The effects of music therapy applied to pregnant women on maternal, fetal, and neonatal results: A randomized controlled study

The role and outcomes of music therapy during pregnancy: a systematic review of randomized controlled trials

INTRODUCTION

The abundant functions of music and its effects on human's mental and physical health have been verified since ancient times, but rarely received attention as an alternative obstetric intervention.

OBJECTIVE

This study aims to investigate the benefits of music therapy on prenatal and delivery experiences of pregnant women.

METHOD

A systematic search for articles was conducted in electronic databases including CINAHL, Web of Science, PubMed/Medline, and CNKI. A total of 240 articles were identified, and 17 studies were selected for this review. The extracted data included author, year, location, sample size, intervention phase, type of music, music therapy strategy, measuring instruments, and results. The data were organized chronologically based on the publication year of each study.

RESULT

The articles indicated that music therapy has advantages in reducing pain during childbirth, lowering anxiety and stress levels in mothers, improving sleep quality, and increasing fetal movements, basal fetal heart rate, and accelerations.

CONCLUSION

Based on the findings, it can be concluded that music therapy is an effective approach to enhance the experience of pregnant women during pregnancy and delivery. Therefore, its implementation in obstetrical clinical practice is highly recommended.

Effect of Music-Based Interventions on Maternal and Fetal Parameters during Pregnancy: A Systematic Review

INTRODUCTION

Music is a non-pharmacological intervention often used to improve maternal mental health during pregnancy. However, there is limited evidence regarding the effectiveness of music-based interventions on maternal and fetal parameters during pregnancy. We present a systematic review of the available research literature on the effects of music interventions on maternal and fetal parameters.

METHODS

A comprehensive literature search was conducted on the Web of Science, PubMed, ScienceDirect, Scopus, CINAHL, MEDLINE, Cochrane, ProQuest, and Turkish databases. The review included randomized controlled and quasi-experimental studies. Two independent authors evaluated the methodological quality of each study using the Quality Assessment Tool for Quantitative Studies. The study was registered in PROSPERO (CRD42018102914).

RESULTS

The literature review yielded a total of 723 studies. Among these studies, 13 were included in this study. Most of the studies involving low-risk pregnant women reported that music had no effect on stress but reduced anxiety and depression. The effect of music on pregnant women's blood pressure varied depending on the presence of medical conditions that could affect their blood pressure. While some studies showed that music interventions effectively increased fetal movement and acceleration, the available findings were limited.

CONCLUSION

Healthcare professionals can use simple, cost-effective, and practical music interventions to improve maternal mental health during pregnancy without neglecting medical treatment. Future well-designed studies are recommended to investigate the effects of music on maternal psychological, physiological parameters and fetal parameters in high-risk pregnancies.

Systematic review on music interventions during pregnancy in favor of the well-being of mothers and eventually their offspring

OBJECTIVE

Mental health affects maternal well-being and indirectly affects the development of fetal brain structures and motor and cognitive skills of the offspring up to adulthood. This study aimed to identify specific characteristics of music interventions that improve validated maternal outcomes.

DATA SOURCES

Randomized controlled trials and systematic reviews investigating music interventions during pregnancy were identified from the start of data sources up to December 2023 using MEDLINE, the Cochrane Central Register of Controlled Trials, or Web of Science.

STUDY ELIGIBILITY CRITERIA

Using Covidence, 2 reviewers screened for randomized controlled trials with ≥3 music interventions during pregnancy and applied either the Perceived Stress Scale score, State-Trait Anxiety Inventory score, Edinburgh Postnatal Depression Scale score, or blood pressure as outcomes.

METHODS

The Cochrane risk-of-bias tool 2, the checklist to assess Trustworthiness in RAndomised Clinical Trials, and the reversed Cohen d were applied. This review was registered in the International Prospective Register of Systematic Reviews (registration number: CRD42022299950).

RESULTS

From 251 detected records, 14 randomized controlled trials and 2375 pregnancies were included. Music interventions varied from 3 to 84 active or passive sessions with either patient-selected or preselected music and a duration of 10 to 60 minutes per session. Thereby, 2 of 4 studies observed a significant decrease in the Perceived Stress Scale, 8 of 9 studies observed a significant decrease in the State-Trait Anxiety Inventory, and 3 of 4 studies observed a significant decrease in the Edinburgh Postnatal Depression Scale. Blood pressure was significantly reduced in 3 of 4 randomized controlled trials. The Cochrane risk-of-bias tool 2 was "high" in 5 of 14 studies or "with concerns" in 9 of 14 studies. Stratifying the Cohen d in 14 intervention arms suggested a big effect in 234 of 469 mothers on blood pressure and in 244 of 489 mothers on maternal anxiety and a medium effect in 284 of 529 mothers on maternal anxiety. Small or very small effects on blood pressure, the Edinburgh Postnatal Depression Scale, and the Perceived Stress Scale were observed in 35 of 70, 136 of 277, and 374 of 784 mothers-to-be, respectively.

CONCLUSION

Our study found a general positive effect of music interventions on maternal stress resilience. This was independent of the music but was influenced by the frequency and empathy of the performances. How far music interventions may improve postnatal development and skills of the offspring should be increasingly evaluated with follow-ups to interrupt vicious epigenetic circles during global pandemics, violent conflicts, and natural catastrophes. El resumen está disponible en Español al final del artículo.

The effect of virtual reality and music on anxiety, non-stress test parameters, and satisfaction of high-risk pregnant women undergoing non-stress tests: Randomized controlled trial

BACKGROUND

Prenatal tests cause high-risk pregnant women to experience high anxiety levels.

AIM

This paper investigated the effect of Virtual Reality (VR) and music on anxiety, non-stress test parameters, and satisfaction of high-risk pregnant women undergoing non-stress tests (NSTs).

METHODS

This was a randomized controlled trial. The sample consisted of 102 participants randomized into three groups (VR = 34, music = 34, and control = 34). Maternal anxiety was assessed using the Spielberger State-Trait Anxiety Inventory-S (STAI-S) before and after NSTs. Satisfaction was evaluated using the Visual Analogue Scale (VAS) after NSTs. NST parameters were evaluated after NSTs. The findings were reported based on the Consolidated Standards of Reporting Trials (CONSORT).

RESULTS

The VR and music groups had significantly lower mean posttest STAI-S scores than the control group (p <.05). There was no significant difference in NST findings (reactive/nonreactive) between the groups (p >.05). The VR group had a significantly shorter reactive NST duration than the control group (p <.05). The VR and music groups had significantly higher mean VAS-satisfaction scores than the control group (p <.05) CONCLUSION: Virtual reality and music during NSTs help high-risk pregnant women experience less anxiety and satisfy them more with the procedure. We recommend that obstetric midwives and nurses use these low-cost, simple, and noninvasive methods to reduce anxiety in high-risk pregnant women during prenatal testing.

Prenatal daily musical exposure is associated with enhanced neural representation of speech fundamental frequency: Evidence from neonatal frequency-following responses

Fetal hearing experiences shape the linguistic and musical preferences of neonates. From the very first moment after birth, newborns prefer their native language, recognize their mother's voice, and show a greater responsiveness to lullabies presented during pregnancy. Yet, the neural underpinnings of this experience inducing plasticity have remained elusive. Here we recorded the frequency-following response (FFR), an auditory evoked potential elicited to periodic complex sounds, to show that prenatal music exposure is associated to enhanced neural encoding of speech stimuli periodicity, which relates to the perceptual experience of pitch. FFRs were recorded in a sample of 60 healthy neonates born at term and aged 12-72 hours. The sample was divided into two groups according to their prenatal musical exposure (29 daily musically exposed; 31 not-daily musically exposed). Prenatal exposure was assessed retrospectively by a questionnaire in which mothers reported how often they sang or listened to music through loudspeakers during the last trimester of pregnancy. The FFR was recorded to either a /da/ or an /oa/ speech-syllable stimulus. Analyses were centered on stimuli sections of identical duration (113 ms) and fundamental frequency (F0  = 113 Hz). Neural encoding of stimuli periodicity was quantified as the FFR spectral amplitude at the stimulus F0 . Data revealed that newborns exposed daily to music exhibit larger spectral amplitudes at F0 as compared to not-daily musically-exposed newborns, regardless of the eliciting stimulus. Our results suggest that prenatal music exposure facilitates the tuning to human speech fundamental frequency, which may support early language processing and acquisition. RESEARCH HIGHLIGHTS: Frequency-following responses to speech were collected from a sample of neonates prenatally exposed to music daily and compared to neonates not-daily exposed to music. Neonates who experienced daily prenatal music exposure exhibit enhanced frequency-following responses to the periodicity of speech sounds. Prenatal music exposure is associated with a fine-tuned encoding of human speech fundamental frequency, which may facilitate early language processing and acquisition.

The effect of virtual reality on fetal movement, fetal heart rate, maternal satisfaction, fatigue, and anxiety levels and vital signs of pregnant women during non-stress test: A randomized controlled trial

The study was conducted to investigate the effect of virtual reality on fetal movement, fetal heart rate, maternal satisfaction, fatigue and anxiety levels.

The data of this randomized control experimental design study were collected using the State Anxiety Inventory, the Visual Analogue for Fatigue and the Newcastle-Satisfaction-Nursing-Care-Scale. A total of 88 pregnant women were included in the study. While the pregnant women in the experimental group watched a nature video with virtual reality during the Non-Stress Test procedure, those in the control group underwent the routine Non-Stress Test. The anxiety scores, the maternal satisfaction scores significantly higher in the experimental group. The virtual reality application is effective in reducing fatigue. There was a significant difference only in the experimental group in terms of systolic blood pressure, pulse values, the number of fetal movements and accelerations. It is recommended to have pregnant women use virtual reality during the Non-Stress Test procedure.

The effects of listening to lullabies and self-selected music at home on prenatal stress and anxiety in nulliparous pregnant women: A randomized-controlled study

To compare the effects of nulliparous pregnant women listening to lullabies and self-selected music on reducing the anxiety and antenatal stress. This was a randomized controlled study. Lullaby group (LG) (n = 40) listened to the lullaby chosen by the researcher, mixed music group (MG) (n = 40) listened to self-selected music and control group (CG) (n = 40) received general care. Post-test anxiety and stress levels was lower in two intervention groups versus CG (p < 0.01). Post-test anxiety was lower in the MG versus LG (p < 0.01), however post-test stress levels were similar. Pregnant women listening to self-selected music at home is more effective in reducing anxiety.

The effect of music-based interventions on short-term postpartum episiotomy pain: A systematic review and meta-analysis

Episiotomy took over as the most common surgery in the field of midwifery that was performed in the second stage of labor to facilitate delivery, and reduce perineal damage. Music is one of the methods used to combat pain. We applied a meta-analysis to investigate whether music-based interventions can reduce short-term postpartum episiotomy pain. Four main English databases including Embase, PubMed, Web of Science, and Scopus were searched until July 2022. All randomized controlled trials (RCTs) with at least two groups (control and intervention) that aimed to measure the effect of music therapy on episiotomy pain were included in the present review. The Cochrane risk of bias checklist was used to assess study quality. Study heterogeneity was determined using the I² statistic and publication bias using Begg's and Egger's tests. Results of random effect analysis are presented as Standard Mean Difference (SMD) with 95% confidence intervals (CI). Data were analyzed using the STATA software version 16. In total, seven articles with 677 subjects were included in the meta-analysis. Overall, the pool estimates of the meta-analysis demonstrated that music therapy has a positive impact on reducing short-term pain derived from episiotomy in both primiparous and multiparous compared to the control group (pooled SMD = -1.60; CI = -2.18, -1.02, p-value<0.001). The heterogeneity was high among including studies (I² = 95.7%, p < 0.001). Our result showed that music-based interventions can be considered a choice for the management of short-term postpartum episiotomy pain among both primiparous and multiparous women. Future studies with large sample sizes and longer follow-up periods will be required to draw better conclusions about the long-term effects on postpartum pain.

Art-based interventions for women's mental health in pregnancy and postpartum: A meta-analysis of randomised controlled trials

Objective

Pregnant and postpartum women are vulnerable to psychological problems with a high estimated prevalence. To date, there is no meta-analysis that specifically assesses the effectiveness of art-based interventions to improve mental health in pregnant and postpartum women. The objective of this meta-analysis was to assess the efficacy of art-based interventions when delivered to pregnant and postpartum women.

Methods

Systematic literature searches were conducted from the inception to 6 March 2022 in seven English databases, including PubMed, Embase, Cochrane Central Register, CINAHL, ProQuest, Scopus, and Web of Science. Randomised controlled trials (RCTs) reporting art-based interventions targeting the improvement of women's mental health in pregnancy and postpartum were included. Cochrane risk of bias tool was applied to assess evidence quality.

Results

Twenty-one randomised controlled trials (RCTs) involving 2,815 participants were eligible for data analysis. A pooled analysis demonstrated that art-based interventions significantly reduced anxiety (SMD = -0.75, 95% CI = -1.10 to -0.40) and depression symptoms (MD = -0.79, 95% CI = -1.30 to -0.28). However, art-based interventions did not alleviate stress symptoms as expected in our findings. Subgroup analysis demonstrated that intervention implementation time, intervention duration and music selected by the participants vs. not could have influence on the efficacy of art-based intervention for anxiety.

Conclusion

In perinatal mental health, art-based interventions may be effective in alleviating anxiety and depression. In the future, we still need to conduct high-quality RCTs to validate our findings and enrich clinical application of art-based interventions.