Abstract
Preterm birth is a highly prevalent phenomenon that was shown to be associated with mental stress during pregnancy (Rich-Edwards and Grizzard in Am J Obstet Gynecol 192(5 Suppl):S30–S35, 2005). We aimed to assess the effects of heart rate variability (HRV)-biofeedback in patients with preterm labour. Therefore, we conducted a controlled randomized parallel group study in 48 female patients aged 19–38 years (median = 29) with preterm labour at gestational week 24th–32nd (median = 29th). In this study, one group (n = 24) attended six sessions of HRV-biofeedback over 2 weeks whereas patients of the other group (n = 24) were assigned to control sessions. In the HRV-biofeedback treated group, perception of chronic stress was decreased 4 weeks after completion of training compared to baseline (p < 0.05) but there was no change in the control group. In the HRV-biofeedback group, preterm birth was seen in 3 patients (13 %) whereas in the control group, preterm delivery occurred in 8 patients (33 %, p = n.s.). There was no difference in birth weight between groups and HRV remained unchanged. In conclusion, our study demonstrates that HRV-biofeedback can reduce chronic stress in patients with preterm labour when administered as an adjunct to routine care. However, it remains unclear whether stress reduction through HRV-biofeedback has a beneficial effect on preterm birth.
Similar content being viewed by others
References
Agelink, M. W., Boz, C., Ullrich, H., & Andrich, J. (2002). Relationship between major depression and heart rate variability. Clinical consequences and implications for antidepressive treatment. Psychiatry Research, 113(1–2), 139–149.
Beck, A. T., Ward, C., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.
Beck, S., Wojdyla, D., Say, L., et al. (2010). The worldwide incidence of preterm birth: A systematic review of maternal mortality and morbidity. Bulletin of the World Health Organization, 88(1), 31–38.
Behrman, R. E., & Butler, A. S. (Eds.). (2007). Preterm birth: Causes, consequences, and prevention. Washington: National Academies Press.
Catipovic-Veselica, K., Galic, A., Jelik, K., et al. (2007). Relation between major and minor depression and heart rate, heart-rate variability, and clinical characteristics of patients with acute coronary syndrome. Psychological Reports, 100(3 Pt 2), 1245–1254.
Copper, R. L., Goldenberg, R. L., Das, A., et al. (1996). The preterm prediction study: Maternal stress is associated with spontaneous preterm birth at less than thirty-five weeks’ gestation. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. American Journal of Obstetrics and Gynecology, 175(5), 1286–1292.
Courtney, R., Cohen, M., & van Dixhoorn, J. (2011). Relationship between dysfunctional breathing patterns and ability to achieve target heart rate variability with features of “coherence” during biofeedback. Alternative Therapies in Health and Medicine, 17(3), 38–44.
Coussons-Read, M. E., Okun, M. L., Schmitt, M. P., & Giese, S. (2005). Prenatal stress alters cytokine levels in a manner that may endanger human pregnancy. Psychosomatic Medicine, 67(4), 625–631.
Culhane, J. F., Rauh, V. A., & Goldenberg, R. L. (2006). Stress, bacterial vaginosis, and the role of immune processes. Current Infectious Disease Reports, 8(6), 459–464.
Derogatis, L. R., & Melisaratos, N. (1983). The Brief Symptom Inventory: An introductory report. Psychological Medicine, 13(3), 595–605.
Field, T., Diego, M., & Hernandez-Reif, M. (2008). Prematurity and potential predictors. International Journal of Neuroscience, 118(2), 277–289.
Gennaro, S., & Hennessy, M. D. (2003). Psychological and physiological stress: Impact on preterm birth. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 32(5), 668–675.
Goldenberg, R. L., Culhane, J. F., Iams, J. D., & Romero, R. (2008). Epidemiology and causes of preterm birth. Lancet, 371(9606), 75–84.
Hassett, A. L., Radvanski, D. C., Vaschillo, E. G., et al. (2007). A pilot study of the efficacy of heart rate variability (HRV) biofeedback in patients with fibromyalgia. Applied Psychophysiology and Biofeedback, 32(1), 1–10.
Hedegaard, M., Henriksen, T. B., Sabroe, S., & Secher, N. J. (1993). Psychological distress in pregnancy and preterm delivery. British Medical Journal, 307(6898), 234–239.
Houtveen, J. H., Hornsveld, H. K., Van Trier, J., & Van Doornen, L. J. P. (2012). Vraagtekens bij het werkingsmechanisme van slow-breathing en hartcoherencetietraining. Tijdschrift Voor Psychiatrie, 54(10), 879–888.
Jartti, T. T., Kuusela, T. A., Kaila, T. J., Tahvanainen, K. U., & Välimäki, I. A. (1998). The dose-response effects of terbutaline on the variability, approximate entropy and fractal dimension of heart rate and blood pressure. British Journal of Clinical Pharmacology, 45(3), 277–285.
Karavidas, M. K., Lehrer, P. M., Vaschillo, E., et al. (2007). Preliminary results of an open label study of heart rate variability biofeedback for the treatment of major depression. Applied Psychophysiology and Biofeedback, 32(1), 19–30.
Kemp, A. H., Quintana, D. S., Felmingham, K. L., Matthews, S., & Jelinek, H. F. (2012). Depression, comorbid anxiety disorders, and heart rate variability in physically healthy, unmedicated patients: implications for cardiovascular risk. PLoS One, 7(2), e30777.
Klinkenberg, A. V., Nater, U. M., Nierop, A., Bratsikas, A., Zimmermann, R., & Ehlert, U. (2009). Heart rate variability changes in pregnant and non-pregnant women during standardized psychosocial stress. Acta Obstetricia et Gynecologica Scandinavica, 88(1), 77–82.
Landsbergis, P. A., & Hatch, M. C. (1996). Psychosocial work stress and pregnancy-induced hypertension. Epidemiology, 7(4), 346–351.
Lang, R. E., Heil, J. W., Ganten, D., Hermann, K., Unger, T., & Rascher, W. (1983). Oxytocin unlike vasopressin is a stress hormone in the rat. Neuroendocrinology, 37(4), 314–316.
Lehrer, P. M., Vaschillo, E., Vaschillo, B., et al. (2003). Heart rate variability biofeedback increases baroreflex gain and peak expiratory flow. Psychosomatic Medicine, 65(5), 796–805.
Lobel, M., Dunkel-Schetter, C., & Scrimshaw, S. C. (1992). Prenatal maternal stress and prematurity: A prospective study of socioeconomically disadvantaged women. Health Psychology, 11(1), 32–40.
Löllgen, D., Müeck-Weymann, M., & Beise, R. D. (2009). The deep breathing test: Median-based expiration–inspiration difference is the measure of choice. Muscle and Nerve, 39(4), 536–544.
Low, P. A., Caskey, P. E., Tuck, R. R., Fealey, R. D., & Dyck, P. J. (1983). Quantitative sudomotor axon reflex test in normal and neuropathic subjects. Annals of Neurology, 14(5), 573–580.
Mancuso, R. A., Schetter, C. D., Rini, C. M., Roesch, S. C., & Hobel, C. J. (2004). Maternal prenatal anxiety and corticotropin-releasing hormone associated with timing of delivery. Psychosomatic Medicine, 66(5), 762–769.
Marc, I., Toureche, N., Ernst, E., et al. (2011). Mind–body interventions during pregnancy for preventing or treating women’s anxiety. Cochrane Database of Systematic Reviews, 6(7), CD007559.
McCraty, R., Atkinson, M., & Tomasino, D. (2003). Impact of a work-place stress reduction program on blood pressure and emotional health in hypertensive employees. The Journal of Complementary and Alternative Medicine, 9(3), 355–369.
McIntire, D. D., & Leveno, K. J. (2008). Neonatal mortality and morbidity rates in late preterm births compared with births at term. Obstetrics and Gynecology, 111(1), 35–41.
Misra, D., Strobino, D., & Trabert, B. (2010). Effects of social and psychosocial factors on risk of preterm birth in black women. Paediatric and Perinatal Epidemiology, 24(6), 546–554.
Mück-Weymann, M., & Beise, R. (2005). Herzkohärenztraining—eine moderne Form der Stressbewältigung. Forum Stressmedizin, I, 1–5.
Nahshoni, E., Aravot, D., Aizenberg, D., et al. (2004). Heart rate variability in patients with major depression. Psychosomatics, 45(2), 129–134.
Nolan, R. P., Kamath, M. V., Floras, J. S., & Stanley, J. (2005). Heart rate variability biofeedback as a behavioral neurocardiac intervention to enhance vagal heart control. American Heart Journal, 149(6), 1137.
Novak, P. (2011). Quantitative autonomic testing. Journal of Visualized Experiments, 19(53). doi:10.3791/2502.
Obel, C., Hedegaard, M., Henriksen, T. B., Secher, N. J., Olsen, J., & Levine, S. (2005). Stress and salivary cortisol during pregnancy. Psychoneuroendocrinology, 30(7), 647–656.
Okun, A., Stein, R. E. K., Bauman, L. J., & Silver, E. J. (1996). Content validity of the Psychiatric Symptom Index, CES-depression Scale, and State-Trait Anxiety Inventory from the perspective of the DSM-IV. Psychological Reports, 79, 1059–1069.
Paul, M., & Garg, K. (2012). The effect of heart rate variability biofeedback on performance psychology of basketball players. Applied Psychophysiology and Biofeedback, 37(2), 131–144.
Pruessner, M., Hellhammer, D. H., Pruessner, J. C., & Lupien, S. J. (2003). Self-reported depressive symptoms and stress levels in healthy young men: Associations with the cortisol response to awakening. Psychosomatic Medicine, 65(1), 92–99.
Rechlin, T., Weis, M., Spitzer, A., & Kaschka, W. P. (1994). Are affective disorders associated with alterations of heart rate variability? Journal of Affective Disorders, 32(4), 271–275.
Rich-Edwards, J. W., & Grizzard, T. A. (2005). Psychosocial stress and neuroendocrine mechanisms in preterm delivery. American Journal of Obstetrics and Gynecology, 192(5 Suppl), S30–S35.
Satyapriya, M., Nagendra, H. R., Nagarathna, R., & Padmalatha, V. (2009). Effect of integrated yoga on stress and heart rate variability in pregnant women. International Journal of Gynecology and Obstetrics, 104(3), 218–222.
Schetter, C. D. (2011). Psychological science on pregnancy: Stress processes, biopsychosocial models, and emerging research issues. Annual Review of Psychology, 62, 531–558.
Shea, A. K., Kamath, M. V., Fleming, A., Streiner, D. L., Redmond, K., & Steiner, M. (2008). The effect of depression on heart rate variability during pregnancy. Clinical Autonomic Research, 18(4), 203–212.
Siepmann, M., Aykac, V., Unterdörfer, J., Petrowski, K., & Mueck-Weymann, M. (2008). A pilot study on the effects of heart rate variability biofeedback in patients with depression and in healthy subjects. Applied Psychophysiology and Biofeedback, 33(4), 195–201.
Siepmann, M., Joraschky, P., Rebensburg, M., et al. (2005). Is autonomic cardiac control disturbed in patients with depression and coronary artery disease? Zeitschrift für Klinische Psychologie und Psychotherapie, 34(4), 277–281.
Speranza, G., Verlato, G., & Albiero, A. (1998). Autonomic changes during pregnancy: Assessment by spectral heart rate variability analysis. Journal of Electrocardiology, 31(2), 101–109.
Spielberger, C. D. (1983). State-Trait Anxiety Inventory: A comprehensive bibliography. Palo Alto: Consulting Psychologist Press.
Stancil, T. R., Hertz-Picciotto, I., Schramm, M., & Watt-Morse, M. (2000). Stress and pregnancy among African-American women. Paediatric and Perinatal Epidemiology, 14(2), 127–135.
Teixeira, J. M., Fisk, N. M., & Glover, V. (1999). Association between maternal anxiety in pregnancy and increased uterine artery resistance index: Cohort based study. British Medical Journal, 318(7177), 153–157.
Togo, F., & Takahashi, M. (2009). Heart rate variability in occupational health—A systematic review. Industrial Health, 47(6), 589–602.
Walther, T., Wessel, N., Baumert, M., Stepan, H., Voss, A., & Faber, R. (2005). Longitudinal analysis of heart rate variability in chronic hypertensive pregnancy. Hypertension Research, 28(2), 113–118.
Walther, T., Wessel, N., Malberg, H., Voss, A., Stepan, H., & Faber, R. (2006). A combined technique for predicting pre-eclampsia: Concurrent measurement of uterine perfusion and analysis of heart rate and blood pressure variability. Journal of Hypertension, 24(4), 747–750.
Weidner, K., Bittner, A., Junge-Hoffmeister, J., et al. (2010). A psychosomatic intervention in pregnant in-patient women with prenatal somatic risks. Journal of Psychosomatic Obstetrics and Gynecology, 31(3), 188–198.
Wheat, A. L., & Larkin, K. T. (2010). Biofeedback of heart rate variability and related physiology: A critical review. Applied Psychophysiology and Biofeedback, 35(3), 229–242.
Yang, C. C., Chao, T. C., Kuo, T. B., Yin, C. S., & Chen, H. I. (2000). Preeclamptic pregnancy is associated with increased sympathetic and decreased parasympathetic control of HR. American Journal of Physiology. Heart and Circulatory Physiology, 278(4), H1269–H1273.
Yeragani, V. K., Rao, K. A., Pohl, R., Jampala, V. C., & Balon, R. (2001). Heart rate and QT variability in children with anxiety disorders: A preliminary report. Depression and Anxiety, 13(2), 72–77.
Zefferino, R., L’Abbate, N., Facciorusso, A., et al. (2003). Assessment of heart rate variability (HRV) as a stress index in an emergency team of urban police. Giornale Italiano di Medicina del Lavoro ed Ergonomia, 25(Suppl 3), 167–169.
Acknowledgments
The present work was part of a thesis. The authors are sincerely thankful to Mrs. E. Hempel, and Mrs. C. Schütte for their assistance in conducting the study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Siepmann, M., Hennig, UD., Siepmann, T. et al. The Effects of Heart Rate Variability Biofeedback in Patients with Preterm Labour. Appl Psychophysiol Biofeedback 39, 27–35 (2014). https://doi.org/10.1007/s10484-013-9238-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10484-013-9238-1