Effectiveness of walking and prenatal yoga on stress, cortisol, and blood pressure among pregnant women at high risk of preeclampsia
Abstract
Background: Preeclampsia is associated with vascular dysfunction, sympathetic nervous system activation, and increased stress responses. Elevated pregnancy-related stress and cortisol levels may contribute to early blood pressure dysregulation preceding preeclampsia.
Objective: This study evaluated the effectiveness of a combined walking and prenatal yoga program in reducing stress, cortisol levels, and blood pressure among pregnant women at high risk of preeclampsia.
Methods: A quasi-experimental pretest–posttest control group study was conducted among 58 high-risk pregnant women recruited through multistage sampling with matching to ensure comparable risk factors between groups. The intervention group received a combined walking and prenatal yoga program for 12 weeks. Outcomes included pregnancy-related stress, cortisol levels, systolic blood pressure, diastolic blood pressure, and mean arterial pressure (MAP). Stress was measured using the Revised Prenatal Distress Questionnaire (NuPDQ), cortisol levels using ELISA, and blood pressure using a calibrated sphygmomanometer. Data were analyzed using Mann–Whitney U, independent t-test, Chi-square, paired t-test, and Wilcoxon signed-rank tests with p<0.05.
Results: Compared with the control group, the intervention reduced pregnancy-related stress (Δ −3.58 vs +2.34), cortisol (Δ −1.38 vs +1.33), systolic blood pressure (Δ −1.89 vs +7.41), diastolic blood pressure (Δ −5.68 vs +6.37), and MAP (Δ −5.03 vs +1.96), with all outcomes showing significant differences (p<0.05) and moderate-to-large effect sizes (ES=0.66–1.36).
Conclusion: The combined walking and prenatal yoga program effectively improved psychological and physiological outcomes and may serve as an early non-pharmacological strategy for preeclampsia prevention.
Full text article
References
2. Yang M, Wang M, Li N. Advances in pathogenesis of preeclampsia. Arch Gynecol Obstet. 2024;309(5):1815-1823. doi:10.1007/s00404-024-07393-6
3. Phipps EA, Thadhani R, Benzing T, Karumanchi SA. Pre-eclampsia: pathogenesis, novel diagnostics and therapies. Nat Rev Nephrol. Nature Publishing Group. 2019;15(5):275-289. doi:10.1038/s41581-019-0119-6
4. Elawad T, Scott G, Bone JN, et al. Risk factors for pre‐eclampsia in clinical practice guidelines: Comparison with the evidence. BJOG. 2024;131(1):46-62. doi:10.1111/1471-0528.17320
5. Zhang S, Ding Z, Liu H, et al. Association between mental stress and gestational hypertension/preeclampsia: a meta-analysis. Obstet Gynecol Surv. 2013;68(12):825-834. doi:10.1097/OGX.0000000000000001
6. Lei AA, Phang VWX, Lee YZ, et al. Chronic stress-associated depressive disorders: the impact of HPA axis dysregulation and neuroinflammation on the hippocampus a mini review. Int J Mol Sci. 2025;26(7):2940. doi:10.3390/ijms26072940
7. Liu CH, Zhang HY, Wang F, Mu SS, Wen FY. Anxiety and hypertensive disorders of pregnancy: epidemiology, mechanisms, and management strategies. World J Psychiatry. 2025; 19;15(6):105944. doi:10. 5498/wjp.v15.i6.105944
8. Wang X, Sahota DS, Wong L, Nguyen-Hoang L, Chen Y, Tai AST, Liu F, Lau SL, Lee APW, Poon LC. Prediction of pre-eclampsia using maternal hemodynamic parameters at 12 + 0 to 15 + 6 weeks. Ultrasound Obstet Gynecol. 2025;65(2):173-182. doi: 10.1002/uog.29177.
9. Green DJ, Smith KJ. Effects of exercise on vascular function, structure, and health in humans. Cold Spring Harb Perspect Med. 2018; 2;8(4):a029819. doi:10.1101/cshperspect.a029819
10. Sánchez-Polán M, Brik M, Silva-Jose C, et al. Physical activity during pregnancy and depression, anxiety and stress: randomized clinical trials. Am J Obstet Gynecol MFM. 2026;8(1):101835. doi:10.1016/j.ajogmf.2025.101835
11. Cahn BR, Goodman MS, Peterson CT, Maturi R, Mills PJ. Yoga, meditation and mind-body health: Increased BDNF, cortisol awakening response, and altered inflammatory marker expression after a 3-month yoga and meditation retreat. Front Hum Neurosci. 2017; 26:11:315. doi:10.3389/fnhum.2017.00315
12. Arora S, Bhattacharjee J. Modulation of immune responses in stress by yoga. Int J Yoga. 2008 ;1(2):45-55. doi: 10.4103/0973-6131.43541.
13. Zainiyah H, Wayan Noviani N, Hipni R. The positive effect of black cumin ethanol extract (nigella sativa) on decreasing serum TNF-α levels and interleukin-8 levels in mice model of preeclampsia. 2018; 29 (21): 3801-3806. doi: 10.4066/ biomedical research.29-18-1097.
14. Birsner ML, Gyamfi-Bannerman C. Physical activity and exercise during pregnancy and the postpartum period. Obstetrics & Gynecology. 2020;135(4):e178-e188. doi: 10.1097/AOG. 0000000000003772.
15. Corrigan L, Moran P, McGrath N, Eustace-Cook J, Daly D. The characteristics and effectiveness of pregnancy yoga interventions: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2022; 25;22(1):250.doi:10.1186/s12884-022-04474-9
16. Karakaş S, Özcan H, Uzun S. Impact of Pregnancy Yoga on Maternal Mental Well-Being: A Meta-Analysis Research. Holist Nurs Pract. 2026;9 (1):10.1097. doi: 10.1097/HNP.0000000000000776
17. Chen PJ, Yang L, Chou CC, Li CC, Chang YC, Liaw JJ. Effects of prenatal yoga on women’s stress and immune function across pregnancy: A randomized controlled trial. Complement Ther Med. 2017;31:109-117. doi:10.1016/j.ctim.2017.03.003
18. Kusaka M, Matsuzaki M, Shiraishi M, Haruna M. Immediate stress reduction effects of yoga during pregnancy: one group pre–post test. Women and Birth. 2016;29(5):e82-e88.doi:10.1016/j.wombi.2016.04.003
19. Aflahiyah S, Tamtomo DG, Prasetya H. A Meta-Analysis on the effectiveness of prenatal yoga in reducing cortisol hormone in pregnancy. The International Conference on Public Health Proceeding. 2020; 5(01): 415. doi:10.26911/the7thicph.05.47
20. Bershadsky S, Trumpfheller L, Kimble HB, Pipaloff D, Yim IS. The effect of prenatal Hatha yoga on affect, cortisol and depressive symptoms. Complement Ther Clin Pract. 2014;20(2):106-113. doi:10.1016/j.ctcp.2014.01.002
21. Lučovnik M, Lackner HK, Žebeljan I, et al. Effect of Prenatal yoga versus moderate-intensity walking on cardiorespiratory adaptation to acute psychological stress: insights from non-invasive beat-to-beat monitoring. Sensors. 2024;24(5). doi:10.3390/s24051596
22. Zhu Z, Xie H, Liu S, et al. Effects of physical exercise on blood pressure during pregnancy. BMC Public Health. 2022;22(1). doi:10.1186/s12889-022-14074-z
23. Rodrigues-Denize N, Zolnikov BTR, Furio F. A systematic review on the physical, mental, and occupational effects of exercise on pregnant women. Dialogues in Health. Elsevier B.V. 2024;4. doi:10.1016/j.dialog.2024.100181
24. Žebeljan I, Lučovnik M, Dinevski D, et al. effect of prenatal yoga on heart rate variability and cardio-respiratory synchronization: a prospective cohort study. J Clin Med. 2022;11(19). doi:10.3390/jcm11195777
25. Barakat R, Silva-Jose C, Zhang D, Sánchez-Polán M, Refoyo I, Montejo R. Influence of physical activity during pregnancy on maternal hypertensive disorders: a systematic review and meta-analysis of randomized controlled trials. J Pers Med. Multidisciplinary Digital Publishing Institute (MDPI). 2024;14(1). doi:10.3390/jpm14010010
26. Rinne GR, Hartstein J, Guardino CM, Dunkel Schetter C. Stress before conception and during pregnancy and maternal cortisol during pregnancy: A scoping review.Psychoneuroendocrinology. 2023;153:106115. doi.10.1016/ j.psyneuen.2023.106115
27. Dixit H, Hegde A, Jain R, Tiwari R, Managutti A, Syed AK. Evaluation of impact of physical activity on maternal health and pregnancy outcome a clinical study. Journal of Contemporary Clinical Practice. 2025;11(6):859-863. doi:10.61336/jccp/25-06-122
Authors
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.