Bereaved mothers with stillbirth (death at >20 weeks of gestation) have more than a 6-fold higher risk for Post Traumatic Stress Disorder (PTSD) compared to mothers after live birth. PTSD declines at a slower rate among bereaved mothers compared to other bereaved populations and often escalates in subsequent pregnancies. Because more than 85% of women will get pregnant within 18-months, the inter-conception period is a critical time to improve the mental and physical health of bereaved mothers with stillbirth. Non-pharmacological approaches, such as yoga, may be an alternative option for bereaved women with stillbirth. Yoga has been established as an effective, safe, acceptable, and a cost effective approach to improving mental health in a variety of populations, including, pregnant and post-partum women and as a means to cope with PTSD associated with surviving a traumatic event. We are unaware of any studies that have explored yoga to reduce PTSD in bereaved mothers with stillbirth. Furthermore, online-streamed yoga (on-demand videos played in the home) has recently grown in popularity and may address the unique barriers that women with stillbirth may have. The primary goal of this project is to determine the feasibility and acceptability of a 12-week, home-based, online-streamed yoga (www.Udaya.com) intervention for bereaved mothers with stillbirth. We will also make adaptations and determine acceptability of a control group that can be used for a future, larger trial. Finally, we will explore the preliminary effects (not powered for efficacy) of a home-based, online-streamed, yoga intervention with differing doses (low and moderate) on symptoms of PTSD and its comorbid conditions (i.e., anxiety, depression) and the potential mechanisms (i.e., self-compassion, emotional regulation, and sleep disturbance) by which yoga may improve PTSD symptoms. This is a three-group randomized feasibility pilot study with baseline, post-intervention (12 weeks from baseline), and follow-up (20 weeks from baseline) assessments. Women will be randomized into one of three arms (intervention low dose (LD) = 60 mins/wk yoga; intervention moderate dose (MD) = 150 mins/wk yoga); or a stretch and tone control group (STC). This study plays an important role in our understanding about yoga and PTSD related outcomes in bereaved mothers with stillbirth. This study will inform the design of a larger study to test the effectiveness of online yoga as a low-cost, non-pharmacological strategy for inter-conception care to improve maternal and fetal outcomes for bereaved mothers with stillbirth.
Stillbirth has been recognized as a major public health concern by academics and clinicians around the world. A dearth of intervention research exists despite the fact that these mothers are at increased risk of post- traumatic stress disorder (PTSD) and related comorbid conditions (i.e., anxiety, depression). PTSD symptoms decline at a slower rate among bereaved mothers compared to other bereaved populations. These affective states may contribute to increased health risks such as weight retention or gain, increased risk of chronic disease (e.g., heart disease, diabetes), premature mortality, and overall poor quality of life. Additionally, the risk of recurring PTSD increases in the pregnancy following a stillbirth as 85% of bereaved mothers get pregnant within the first 18-months after loss. These emotional stressors may contribute to premature births, low birth weight, and cognitive delays in subsequently born children. This project is relevant to NIH?s mission because the high prevalence of PTSD underscores an unmet need to help women cope with the psychological and physiological effects of traumatic grief after stillbirth, provides a safe, non-pharmacological method for addressing PTSD (i.e., yoga), and is one of the first interventions of any kind for these women that specifically targets barriers to physical activity as reported by this population.
| Huberty, Jennifer; Matthews, Jeni; Leiferman, Jenn et al. (2018) A study protocol of a three-group randomized feasibility trial of an online yoga intervention for mothers after stillbirth (The Mindful Health Study). Pilot Feasibility Stud 4:12 |
