–S48. https://doi.org/10.5014/ajot.2014.682006

Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8, 19–32. https://doi.org/10.1080/1364557032000119616

Hans, S. L., & Thullen, M. J. (2012). The relational context of adolescent motherhood. In C. H. Zeanah (Ed.), Handbook of infant mental health (3rd ed., pp. 214–229). New York: Guilford Press.

Ruiz, R. J., & Avant, K. C. (2005). Effects of maternal prenatal stress on infant outcomes: A synthesis of the literature. Advances in Nursing Science, 28, 345–355.