Elsevier

Journal of Affective Disorders

Volume 245, 15 February 2019, Pages 428-439
Journal of Affective Disorders

Review article
The effect of complementary medicines and therapies on maternal anxiety and depression in pregnancy: A systematic review and meta-analysis

https://doi.org/10.1016/j.jad.2018.11.054Get rights and content

Highlights

  • Massage, bright light therapy and acupuncture may reduce depressive symptoms.

  • Anxiety did not differ significantly between groups for any CAM modality.

  • High quality trials of CAM in pregnant women with depression and anxiety are needed.

Abstract

Background

Depression and anxiety are common during the antenatal and postnatal period, and are known to have a significant impact on the woman and her unborn infant. Pregnant women state a preference for non-pharmacological treatment options, and use complementary medicines and therapies to manage these symptoms. We examined the effectiveness and safety of these modalities on depression and anxiety during pregnancy.

Methods

CENTRAL, EMBASE and PubMed databases were searched for randomised controlled trials comparing complementary therapies and medicines to a control, for pregnant women with depression or anxiety. The primary outcome measure was antenatal depression or anxiety.

Results

Twenty randomised controlled trials containing 1092 women were included in the review. We found some evidence of reduced antenatal depression from three modalities. Acupuncture reduced the number of women diagnosed with antenatal depression (RR 1.68, 95% CI 1.06–2.66, 1 trial). Massage reduced the severity of antenatal depression in one trial of 149 women (SMD −0.73, 95%CI −1.07–−0.39). One small trial of bright light therapy found reduced antenatal depression (RR 4.80, 95% CI −8.39–−1.21, 27 women). There was no evidence of a reduction in depression and anxiety from relaxation, yoga, mindfulness and fish oils. Overall the risk of bias was high or unclear for the majority of studies.

Limitations

There are few high quality randomised controlled trials of complementary medicines and therapies examining the effect on anxiety and depression.

Conclusion

Acupuncture, bright light therapy, and massage may reduce antenatal depression. There is a need for high quality and larger studies that include postnatal follow up and maternal and neonatal outcomes.

Section snippets

Background

Depression and anxiety in pregnancy frequently co-exist (Lee et al., 2007), and are common conditions experienced by pregnant women across countries. Up to 13% of women will experience major depression during pregnancy, with increasing prevalence up to around 22% in the first twelve months postpartum (Wisner et al., 2013). Postnatal depression (PND) is one of the most common forms of maternal morbidity following childbirth, and can lead to a chronic or recurring depression throughout the

Study selection and eligibility

A priori we included parallel randomised, cross over or quasi randomised controlled trials comparing complementary health approaches for women diagnosed or screening positive for clinical anxiety and depression during the antenatal period with placebo/no treatment, medication, or any psychological intervention. We included studies of women with antenatal anxiety and or depression (variously defined), and aged 16 years or above. The primary outcome was antenatal depression or anxiety. Secondary

Results

A total of 156 potential references were identified from database searches and other sources. After duplicates were removed, the studies were sequentially examined by title, abstract, and full text for eligibility (Fig. 1). Twenty trials containing 1092 women met the inclusion criteria for our review. Twenty studies were excluded. Thirteen studies were excluded due to women not meeting a clinical diagnosis of anxiety or depression (Field et al., 1999, Haakstad et al., 2016, Karol and von

Discussion

This review included 20 clinical trials containing 1092 women with anxiety or depression during pregnancy. Seven complementary health modalities were included, studies were conducted in five countries, and varied in their methodological quality. There was some evidence from four CM approaches of a potential benefit. Acupuncture reduced the number of women with depression during the antenatal period, but not in the postnatal period, and did not reduce the severity of symptoms. Although animal

Conclusion

There is preliminary very low to moderate quality evidence from complementary health approaches to reduce anxiety and depression. However few well designed RCTs have been conducted evaluating complementary health modalities on perinatal mental health during pregnancy and in the postnatal period. These interventions are accessible to women in the community and further studies are needed to assist women and their clinicians to make evidence-based, informed decisions about the management of

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author contributions

CS deigned the study.

ZS undertook the search of the literature.

CS and ZS screened all studies.

All authors contributed to data extraction, read and commented on the draft and approved the final version of the paper.

Declarations of interest

Caroline Smith and Zewdneh Shewamene declare as a medical research institute, NICM Health Research Institute receives research grants and donations from foundations, universities, government agencies and industry. Sponsors and donors provide untied and tied funding for work to advance

Acknowledgements

Nil.

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