Background: In the USA, stillbirth (in utero fetal death ≥20 weeks gestation) is a major public health issue. Women who experience stillbirth, compared to women with live birth, have a nearly sevenfold increased risk of a positive screen for post-traumatic stress disorder (PTSD) and a fourfold increased risk of depressive symptoms. Because the majority of women who have experienced the death of their baby become pregnant within 12–18 months and the lack of intervention studies conducted within this population, novel approaches targeting physical and mental health, specific to the needs of this population, are critical. Evidence suggests that yoga is efficacious, safe, acceptable, and cost-effective for improving mental health in a variety of populations, including pregnant and postpartum women. To date, there are no known studies examining online-streaming yoga as a strategy to help mothers cope with PTSD symptoms after stillbirth.

Methods: The present study is a two-phase randomized controlled trial. Phase 1 will involve (1) an iterative design process to develop the online yoga prescription for phase 2 and (2) qualitative interviews to identify cultural barriers to recruitment in non-Caucasian women (i.e., predominately Hispanic and/or African American) who have experienced stillbirth (N = 5). Phase 2 is a three-group randomized feasibility trial with assessments at baseline, and at 12 and 20 weeks post-intervention. Ninety women who have experienced a stillbirth within 6 weeks to 24 months will be randomized into one of the following three arms for 12 weeks: (1) intervention low dose (LD) = 60 min/week online-streaming yoga (n = 30), (2) intervention moderate dose (MD) = 150 min/week online-streaming yoga (n = 30), or (3) stretch and tone control (STC) group = 60 min/week of stretching/toning exercises (n = 30).

Discussion: This study will explore the feasibility and acceptability of a 12-week, home-based, online-streamed yoga intervention, with varying doses among mothers after a stillbirth. If feasible, the findings from this study will inform a full-scale trial to determine the effectiveness of home-based online-streamed yoga to improve PTSD. Long-term, health care providers could use online yoga as a non-pharmaceutical, inexpensive resource for stillbirth aftercare.

Excessive gestational weight gain (GWG) during pregnancy is a major public health concern. Studies have reported more than 70% of pregnant women gain excessive weight which may pose increased maternal and fetal risks. Little is known about the relationships of GWG to behavioral factors (i.e., physical activity, sleep, social support) and maternal mental health (i.e., stress, anxiety, depression) during pregnancy. This descriptive, cross-sectional study explored the relationships of GWG to behavioral factors and maternal mental health during pregnancy. Secondarily, this study described the preferences, uses of, and interests in alternative approaches as well as the mental health differences between users and non-users of alternative approaches during pregnancy. A national survey was administered to women ≥8 weeks pregnant, ≥18 years old, and residing in the United States (N=968). Bivariate correlations were used to determine relationships between GWG and variables of interest. Independent t-tests were used to observe mental health differences between users and non-users of alternative approaches. Data were analyzed throughout pregnancy and by trimester. Throughout pregnancy, significant relationships were found in GWG to stressful events (r=-.112, p<.01), depression (r=.066, p<.05), mindfulness (r=-.067, p<.05), and sleep (r=.089, p<.01). When GWG was assessed by trimester, stressful events were significant in the second (r=-.216, p<.01) and third trimesters (r=-.085, p<.05). Depression remained positively related to GWG in the first (r=.409, p<.01) and second trimesters (r=.162, p<.01). A positive relationship emerged between GWG and anxiety in the first trimester (r=.340, p<.01) and physical activity became significant in the second (r=-.136; p<.05) and third trimesters (r=-.100; p<.05). Mindfulness was the only variable significantly related to GWG throughout all time points. Mean anxiety (d=.236; p=.001) and depression (d=.265; p<.001) scores were significantly lower in users compared to non-users of alternative approaches throughout pregnancy and when assessed by trimester anxiety (d=.424; p=.001) and depression (d=.526; p<.001) were significant in the second trimester. This study provides a framework for future analyses in GWG and maternal mental health. The information presented here may inform future interventions to test the effectiveness of alternative approaches to simultaneously manage maternal mental health and GWG due to the integrative nature of alternative approaches.