Citation Information :
Neel S, Swaminathan E, Neel PB, Lazar J, Gireesh E, Pande P, Pawar BP. Study of Integrated Approach of Antenatal Care to improve the Gestational Age at Birth. World J Anemia 2018; 2 (1):1-10.
Aim and objective: Study of integrated approach of antenatal care (ANC) to improve the gestational age (GA) at birth.
Materials and methods: A total of 532 women attending the antenatal clinic at Neel clinic in Panvel, Navi Mumbai, India, were enrolled between 18 and 28 weeks of pregnancy from April 2015 to March 2017, in prospective nonrandomized, matched, interventional study.
A total of 254 women were enrolled in the study group; 278 women were enrolled in the control group. Women were matched for age, gravida, parity, educational, religion, and residential area.
Integrated approach of ANC:
• Stress management through Rajyoga meditation (Brahma Kumaris).
• Nutritious and satwik food.
• Antenatal physical and breathing exercises.
Exercises, walking, and meditation were practiced by the study group from date of entry into the study until delivery. The control group walked ½ an hour twice a day (standard obstetric advice) during the study period. Compliance in both groups was ensured by frequent telephone calls and maintenance of a daily activity charts.
Result: Preterm labor was significantly lower (<0.02) in the study group.
Conclusion: Stress management through meditation and nutritional management may contribute to decreased risk of premature delivery or low birth weight (LBW) babies, and eventually would decrease problems in the infant, children, adolescent, and fetal origin of adult diseases. Exercise during pregnancy would reduce the risk of cesarean delivery.
Integrated approach of ANC is safe, relatively cheap to implement, and would reduce the costs of long-term health care.
Da Costa D, Larouche J, Dritsa M, Brender W. Variations in stress levels over the course of pregnancy: factors associated with elevated hassles, state anxiety and pregnancy-specific stress. J Psychosom Res 1999 Dec;47(6):609-621.
Wadhwa PD, Sandman CA, Porto M, Dunkel-Schetter C, Garite TJ. The association between prenatal stress and infant birth weight and gestational age at birth: a prospective investigation. Am J Obstet Gynecol 1993 Oct;169(4):858-865.
Dunkel-Schetter C. Maternal stress and preterm delivery. Prenat Neonatal Med 1998;3:39-42.
WHO. Physical status: the use and interpretation of anthropometry. Technical Report Series 854. Geneva: World Health Organization; 1995.
Austin MP, Leader L. Maternal stress and obstetric and infant outcomes: epidemiological findings and neuroendocrine mechanisms. Aust N Z J Obstet Gynaecol 2000 Aug;40(3): 331-337.
Copper RL, Goldenberg RL, Das A, Elder N, Swain M, Norman G, Ramsey R, Cotroneo P, Collins BA, Johnson F, et al. The preterm prediction study: maternal stress is associated with spontaneous preterm birth at less than 35 weeks’ gestation. Am J Obstet Gynecol 1996 Nov;175(5):1286-1292.
Pritchard CW, Teo PY. Preterm birth, low birthweight and the stressfulness of the household role for pregnant women. Soc Sci Med 1994 Jan;38(1):89-96.
Steer RA, Scholl TO, Hediger ML, Fischer RL. Self-reported depression and negative pregnancy outcomes. J Clin Epidemiol 1992 Oct;45(10):1093-1099.
Orr ST, Miller CA. Maternal depressive symptoms and the risk of poor pregnancy outcome: review of literature and preliminary findings. Epidemiol Rev 1995;17(1):165-171.
Gorsuch RL, Key MK. Abnormalities of pregnancy as a function of anxiety and life stress. Psychosom Med 1974;36(4): 352-362.
Molfese VJ, Bricker MC, Manion LG, Beadnell B, Yaple K, Moires KA. Anxiety, depression and stress in pregnancy: a multivariate model of intra-partum risks and pregnancy outcome. J Psychosom Obstet Gynecol 1987 Oct;7(2):77-92.
Mulder EJ, Robles de Medina PG, Huizink AC, Van den Bergh BR, Buitelaar JK, Visser GH. Prenatal maternal stress: Effects on pregnancy and the (unborn) child. Early Hum Dev 2002 Dec;70(1-2):3-14.
Hoffman S, Hatch MC. Stress, social support and pregnancy outcome: a reassessment based on recent research. Paediatr Perinat Epidemiol 1996 Oct;10(4):380-405.
Fenster L, Schaefer C, Mathur A, Hiatt RA, Pieper C, Hubbard AE, Von Behren J, Swan SH. Psychologic stress in the workplace and spontaneous abortion. Am J Epidemiol 1995 Dec;142(11):1176-1183.
Villar J, Farnot U, Barros F, Victora C, Langer A, Belizan JM. A randomized trial of psychosocial support during high risk pregnancies. The Latin American Network for Perinatal and Reproductive Research. N Engl J Med 1992 Oct;327(18): 1266-1271.
Langer A, Farnot U, Garcia C, Barros F, Victora C, Belizan JM, Villar J. The Latin American trial of psychosocial support during pregnancy: effects on mother's wellbeing and satisfaction. Latin American Network for Perinatal and Reproductive Research (LANPER). Soc Sci Med 1996 Jun;42(11):1589-1597.
Hodnett ED, Fredericks S. Support during pregnancy for women at increased risk of low birth weight babies. Cochrane Database Syst Rev 2003;3:CD000198.
Collins C. Yoga: intuition, preventive medicine, and treatment. J Obstet Gynecol Neonatal Nurs 1998 Sep-Oct;27(5):563-568.
Narendran S, Nagarathna R, Narendran V, Gunasheela S, Nagendra HR. Efficacy of Yoga on pregnancy outcome. J Altern Complement Med 2005 Apr;11(2):237-244.
Kiran U, Behari M, Venugopal P, Vivekanandhan S, Pandey RM. The effect of autogenic relaxation on chronic tension headache and in modulating Cortisol response. Indian J Anaesth 2005 Dec;49(6):474-478.
Kiran U, Makhija N, Malik V, Gharde P. Relaxation therapies in pain management. Indian J Pain 2009;23:218-225.
Gupta SK. Soul-Mind-Body medicine for healthy happy living: for prevention of angina and heart attacks. World Congress on Clinical and Preventative Cardiology, 22–24 Sep 2006. Souvenir Program.
Patel N, Giorgio B. Meditation in a lived faith context as therapeutic intervention for substance abuse, dependence and addiction: an empirical study. Arch Indian Psychiatry 2005;7(1):52-56.
Gupta SK, Sawhney RC, Rai L, Chavan VD, Dani S, Arora RC, Selvamurthy W, Chopra H, Nanda NC. Regression of coronary atherosclerosis through healthy lifestyle in coronary artery disease patients-Mount Abu opens heart trial. Indian Heart J 2011 Sep-Oct;63(5):461-469.
Sasaki A, Shinkawa O, Yoshinaga K. Placental corticotropinreleasing hormone may be a stimulator of maternal pituitary adrenocorticotropic hormone secretion in humans. J Clin Invest 1989 Dec;84(6):1997-2001.
Hobel CJ, Dunkel-Schetter C, Roesch SC, Castro LC, Arora CP. Maternal plasma corticotropin-releasing hormone associated with stress at 20 weeks’ gestation in pregnancies ending in preterm delivery. Am J Obstet Gynecol 1999 Jan;180(1 Pt 3):S257-S263.
McLean M, Bisits A, Davies J, Woods R, Lowry P, Smith R. A placental clock controlling the length of human pregnancy. Nat Med 1995 May;1(5):460-463.
Challis JR, Matthews SG, Van Meir C, Ramirez MM. Current topic: the placental corticotropin-releasing hormone-adrenocorticotropin axis. Placenta 1995 Sep;16(6):481-502.
Petraglia F, Florio P, Nappi C, Genazzani AR. Peptide signaling in human placenta and membranes: autocrine, paracrine, and endocrine mechanisms. Endocr Rev 1996 Apr;17(2):156-186.
Jones SA, Challis JR. Steroid, corticotropin-releasing hormone, ACTH and prostaglandin interactions in the amnion and placenta of early pregnancy in man. J Endocrinol 1990 Apr;125(1):153-159.
Quartero HW, Noort WA, Fry CH, Keirse MJ. Role of prostaglandins and leukotrienes in the synergistic effect of oxytocin and corticotropin-releasing hormone (CRH) on the contraction force in human gestational myometrium. Prostaglandins 1991 Aug;42(2):137-150.
Rivier C, Vale W. Interaction of gonadotropin-releasing hormone agonist and antagonist with progesterone, prolactin, or human chorionic gonadotropin during pregnancy in the rat. Endocrinology 1982 Feb;110(2):347-351.
Chrousos GP. Regulation and dysregulation of the hypothalamic- pituitary-adrenal axis. The corticotropin-releasing hormone perspective. Endocrinol Metab Clin North Am 1992 Dec;21(4):833-858.
Omer H. Possible psychophysiologic mechanisms in premature labor. Psychosomatics 1986 Aug;27(8):580-584.
McEwen BS, Biron CA, Brunson KW, Bulloch K, Chambers WH, Dhabhar FS, Goldfarb RH, Kitson RP, Miller AH, Spencer RL, et al. The role of adrenocorticoids as modulators of immune function in health and disease: neural, endocrine and immune interactions. Brain Res Brain Res Rev 1997 Feb;23(1-2):79-133.
Chrousos GP. Stressors, stress, and neuroendocrine integration of the adaptive response. The 1997 Hans Selye Memorial Lecture. Ann N Y Acad Sci 1998 Jun;851:311-335.
Petraglia F, Sutton S, Vale W. Neurotransmitters and peptides modulate the release of immunoreactive corticotropinreleasing factor from cultured human placental cells. Am J Obstet Gynecol 1989 Jan;160(1):247-251.
Falkenberg ER, Davis RO, Dubard M, Parker CR Jr. Effects of maternal infections on fetal adrenal steroid production. Endocr Res 1999;25(3-4):239-249.
Romero R, Mazor M, Munoz H, Gomez R, Galasso M, Sherer DM. The preterm labor syndrome. Ann N Y Acad Sci 1994 Sep;734:414-429.
Romero R, Gomez R, Ghezzi F, Yoon BH, Mazor M, Edwin SS, Berry SM. A fetal systemic inflammatory response is followed by the spontaneous onset of preterm parturition. Am J Obstet Gynecol 1998 Jul;179(1):186-193.
Herrera JA, Alvarado JP, Martinez JE. The psychosocial environment and cellular immunity in the pregnant patient. Stress Med 1988 Jan-Mar;4(1):49-56.
Stein Z, Susser M. The Dutch famine, 1944-1945, and the reproductive process. I. Effects or six indices at birth. Pediatr Res 1975 Feb;9(2):70-76.
Barker DJ, Osmond C. Infant mortality, childhood nutrition, and ischaemic heart disease in England and Wales. Lancet 1986 May;1(8489):1077-1081.
Godfrey K, Robinson S, Barker DJ, Osmond C, Cox V. Maternal nutrition in early and late pregnancy in relation to placental and fetal growth. BMJ 1996 Feb;312(7028):410-414.
Rich-Edwards JW, Stampfer MJ, Manson JE, Rosner B, Hankinson SE, Colditz GA, Willett WC, Hennekens CH. Birth weight and risk of cardiovascular disease in a cohort of women followed up since 1976. BMJ 1997 Aug;315(7105):396-400.
McAnarney ER, Stevens-Simons C. Maternal psychological stress/depression and low birth weight. Am J Dis Child 1990 Jul;144(7):789-792.
Paarlberg KM, Vingerhoets AJ, Passchier J, Dekker GA, Van Geijn HP. Psychosocial factors and pregnancy outcome: a review with emphasis on methodological issues. J Psychosom Res 1995 Jul;39(5):563-595.