Improve the Psychological and Physical Health of Pregnant Low-Income Women with Mindfulness

By John M. de Castro, Ph.D.

“in pregnant women at high risk for excessive weight gain, it is both feasible and effective to use mindfulness strategies taught in a group format. Further, increases in certain mindfulness skills may help with better management of stress and overeating during pregnancy.” – Thomas Vieten

The period of pregnancy is a time of intense physiological and psychological change. Anxiety, depression, and fear are quite common during pregnancy. Pregnancy produces vast changes in the woman’s life, her body, her emotions, and her family. These changes may well be desired and welcomed, but they produce stress. Indeed, stress is a common experience in pregnancy. But it must be controlled. Too much stress can produce sleeping problems, headaches, loss of appetite or its opposite, overeating. If the levels of stress are high and prolonged it can produce health problems such as hypertension (high blood pressure) and heart disease in the mother. It can also make it more likely that the baby will be born prematurely or with a low birthweight, both of which are indicators of health problems for the infant and in the later child’s life. These stresses are magnified in low-income women.

So, it is important to either control stress during pregnancy or find ways to better cope with it. Mindfulness training has been shown to reduce the individual’s psychological and physiological responses to stress. Hence, mindfulness training may be a safe and effective method to assist the pregnant woman in coping with the stresses of pregnancy. Low-income women are particularly vulnerable to these stresses and have a high rate of rapid weight gain and metabolic syndrome during pregnancy. Indeed, mindfulness training appears to be effective in improving the mental and physical health of low-income individuals. Hence, it is important to study if mindfulness training can improve the health of low-income women.

In today’s Research News article “Effects of a Mindfulness-Based Intervention on Distress, Weight Gain, and Glucose Control for Pregnant Low-Income Women: A Quasi-Experimental Trial Using the ORBIT Model.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6785577/), Epel and colleagues recruited low-income overweight and obese, pregnant women who were in their12th to 19th week of gestation. They were provided with a 2 hour once a week for 8 weeks program of a Mindful Moms training program. This included mindful movements and mindfulness practices and discussions of stress reduction, mindful eating, and nutrition. They were compared to a comparable group who simply continued with their usual treatments. They were measured for gestational weight gain, postpartum weight retention, and before and after the intervention for physical activity perceived stress, depression, pregnancy related anxiety, acceptance of negative experiences, eating behaviors, eating addiction, and mindfulness. They also received a glucose tolerance test.

They found that in comparison to baseline the group that received mindfulness training had significant reductions in perceived stress, depression, food addiction, emotional eating, external eating and significant increases in acceptance of negative experiences, glucose tolerance, and physical activity. Both groups gained excessive weight during pregnancy and retained it postpartum with no significant differences.

Conclusions must be tempered with the knowledge that the women were not randomly assigned to intervention and control conditions, rather they were assigned based upon whether their schedules allowed participation in the mindfulness training classes. Hence, there may have been systematic differences between the groups at the outset.

Nevertheless, the results are both disappointing and encouraging. They were disappointing in that the intervention did not alter the high weight gains during pregnancy or their retention postpartum even though there were improvements in their eating behaviors, physical activity, and glucose tolerance. These women were overweight and obese at the beginning, so the excess weight gains are unwanted and may further damage their health and that of their offspring.

The results, however, are encouraging in that they suggest that mindfulness training may improve the psychological and physical health of these women. Having low-income provides additional difficulty and stress on these pregnant women. So, the ability of mindfulness training to reduce the stress and improve their psychological health is welcome. The improvements in physical activity and glucose tolerance may signal improvements in the overall metabolic health of these women. Follow ups of these women need to be pursued to determine if there were significant impacts of the training on the infants and their development.

So, improve the psychological and physical health of pregnant low-income women with mindfulness.

“women in the mindfulness group had lower stress levels, higher mindfulness measures, and lower weight gains during pregnancy.” Elissa Epel

CMCS – Center for Mindfulness and Contemplative Studies

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Study Summary

Epel, E., Laraia, B., Coleman-Phox, K., Leung, C., Vieten, C., Mellin, L., … Adler, N. (2019). Effects of a Mindfulness-Based Intervention on Distress, Weight Gain, and Glucose Control for Pregnant Low-Income Women: A Quasi-Experimental Trial Using the ORBIT Model. International journal of behavioral medicine, 26(5), 461–473. doi:10.1007/s12529-019-09779-2

Abstract

Background

Stress can lead to excessive weight gain. Mindfulness-based stress reduction that incorporates mindful eating shows promise for reducing stress, overeating, and improving glucose control. No interventions have tested mindfulness training with a focus on healthy eating and weight gain during pregnancy, a period of common excessive weight gain. Here, we test the effectiveness of such an intervention, the Mindful Moms Training (MMT), on perceived stress, eating behaviors, and gestational weight gain in a high-risk sample of low income women with overweight/obesity.

Method

We conducted a quasi-experimental study assigning 115 pregnant women to MMT for 8 weeks and comparing them to 105 sociodemographically and weight equivalent pregnant women receiving treatment as usual. Our main outcomes included weight gain (primary outcome), perceived stress, and depression.

Results

Women in MMT showed significant reductions in perceived stress (β = − 0.16) and depressive symptoms (β = − 0.21) compared to the treatment as usual (TAU) control group. Consistent with national norms, the majority of women (68%) gained excessive weight according to Institute of Medicine weight-gain categories, regardless of group. Slightly more women in the MMT group gained below the recommendation. Among secondary outcomes, women in MMT reported increased physical activity (β = 0.26) and had lower glucose post-oral glucose tolerance test (β = − 0.23), being 66% less likely to have impaired glucose tolerance, compared to the TAU group.

Conclusion

A short-term intervention led to significant improvements in stress, and showed promise for preventing glucose intolerance. However, the majority of women gained excessive weight. A longer more intensive intervention may be needed for this high-risk population.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6785577/