Prenatal listening to songs composed for pregnancy and symptoms of anxiety and depression: a pilot study

Effect of music intervention on perinatal depressive symptoms: A meta-analysis

BACKGROUND

Little is known about the effect of music intervention on perinatal depressive symptoms (PDS), especially the effectiveness of specific aspects of the intervention. This meta-analysis aimed to evaluate the effectiveness of music intervention and explore the role of different intervention features.

METHODS

Six databases were searched from inception to May 21, 2024, to identify randomized controlled trials evaluating the effect of music intervention on PDS. The Cochrane Risk of Bias (RoB) 2.0 tool was used to assess RoB.

RESULTS

The meta-analysis of 10 studies including 988 participants showed that music intervention significantly improved PDS (standardized mean difference (SMD): 0.61, 95% confidence interval (CI): 0.91, -0.32), with statistical heterogeneity among the studies (I2 = 78%). Subgroup analysis showed significant effects on pregnant and postpartum women, and women with or without perinatal complications. Effects were also significant in low- and middle-income countries (SMD: 0.79, 95% CI: 1.16, -0.42), music medicine (SMD: 0.82, 95% CI: 1.17, -0.47), and total intervention length of less than 6 weeks (SMD: 0.85, 95% CI: 1.25, -0.45), but not in high-income countries, music therapy, or total intervention length of 6 weeks or more. Hospital intervention (SMD: 0.86, 95% CI: 1.41, -0.31) showed greater effects compared with home intervention and hospital combined with home intervention. Six studies had a high overall RoB and four had some concerns.

CONCLUSIONS

Music intervention is effective in alleviating PDS. Interventions in low- and middle-income countries, music medicine, total intervention length of less than 6 weeks, and hospital intervention may be advisable.

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 music played to new birth mothers on postpartum blues: A randomized controlled trial

BACKGROUND

Postpartum blues/postpartum maternal blues is a psychological disorder experienced by mothers with symptoms of postpartum sadness, easy crying, easy anxiety, sensitivity, indecisiveness. The study aimed to examine the effect of music played on newly delivered mothers on postpartum blues.

METHODS

A prospective, two-arm, randomized controlled study was conducted on n = 82 (41 = control, 41 = music group) mothers who gave birth at term in Trakya University Health Research and Application Center Maternity Service between May and December 2023. The research data were collected through the Personal Information Form, Stein Blues Scale (SBS), and Edinburgh Postpartum Depression Scale (EPDS). The scales used in the study were evaluated four times: postoperative 0-3 h, 12th, 24th, and 36th hours.

RESULTS

The postoperative 0-3 h SBS test median of the new mothers in the music group was 19.00, and the 36th hours test median was 2.00, while the postoperative 0-3 h SBS test median of the control group was 21.00, and the 36th hour test median was 13.00. The postoperative 0-3 h EPDS test median of the new mothers in the music group was 22.00, and the 36th hours test median was 0.00, while the postoperative 0-3 h EPDS test median of the control group was 26.00, and the 36th hours test median was 10.00. A significant difference was found in the 12th, 24th, and 36th hours (p < .001). A statistically significant high positive correlation was found between EPDS and SBS in the 12th, 24th, and 36th hours (p < .001).

CONCLUSIONS

In the study, it was found that music played to newly delivered mothers reduced postpartum blues and depression levels.

REGISTRATION

The submission date for a clinical trial protocol is prior to completing participant recruitment and for a systematic review, prior to completing full paper screening. NCT06252155.

Maternal music exposure during pregnancy influences reflexive motor behaviors in mice offspring

Evidence supports that music can modulate many physiological roles, exerting clear effects on the central nervous system. For this effect to be positive, music should be tuned at a frequency of 432 Hz. This study aims to determine the effects of prenatal exposure to music on reflexive motor behaviors in mice offspring. Six pregnant female NMRI mice (8-10 weeks old) were randomly and equally allocated into two groups. Group 1 as control was placed in a normal housing area (average room noise 35 dB), and Group 2 was exposed to music pitched at 432 Hz for 2 h a day played at constant volume (75/80 dB) during pregnancy. Following delivery, four pups from each pregnant mouse were selected, and reflexive motor behaviors including ambulation, hind-limb foot angle, surface righting, grip strength, front- and hind-limb suspension, and negative geotaxis were determined. Based on the findings, prenatal exposure to music significantly increased ambulation score, grip strength, and front- and hind-limb suspension compared to the control group (P < 0.05). Also, prenatal exposure to music significantly decreased hind-limb foot angle, negative geotaxis, and surface righting compared to the control group (P < 0.05). These results suggested that music exposure during pregnancy had a significant positive effect on all tested reflexive motor behaviors in mice offspring.

The effect of emotional freedom technique and music applied to pregnant women who experienced prenatal loss on psychological growth, well-being, and cortisol level: A randomized controlled trial

INTRODUCTION

Research has shown that application of emotional freedom technique and music ensures psychological growth, increases well-being, and decreases cortisol level.

PURPOSE

In the study, it was aimed to determine the effect of EFT and music applied to pregnant women who had experienced prenatal loss on their psychological growth, well-being, and cortisol level.

METHODS

The study was conducted as a randomized controlled trial in a city hospital in eastern Türkiye with 159 pregnant women, 53 of whom were in the EFT, 53 in the music group, and 53 in the control group. The study data were collected through Subjective Units of Disturbance Scale (SUDS), Subjective Units of Experience (SUE) Scale, Post Traumatic Growth Inventory (PTGI), and WHO-5 Well-Being Index, and saliva samples were taken for cortisol evaluation. EFT was applied to the women two times every other week; the women in the music group listened to music two times every other week. Throughout the week following the first intervention, the women continued the interventions at home.

RESULTS

It was determined that EFT and music significantly decreased the participants' subjective anxiety and salivary cortisol median scores, the lowest anxiety was in the EFT group, and PTGI and WHO-5 Well-Being Index mean scores increased (p < 0.005). Further analyses showed that EFT was more effective in terms of increasing well-being than music (p < 0.001; a > b > c). It was determined that the anxiety levels and salivary cortisol median values of the control group were statistically significantly higher compared to the EFT and music groups (p < 0.001).

CONCLUSION

It was found that EFT and music applied to the women who had experienced prenatal loss decreased anxiety, ensured psychological growth, improved well-being, and decreased salivary cortisol level.

Effects of Auditory Enrichment on Welfare and Performance of Sows During Pregnancy and Farrowing/lactation Periods

This study is an observational study that aimed to evaluate whether exposure to music in the final third of sows' gestation and during farrowing/lactation would change behavior, reduce stress, and improve reproductive rates. Forty-eight sows were used at 90 days of gestation until the weaning of their piglets. During gestation, sows were divided into two treatments: control and with music enrichment. In farrowing/lactation, sows were divided into four treatments: control - control (without music); control - music (music during farrowing/lactation); music - control (music during pregnancy); music - music (music in both phases). Sows' behavior, eye temperature, and reproductive performance were evaluated. In the gestation phase, control group sows remained standing more times and had more negative interactions with the other sows in the pen. In the farrowing/lactating phase, sows exposed to music presented more nursing behaviors. The number of weaned piglets was higher in litters in which the sows had environmental enrichment in at least one of the phases of reproductive lives. Music may be used as environmental enrichment for sows in their reproductive phases due to beneficial responses in behavior, stress relief, and reproductive rates.

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.

Acute relaxation during pregnancy leads to a reduction in maternal electrodermal activity and self-reported stress levels

BACKGROUND

Prenatal maternal stress can have adverse effects on birth outcomes and fetal development. Relaxation techniques have been examined as potential countermeasures. This study investigates different relaxation techniques and their effect on self-reported stress levels and physiological stress levels in pregnant women.

METHODS

In this cross-sectional study, 38 pregnant women in their 30th to 40th gestational week were assigned to one of three, 20-min lasting relaxation groups: listening to music (N = 12), following a guided imagery (N = 12) or resting (N = 12). The intervention, i.e., acute relaxation (music, guided imagery or resting) took place once for each study participant. Study inclusion criteria were age over 18 years, German speaking, singleton and uncomplicated pregnancy during the 30th and 40th week of gestation. The stress levels were determined during the study. Current stress level during the study was assessed by a visual analogue scale. Chronic stress levels were assessed by the Trier Inventory of Chronic Stress and the Pregnancy Distress questionnaire. Multivariate analyses of covariance were performed and dependent measures included stress levels as well as physiological measures, i.e., cardiovascular activity (electrocardiogram) and skin conductance levels.

RESULTS

All three forms of relaxation led to reduced maternal stress which manifested itself in significantly decreased skin conductance, F(3,94) = 18.011, p = .001, η_p² = .365, and subjective stress levels after the interventions with no significant group difference. Post-intervention stress ratings were further affected by gestational age, with less subjective relaxation in women later in gestation, F (1, 34)=4.971, p = .032, η_p² = .128.

CONCLUSION

Independent of relaxation technique, single, 20-min relaxation intervention (music, guided imagery or resting) can significantly reduce maternal stress. Notably, women at an earlier stage in their pregnancy reported higher relaxation after the intervention than women later in gestation. Hence, gestational age may influence perceived stress levels and should be considered when evaluating relaxation or stress management interventions during pregnancy.

TRIAL REGISTRATION

Not applicable.

The effect of music, massage, yoga and exercise on antenatal depression: A meta-analysis

BACKGROUND

Prenatal depression affects 20.7 percent of women worldwide, which was associated with preterm birth, low birth weight and Apgar score, as well as cognitive, emotional and behavioral development disorders. We conducted a systematic review and meta-analysis to retrieve the latest and best evidence about music, massage, yoga and exercise in the prevention and treatment of prenatal depression, and to preliminarily compare the four methods to explore the most effective means. We also compared different types of yoga and music, in order to find the most effective type of intervention.

METHODS

A comprehensive literature search was carried out through six databases on randomized controlled trials (RCTs). Effects were summarized by a random effects model using mean differences with 95% confidence intervals. Evidence quality was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria.

RESULTS

This research found low to very low evidence that yoga, exercise, music and massage could reduce antenatal depression. Among them, music may be the most effective intervention, and integrated yoga other than simple yoga would improve prenatal depression. The effect of Chinese Medicine Five Element Music may be better than ordinary music.

CONCLUSION

It is important to support prenatal depression patients to make informed decisions about their behavior therapy.

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

The researchers' aims were to investigate the effects of music therapy applied to pregnant women on maternal, fetal, and neonatal results. Sample of the randomized controlled trial consisted of 100 (50 intervention, 50 control) primipara women. Nonstress Test was applied to women in 36th, 37th, and 38th gestational weeks. During the test, we played music to the intervention group and gave routine care to the control group. We determined that the mean scores of State Anxiety Inventory, evaluated during the Nonstress Test applications, decreased significantly after the application.Acceleration, mean number of fetal movements and reactivity findings were significantly higher in the intervention group. There was no significant difference between the groups in terms of the State Anxiety Inventory means after childbirth and neonatal findings. According to the results, we determined that the music therapy applied to pregnant women decreased maternal anxiety and had positive effects on Nonstress Test findings.

The effect of oxytocin massage and music on breast milk production and anxiety level of the mothers of premature infants who are in the neonatal intensive care unit: A self-controlled trial

This study was conducted to evaluate the effect of music and oxytocin massage on production and anxiety in mothers of premature infants. The study was designed in the self-controlled trial type and conducted with 73 mothers. The anxiety scores of mothers decreased in the oxytocin massage and the music interventions, and the amount of their breast milk secretion increased (p < 0.05). Music and oxytocin massage has a positive effect on increasing breast milk and decreasing the anxiety of mothers.

The influence of maternal singing on well-being, postpartum depression and bonding - a randomised, controlled trial

BACKGROUND

Postpartum depression is fairly common in new mothers and moreover associated with impaired bonding and poor maternal well-being. The aim of the present study was to investigate the impact of a mother-infant singing intervention within the first three months after birth on maternal well-being, depressive symptoms and bonding.

METHODS

120 women who were recruited at the maternity ward at the University Clinic in Düsseldorf took part in this prospective, randomised-controlled study. Beside the baseline measurement 1-3 days after childbirth, depressive symptoms, maternal well-being and mother-infant bonding were evaluated with questionnaires before (two weeks after birth) and after (twelve weeks after birth) the intervention took place. The experimental group (n = 59) participated in several singing intervention sessions while the control group (n = 61) did not. In the intervention group, salivary cortisol as well as attachment and mood were assessed immediately before and after the singing sessions.

RESULTS

The participants of the intervention group showed a significant reduction of cortisol (p = .023) and an improvement of attachment and mood from start to end of the intervention session (all p ≤ .008). However, no prolonged effects were revealed beyond the intervention sessions as the two groups did not differ regarding the alterations of the primary outcomes postpartum depression (interaction effect p = .187) and postpartum bonding (interaction effect p = .188) in the 10-week period from two up to twelve weeks after childbirth (all p > .05). Additional analyses of singing habits at home in both groups, revealed that only in the singing group more frequent singing was associated with less anxiety and more well-being of the mother.

CONCLUSION

Singing towards the infant seems to have positive immediate effects on the well-being of new mothers (on subjective variables as well as physiological measurements). However, the intervention did not lead to more long lasting positive effects although several limitations should be considered.

TRIAL REGISTRATION

DRKS00015178 (registered at the German Clinical Trial Registry), date of registration: 09.11.2018.

Interventions among Pregnant Women in the Field of Music Therapy: A Systematic Review

OBJECTIVE

 To investigate in the literature the studies on the benefits of music therapy interventions among pregnant women in the prenatal, delivery and postpartum periods.

DATA SOURCES

 The search for articles was carried out in the following electronic databases: VHL, LILACS, SciELO, Portal CAPES, PsycINFO, ERIC, PubMed/Medline, and journals specialized in this field: Revista Brasileira de Musicoterapia ("Brazilian Journal of Music Therapy") and Voices.

STUDY SELECTION

 Descriptors in Portuguese (musicoterapia, gravidez, gestantes, revisão), English (music therapy, pregnancy, pregnant women, review) and Spanish (musicoterapia, embarazo, mujeres embarazadas, revisión) were used. The search was delimited between January 2009 and June 2019. The process of selection and evaluation of the articles was performed through peer review.

DATA COLLECTION

 The following data were extracted: article title, year of publication, journal, author(s), database, country and date of collection, purpose of the study, sample size, type of care, intervention, instruments used, results, and conclusion. The data were organized in chronological order based on the year of publication of the study.

SUMMARY OF THE DATA

 In total, 146 articles were identified, and only 23 studies were included in this systematic review. The articles found indicate among their results relaxation, decreased levels of anxiety, psychosocial stress and depression, decreased pain, increase in the maternal bond, improvement in the quality of sleep, control of the fetal heart rate and maternal blood pressure, and decreased intake of drugs in the postoperative period.

CONCLUSION

 Music therapy during the prenatal, delivery and postpartum periods can provide benefits to pregnant women and newborns, thus justifying its importance in this field.

Prenatal music exposure influences weight, ghrelin expression, and morphology of rat hypothalamic neuron cultures

Music plays an important role in brain physiology, in some areas related to emotions, food intake and body weight, such as the hypothalamus. There are different frequencies to which it can be tuned, today the most utilized is at 440 Hz, while in the past the 432 Hz frequency was more used to show particular effects on brain. It is known that Ghrelin, a peptide hormone, regulates food intake in the hypothalamus; in a previous paper, we reported that musical stimuli at 432 Hz modified the Ghrelin expression in the rat, increasing beneficial effects on metabolism. In this study, we used this frequency and we focused our attention on body weight, Ghrelin expression, and neuron morphology in hypothalamic cultures. To investigate the role of music, we utilized newborn pups from pregnant rats that were exposed to music stimuli at 432 Hz during the perinatal period and for the postnatal period, some for 3 days (P3) and others for 6 days (P6). Some pups were not exposed to music stimuli (controls). Our results showed that music increased the body weight of pups; in addition, enhanced Ghrelin expression in hypothalamic neurons and their axonal elongation were highlighted by immunocytochemical techniques. Moreover, we found that the positive music effect started in pups at P3 and increased at P6 compared with controls. These results suggest that the musical frequency at 432 Hz could stimulate the orexigenic Ghrelin effects influencing the increase in body weight and affecting the number of hypothalamic neurons expressing Ghrelin.

Effects of music therapy on depression: A meta-analysis of randomized controlled trials

Background

We aimed to determine and compare the effects of music therapy and music medicine on depression, and explore the potential factors associated with the effect.

Methods

PubMed (MEDLINE), Ovid-Embase, the Cochrane Central Register of Controlled Trials, EMBASE, Web of Science, and Clinical Evidence were searched to identify studies evaluating the effectiveness of music-based intervention on depression from inception to May 2020. Standardized mean differences (SMDs) were estimated with random-effect model and fixed-effect model.

Results

A total of 55 RCTs were included in our meta-analysis. Music therapy exhibited a significant reduction in depressive symptom (SMD = −0.66; 95% CI = -0.86 to -0.46; P<0.001) compared with the control group; while, music medicine exhibited a stronger effect in reducing depressive symptom (SMD = −1.33; 95% CI = -1.96 to -0.70; P<0.001). Among the specific music therapy methods, recreative music therapy (SMD = -1.41; 95% CI = -2.63 to -0.20; P<0.001), guided imagery and music (SMD = -1.08; 95% CI = -1.72 to -0.43; P<0.001), music-assisted relaxation (SMD = -0.81; 95% CI = -1.24 to -0.38; P<0.001), music and imagery (SMD = -0.38; 95% CI = -0.81 to 0.06; P = 0.312), improvisational music therapy (SMD = -0.27; 95% CI = -0.49 to -0.05; P = 0.001), music and discuss (SMD = -0.26; 95% CI = -1.12 to 0.60; P = 0.225) exhibited a different effect respectively. Music therapy and music medicine both exhibited a stronger effects of short and medium length compared with long intervention periods.

Conclusions

A different effect of music therapy and music medicine on depression was observed in our present meta-analysis, and the effect might be affected by the therapy process.

Effect of music intervention on mental health in patients with diabetes mellitus: protocol for a systematic review and meta-analysis of randomizsed controlled trials

INTRODUCTION

About 463 million adults aged 20-79 have diabetes globally. Mental disorders often exist in patients with diabetes as comorbidities, which can lead to aggravation of the diseases, increased difficulties in treatment, as well as elevated mortality rates. Music intervention has been applied in the treatment of comorbidities for 12 years now, but there are still no recommendations due to the lack of evidence. Thus, a meta-analysis is necessary to evaluate the effect of music intervention in treating mental disorders of patients with diabetes.

METHODS AND ANALYSIS

We will search the following nine online electronic databases from their inception until March 2020: PubMed, Web of Science, Embase, EBSCO, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang Database, Chinese Scientific Journal Database (VIP) and Chinese Biomedical and Medical Database. We also plan to search other relevant resources, including grey literature and the reference lists of relevant publications. Only randomised controlled trials of music intervention to treat depression or anxiety in patients with diabetes will be involved. The primary outcomes include the depression score and anxiety score measured on certain scales, and the secondary outcome is safety. Data extraction will be independently implemented by two researchers. The risk of bias will be evaluated through the Cochrane Collaboration's Risk of Bias tool. Eventually, all the data will be analysed via the Review Manager V.5.3 software.

ETHICS AND DISSEMINATION

This meta-analysis will provide information about applying music intervention to treat depression or anxiety in patients with diabetes. No ethical approval is required because this meta-analysis is based on published data. The results of this systematic review will be published in a peer-reviewed journal.PROSPERO registration numberCRD42019146439.

The effects of a music and singing intervention during pregnancy on maternal well-being and mother-infant bonding: a randomised, controlled study

Purpose

Stress and impaired mother–infant bonding during pregnancy can lead to adverse effects for the expectant mother and the unborn child. The present study investigates whether a prenatal music and singing intervention can improve maternal well-being as well as mother–infant bonding.

Methods

A total of 172 pregnant women took part in this prospective, randomised, three-armed (music, singing or control group) study. Depressive symptoms, self-efficacy, maternal well-being and mother–infant bonding were assessed with visual analogue scales and questionnaires before the intervention phase (30th week of gestation) and afterwards (36th week of gestation). Additionally, immediate changes regarding experienced stress and mood from before until after the music and singing interventions were explored with questionnaires as well as saliva samples (for cortisol, alpha-amylase and oxytocin determination).

Results

Regarding immediate effects, both interventions showed positive effects on the emotional state, stress (cortisol) and bonding (oxytocin). Additionally, the singing group showed a larger reduction in cortisol and a larger improvement in valence than the music group. Looking at more prolonged effects, significant effects on general self-efficacy and perceived closeness to the unborn child (measured with a visual analogue scale) were found. No significant effects were revealed for the mother–infant bonding questionnaire and for depressive symptoms.

Conclusion

In the present study, promising effects of music and in particular singing on maternal well-being and perceived closeness during pregnancy appeared. Prenatal music and singing interventions could be an easy to implement and effective addition to improve mood and well-being of the expectant mother and support mother-infant bonding.

Trial registration number

DRKS00012822, date of registration: 17.10.2017

Electronic supplementary material

The online version of this article (10.1007/s00404-020-05727-8) contains supplementary material, which is available to authorized users.

Music-based interventions to improve fibromyalgia syndrome: A meta-analysis

OBJECTIVE

We evaluated the effects of music therapy on pain, depression and quality of life in patients with fibromyalgia.

METHODS

Ten online databases were searched to identify randomized controlled trials that investigated the effects of music therapy on fibromyalgia patients, published up to 1st January 2019. The results were filtered and independently extracted. Statistical heterogeneity was assessed using the chi-square test. According to the outcome of the heterogeneity indices, either a fixed effect or a random effect model was used.

RESULTS

In total, seven randomized controlled trials were included. The Pain Visual Analog Scale, the McGill Pain Scale, the Beck Depression Scale and the Fibromyalgia Impact Questionnaire were used as outcome measures. Our evidence indicated that patient intervention with music therapy had lower scores on the Pain Visual Analog Scale (95% confidence interval [CI] -2.22 to -1.18, Z = 6.44, P < 0.00001, four studies) and Beck Depression Scale (95% CI -0.65 to -0.03, Z = 2.17, P = 0.03, two studies). No significant differences were observed on the McGill Pain Scale between the music intervention and control groups (95% CI -0.83 to -0.09, Z = 1.59, P = 0.11). A general qualitative description of the Fibromyalgia Impact Questionnaire results was given due to high heterogeneity (I² = 96%, P < 0.00001).

CONCLUSIONS

The music therapy is superior to non-music therapy in the treatment of pain, depression, and improvement of quality of life in fibromyalgia patients. However, due to the low quantity and quality of the included studies, a larger number and high-quality of RCTs are needed to confirm the beneficial effects of music therapy.

Spotlight on the fetus: how physical activity during pregnancy influences fetal health: a narrative review

Before and during pregnancy, women often aim to improve their lifestyle so as to provide a healthier environment for their developing child. It remains unresolved, however, as to whether physical activity (PA) during pregnancy poses a possible risk or whether it might even have beneficial effects on the developing child. There is increasing evidence that PA during pregnancy is indeed beneficial to maternal physiological and psychological health and that it is generally not detrimental to the fetal cardiovascular system and neuronal function in the developing child. This also led to international recommendations for PAs during pregnancy. In the current review, we aimed to comprehensively assess the evidence of beneficial and harmful effects of maternal PA, including high-performance sports, on fetal development. The different mental and body-based relaxation techniques presented here are frequently performed during pregnancy. We found a considerable number of studies addressing these issues. In general, neither low key, moderate maternal PA nor relaxation techniques were observed to have a harmful effect on the developing child. However, we identified some forms of PA which could have at least a transient unfavourable effect. Notably, the literature currently available does not provide enough evidence to enable us to make a general conclusive statement on this subject. This is due to the lack of longitudinal studies on the metabolic and cognitive effects of regular PA during pregnancy and the wide diversity of methods used. In particular, the kind of PA investigated in each study differed from study to study.

Music Interventions for Anxiety in Pregnant Women: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Prenatal anxiety is extremely common and may result in adverse effects on both the mother and the baby. Music interventions have been used to reduce anxiety in various medical patients and in pregnant women during childbirth. This study aims to assess the clinical efficacy of music interventions in women during pregnancy rather than during labor. Seven databases were searched from inception to September 2019 without language restrictions. We included only randomized controlled trials that compared music intervention and control groups for anxiety reduction in pregnant women. We used the revised Cochrane risk-of-bias tool (RoB 2.0) for quality assessment. Finally, 11 studies with 1482 participants were included. The pooled meta-analysis results showed that music interventions significantly decreased anxiety levels (standardized mean difference (SMD), −0.42; 95% confidence interval (CI), −0.83 to −0.02; I² = 91%). Moreover, subgroup analysis showed that listening to music at home had significant anxiolytic benefits (SMD, −0.28; 95% CI, −0.47 to −0.08; I² = 0%). However, meta-regression revealed a nonsignificant trend for increase in the anxiety-reducing effects of music interventions with increasing maternal age. In conclusion, music interventions may be beneficial in reducing anxiety and may be applied in pregnant women.

The effect of complementary medicines and therapies on maternal anxiety and depression in pregnancy: A systematic review and meta-analysis

BACKGROUND

Depression and anxiety are common during the antenatal and postnatal period, and are known to have a significant impact on the woman and her unborn infant. Pregnant women state a preference for non-pharmacological treatment options, and use complementary medicines and therapies to manage these symptoms. We examined the effectiveness and safety of these modalities on depression and anxiety during pregnancy.

METHODS

CENTRAL, EMBASE and PubMed databases were searched for randomised controlled trials comparing complementary therapies and medicines to a control, for pregnant women with depression or anxiety. The primary outcome measure was antenatal depression or anxiety.

RESULTS

Twenty randomised controlled trials containing 1092 women were included in the review. We found some evidence of reduced antenatal depression from three modalities. Acupuncture reduced the number of women diagnosed with antenatal depression (RR 1.68, 95% CI 1.06-2.66, 1 trial). Massage reduced the severity of antenatal depression in one trial of 149 women (SMD -0.73, 95%CI -1.07--0.39). One small trial of bright light therapy found reduced antenatal depression (RR 4.80, 95% CI -8.39--1.21, 27 women). There was no evidence of a reduction in depression and anxiety from relaxation, yoga, mindfulness and fish oils. Overall the risk of bias was high or unclear for the majority of studies.

LIMITATIONS

There are few high quality randomised controlled trials of complementary medicines and therapies examining the effect on anxiety and depression.

CONCLUSION

Acupuncture, bright light therapy, and massage may reduce antenatal depression. There is a need for high quality and larger studies that include postnatal follow up and maternal and neonatal outcomes.

Fetal programming of neuropsychiatric disorders by maternal pregnancy depression: a systematic mini review

BACKGROUND

Maternal depression complicates a large proportion of pregnancies. Current evidence shows numerous harmful effects on the offspring. Reviews, which include depression, concluded that stress has harmful effects on the offspring's outcomes neuro-cognitive development, temperament traits, and mental disorders.

OBJECTIVE

This mini review of recent studies, sought to narrow the scope of exposure and identify studies specifically assessing prenatal depression and offspring neuropsychiatric outcomes.

STUDY ELIGIBILITY CRITERIA

The review included longitudinal, cohort, cross-sectional, clinical, quasi-experimental, epidemiological, or intervention study designs published in English from 2014 to 2018.

PARTICIPANTS

Study populations included mother-child dyads, mother-father-child triads, mother-alternative caregiver-child triads, and family studies utilizing sibling comparisons.

METHODS

We searched PubMED and Web of Science. Study inclusion and data extraction were based on standardized templates. The quality of evidence was assessed using the Newcastle-Ottawa Scale (NOS).

RESULTS

Thirteen studies examining neuropsychiatric outcomes were included. We judged the evidence to be moderate to high quality.

CONCLUSIONS

Our review supports that maternal prenatal depression is associated with neuropsychiatric adversities in children.

IMPLICATIONS

Future investigations should unravel the biological underpinnings and target timely interventions as early in pregnancy as possible to prevent offspring neuropsychiatric harms.

Prenatal maternal stress, fetal programming, and mechanisms underlying later psychopathology-A global perspective

There is clear evidence that the mother's stress, anxiety, or depression during pregnancy can alter the development of her fetus and her child, with an increased risk for later psychopathology. We are starting to understand some of the underlying mechanisms including the role of the placenta, gene-environment interactions, epigenetics, and specific systems including the hypothalamic-pituitary-adrenal axis and cytokines. In this review we also consider how these effects may be different, and potentially exacerbated, in different parts of the world. There can be many reasons for elevated prenatal stress, as in communities at war. There may be raised pregnancy-specific anxiety with high levels of maternal and infant death. There can be raised interpersonal violence (in Afghanistan 90.2% of women thought that "wife beating" was justified compared with 2.0% in Argentina). There may be interactions with nutritional deficiencies or with extremes of temperature. Prenatal stress alters the microbiome, and this can differ in different countries. Genetic differences in different ethnic groups may make some more vulnerable or more resilient to the effects of prenatal stress on child neurodevelopment. Most research on these questions has been in predominantly Caucasian samples from high-income countries. It is now time to understand more about prenatal stress and psychopathology, and the role of both social and biological differences, in the rest of the world.

Could listening to music during pregnancy be protective against postnatal depression and poor wellbeing post birth? Longitudinal associations from a preliminary prospective cohort study

OBJECTIVES

This study explored whether listening to music during pregnancy is longitudinally associated with lower symptoms of postnatal depression and higher well-being in mothers post birth.

DESIGN

Prospective cohort study.

PARTICIPANTS

We analysed data from 395 new mothers aged over 18 who provided data in the third trimester of pregnancy and 3 and 6 months later (0-3 and 4-6 months post birth).

PRIMARY AND SECONDARY OUTCOME MEASURES

Postnatal depression was measured using the Edinburgh Postnatal Depression Scale, and well-being was measured using the Short Warwick-Edinburgh Mental Well-being Scale. Our exposure was listening to music and was categorised as 'rarely; a couple of times a week; every day <1 hour; every day 1-2 hours; every day 3-5 hours; every day 5+hrs'. Multivariable linear regression analyses were carried out to explore the effects of listening to music during pregnancy on depression and well-being post birth, adjusted for baseline mental health and potential confounding variables.

RESULTS

Listening during pregnancy is associated with higher levels of well-being (β=0.40, SE=0.15, 95% CI 0.10 to 0.70) and reduced symptoms of postnatal depression (β=-0.39, SE=0.19, 95% CI -0.76 to -0.03) in the first 3 months post birth. However, effects disappear by 4-6 months post birth. These results appear to be particularly found among women with lower levels of well-being and high levels of depression at baseline.

CONCLUSIONS

Listening to music could be recommended as a way of supporting mental health and well-being in pregnant women, in particular those who demonstrate low well-being or symptoms of postnatal depression.