First published: 02/08/2024
Introduction
Hypertension is a prevalent complication in pregnancy, affecting up to 10% of pregnancies and significantly increasing maternal and fetal morbidity and mortality. Despite the severity, effective non-pharmacological treatments are limited. This study, first published online in January 2021, led by M. Felton, V. A. Hundley, S. Grigsby, and A. K. McConnell, explored the feasibility of using slow and deep breathing (SDB) as an intervention to reduce obstetric interventions in women with pregnancy-induced hypertension (PIH).
Slow and deep breathing (SDB) is a technique that involves reducing the breathing rate to fewer than 10 breaths per minute, typically guided by a video aid or other pacing tools. This practice aims to enhance relaxation and reduce stress, promoting a shift from sympathetic (stress-related) to parasympathetic (relaxation-related) nervous system activity.
Study Objective
The primary objective was to evaluate the acceptability of an SDB intervention among pregnant women with PIH. The study hypothesised that SDB, a lifestyle-related method previously shown to reduce blood pressure in primary hypertension, could be particularly effective in managing PIH due to its linkage with dysfunctional breathing patterns during pregnancy.
Methodology
Design: A feasibility study recruited 67 pregnant women diagnosed with PIH. The participants performed SDB daily for 10 minutes using a video aid and self-monitored their blood pressure (BP).
Recruitment and Participants: Women diagnosed with PIH according to NICE guidelines were recruited from an Antenatal Day Assessment Unit (ANDA) at a single NHS Foundation Trust. Recruitment included a diverse population representative of the typical patient demographic.
Intervention: The SDB intervention involved a guided breathing exercise at a rate of six breaths per minute, supported by a video aid accessible online or via download. Participants also self-monitored BP daily using validated devices.
Data Collection: Adherence, recruitment rates, and acceptance of the intervention were evaluated. Participants recorded their adherence and BP measurements daily and completed an online questionnaire at 36-weeks gestation to provide feedback on the intervention's acceptability and feasibility.
Results
The study found high acceptability and adherence to the SDB intervention among the participants. Over 80% of women adhered to the SDB protocol, completing the breathing exercises at least 57% of the time. The majority of women reported feeling empowered and reassured by self-monitoring their BP and using the SDB intervention.
Preliminary data indicated a reduction in systolic and diastolic BP among participants, suggesting a potential benefit of SDB in managing PIH. Additionally, there was a decrease in the need for obstetric interventions, with fewer women requiring medication or early delivery due to hypertension.
Discussion
This feasibility study addressed a critical gap in non-pharmacological treatments for PIH. By focusing on SDB, the study explored an accessible, low-cost intervention that could reduce the reliance on medications and decrease the frequency of hospital visits, especially crucial during the COVID-19 pandemic.
The results provided foundational data to support a larger randomised controlled trial (RCT), potentially establishing SDB as a standard non-pharmacological treatment for PIH. The study emphasised the importance of patient-centred research, ensuring that future interventions are both effective and acceptable to the target population.
Conclusion
The study by Felton et al. represented a promising step towards innovative, non-pharmacological management of PIH. The high acceptability and preliminary effectiveness of SDB in reducing BP and obstetric interventions highlighted its potential as a valuable treatment option for hypertensive pregnancies. Future research should focus on larger-scale trials to confirm these findings and further explore the benefits of SDB for pregnant women with PIH.
For more detailed information, the full study can be accessed here.
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