Volume 30, Issue 3 (Summer 2022)                   Avicenna J Nurs Midwifery Care 2022, 30(3): 211-220 | Back to browse issues page

Ethics code: IR.MUI.RESEARCH.REC.1397.312
Clinical trials code: IRCT20091219002889N11

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Naseh Z, Bahadoran P, Valiani M. Effect of Relaxation Technique on Anxiety, Stress, and Depression Scores of High-risk Pregnant Women Prone to Preeclampsia and the Physiological Indicators of Their Babies. Avicenna J Nurs Midwifery Care 2022; 30 (3) :211-220
URL: http://nmj.umsha.ac.ir/article-1-2321-en.html
1- Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2- Department of Midwifery and Reproductive Health, Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
3- Department of Midwifery and Reproductive Health, Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran , Valiani@nm.mui.ac.ir
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 Background and Objective
Preeclampsia is one of the most common and dangerous complications of pregnancy with a prevalence of 2-8% in all pregnancies, especially in the second and third trimesters. Stress and anxiety have been reported to be major risk factors for preeclampsia. Researchers believe that anxiety during pregnancy increases arterial blood pressure, decreases uterine-placental blood flow, and increases the resistance of placental vessels. As a result, anxiety, and stress lead to preeclampsia and can indirectly cause changes in the baby’s health, such as intrauterine growth restriction, amniotic fluid reduction, abnormal fetal oxygenation, low fetal weight, and premature delivery. Relaxation exercises are among the non-drug alternative treatment methods for pre-eclampsia, stress, and anxiety.
Given that no research has been conducted so far in Iran on the effects of Jacobson and Benson’s relaxation exercises on pregnant mothers at high risk for preeclampsia, this study aimed to determine the effect of relaxation on stress, anxiety, and depression in this group of women (susceptible to preeclampsia) and the physiological indicators of their babies.
Materials and Methods
This study is a controlled clinical trial. The statistical population included 100 pregnant mothers at risk of high blood pressure during pregnancy. Electronic records of pregnant mothers who met the inclusion criteria and had at least three high-risk maternal characteristics were selected. High-risk pregnant mothers in the 20th week of pregnancy with high blood pressure risk factors were randomly divided into two groups.
Inclusion criteria were 1) pregnant mothers in 20-24 weeks of pregnancy, 2) having reading and writing literacy, 3) experiencing first or second pregnancy, 4) history of preeclampsia or chronic hypertension in a previous pregnancy, for women in their second pregnancy, 5) no history of smoking, alcohol consumption, and psychotropic substances, 6) blood pressure less than 140/90 mm Hg, 7) lack of severe psychological and anxiety disorders, for those who received a score of 26 or higher from the DASS21 questionnaire, 8) having a CD player, a computer, or an android mobile phone to listen to the relaxation audio file at home. Exclusion criteria were 1) absence of more than two sessions in a row in body relaxation sessions, 2) failure to perform more than three consecutive body relaxation sessions at home, 3) unwillingness to participate in the study, 4) occurrence of symptoms of preeclampsia, eclampsia, and HELLP syndrome, and 5) preterm delivery and/or delivery before completing four sessions of relaxation. The study tools included a checklist of personal and midwifery information, a checklist of relaxation sessions and blood pressure control information (completed before and after each session), a digital blood pressure device, an Anxiety and Stress Scales (DASS21) questionnaire, and a checklist of infant physiological indices.
In addition to receiving the usual medical care and a compact disk, the intervention group participated in eight sessions (each 30 min) of relaxation classes available in comprehensive health centers using the Jacobson and Benson methods. At the end of the 8th body relaxation session, the pregnancy stress questionnaires were completed again by the mothers in the 36th week of pregnancy. Meanwhile, the control group received only routine care. After 36 weeks, mothers were followed up weekly by phone. Height, weight, head circumference, and Apgar scores of the 1st and 5th minutes of the newborn were recorded by visiting the birthing center or sending a photo of the birth information. Data were analyzed using SPSS software (version 16). The significance level was set at 5% (P<0.05).
The results of intergroup comparisons showed that the average stress and anxiety scores after intervention were significantly lower in the intervention group compared to the control group (P<0.05); however, the average depression score was not significantly different between the two groups (P>0.05). Neonatal physiological indicators including weight, height, and head circumference in the intervention group and the control group were 3026.33 vs. 3124.02; 50.37 vs. 49.75; and 34.81 vs. 34.22, respectively. Although these scores were higher in the intervention group compared to the control group, the differences were not significant.
 The results of the present study showed that after performing body relaxation, the stress and anxiety level of high-risk mothers in the intervention group was significantly reduced compared to the control group. However, no significant difference was observed in the level of depression between the two study groups. Furthermore, no significant differences were observed in the physiological indicators of the newborns, including weight, height, and head circumference.
Relaxation is an accepted method for the reduction of stress and anxiety since it can affect sympathetic-adrenergic activities and control the level of plasma catecholamines. In other words, relaxation can affect the release of neurotransmitters and hormones caused by stress and stimulates the body to produce nitric oxide (NO) molecules. These substances affect the blood vessel walls and lead to a decrease in blood pressure. The results of this study indicate that the relaxation method is effective in reducing stress and anxiety in this type of high-risk pregnant mother, but it does not affect depression. Given the fact that psychological distress is associated with adverse pregnancy outcomes, the findings raise the possibility that the benefits of relaxation may be clinically meaningful. The findings of this study can be used in various fields, such as practice, education, management, and research. Therefore, due to the importance of improving the health of pregnant mothers, it is recommended that body relaxation should be taught to all high-risk pregnant women and that more attention should be paid to it in childbirth preparation classes since it is an uncomplicated technique that can be easily taught by midwives and practiced by pregnant women to reduce their stress and anxiety.
Type of Study: Original Research | Subject: Midwifery
Received: 2021/04/13 | Accepted: 2022/05/14 | Published: 2022/09/5

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