Recently, I was asked to put together a handout reviewing the research supporting the benefits of fertility yoga.  I am often recommending these modalities to patients for self-care during preconception, pregnancy and post-partum and even I was surprised by the wealth of evidence out there. Importantly, while most of the focus tends to be on prenatal yoga, the evidence points to starting a yoga practice, like a prenatal vitamin, months prior to conception to improve fertility, including in conjunction with conventional fertility treatments, and though the postpartum period to reap the benefits for both mother & baby.

It is important to note that this article and many of the studies, use the term "yoga" to represent a multifaceted approach to exercise that encourages strength & stretching (asana), mental centering (meditation), and focused breathing (pranayama).

Research suggests that in this way, yoga prior to and during pregnancy is safe and can have many benefits for women and their babies:

• Improved sleep, quality of life  & self-efficacy 1,2, 5, 6, 13
• Reduced stress, depression and anxiety. Compared to non-depressed women, depressed pregnant women experience higher rates of pre-eclampsia, miscarriage, pre-birth complications, pre-term delivery, low birth weight and is associated with cognitive and emotional problems in children 1-7, 9-16, 18, 21
• Improve fertility and increase the success rates of IVF by improving physiological & psychological states, in addition to improved tolerance of IVF treatments. 19, 20
• Improved immune function as evidenced by increased immunoglobulin A 10
• Decreased heart rate variability, indicating increased parasympathetic: sympathetic functioning more than relaxation or exercise alone 2
• Increased strength, flexibility and endurance of muscles needed for childbirth 2
• Decreased lower back pain, nausea, carpal tunnel syndrome, headaches, hypertension, diabetes and shortness of breath 1, 2, 5, 6, 14, 23
• Significantly decreased duration of first stage of labor and the total duration of labor, frequency of labor induction, perineal tears, episiotomy & C-section; increased rates of comfort during delivery and post delivery through the increased production of endorphins and dopamine 2, 5, 11, 15, 23
• Improves socialization with other pregnant women and prepares for the stress of being a new parent. 2, 3, 4, 5 as evidenced by decreased levels of cortisol 10, 12, 14, 18
• Cord blood cortisol level of babies indicates positive health status of the newborns verifies that prenatal meditation can influence fetal health and better temperament at fifth month reflecting the importance of prenatal meditation in relation to child health. 17
• Infants prenatally exposed to maternal mindfulness have been found to be “less fussy” when compared to those exposed to higher levels of anxiety; an example of “prenatal programming”: Positive/negative traits of mother during pregnancy may ‘program’ infant. 18
• In the postnatal period, yoga during pregnancy & after delivery was linked with a lower risk of maternal depression & anxiety by up to 67%. 24-26

When to start and what to do

Yoga can be started anytime in the preconception period.  New or returning students should focus on yin, slow flow, restorative or prenatal classes; heated classes should be avoided. Research indicates that pregnant women should start at by 18-26 weeks gestation, one to three times per week for 30-60 minutes with the most benefit seen in the integrated yoga interventions (mindfulness + asana). Students should inform the teacher of possibility of pregnancy. 2, 6-9.

References

1. Yoga during Pregnancy: A Review, American Journal of Perinatology; 2012.

2. Systematic Review of Yoga for Pregnant Women: Current Status and Future Directions;Evid Based Complement Alternat Med. 2012.

3. Mindfulness-based childbirth and parenting education: promoting family mindfulness during the perinatal period. Journal of Child and Family Studies. 2010

4.  Effects of a mindfulness-based intervention during pregnancy on prenatal stress and mood: results of a pilot study. Archives of Women’s Mental Health. 2008.

5. [Effects of prenatal yoga: a systematic review of randomized controlled trials]. Nihon Koshu Eisei Zasshi.2015.

6 .Yoga in Pregnancy. Clin Obstet Gynecol. 2016.

7. Potential for prenatal yoga to serve as an intervention to treat depression during pregnancy.Womens Health Issues. 2015 .

8. Mindfulness yoga during pregnancy for psychiatrically at-risk women: preliminary results from a pilot feasibility study.Complement Ther Clin Pract. 2012.

9. Yoga for prenatal depression: a systematic review and meta-analysis, BMC Psychiatry. 2015.

10.Effects of prenatal yoga on women's stress and immune function across pregnancy: A randomized controlled trial. Complement Ther Med. 2017.

11. Yoga during pregnancy: The effects on labor pain and delivery outcomes (A randomized controlled trial).  Complement Ther Clin Pract. 2017.

12. The effect of prenatal Hatha yoga on affect, cortisol and depressive symptoms. Complement Ther Clin Pract. 2014.

13. The Effects of Prenatal Yoga on Birth Outcomes: A Systematic Review of the Literature. Journal of Prenatal & Perinatal Psychology & Health. 2013.

14. The effects of mindfulness-based yoga during pregnancy on maternal psychological and physical distress. J Obstet Gynecol Neonatal Nurs. 2009.

15. Benefits of preparing for childbirth with mindfulness training: a randomized controlled trial with active comparison, BMC Pregnancy Childbirth. 2017.

16. CALM Pregnancy: Results of a Pilot Study of Mindfulness-Based Cognitive Therapy for Perinatal Anxiety. Arch Womens Ment Health. 2014.

17.Prenatal meditation influences infant behaviors. Infant Behav Dev. 2014.

18. Maternal mindfulness and anxiety during pregnancy affect infants’ neural responses to sounds. Social Cognitive and Affective Neuroscience,2015.

19. Yoga can improve ART outcomes in couples with infertility. Altern Ther Health Med 2018.

20. Yoga: an adjunct to infertility treatment. Fertil Steril. 2003.

21. Meditation for preterm birth prevention: A randomized controlled trail in Udonthani, Thailand. International Journal of Public Health. 2016.

22. Effects of a mindfulness-based intervention during pregnancy on prenatal stress and mood. Arch Womens Ment Health. 2008.

23 Brain mechanisms supporting the modulation of pain by mindfulness meditation. J Neurosci. 2011.

24. Impact of prenatal exercise on both prenatal and postnatal anxiety & depressive symptoms. Br J Sports Med. Nov 2018

25. Effects of exercise-based interventions on postpartum depression: A meta-analysis of randomized control trials. Birth. Sept 2017

26. Efficacy of yoga for depressed and postpartum women: A randomized controlled trial. Complement Ther Clin Pract. May 2015

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