The efficacy of biobehavioral and compliance interventions in the adjunctive treatment of mild pregnancy-induced hypertension

Abstract

This investigation assessed the efficacy of a biobehavioral intervention in the adjunctive treatment of mild pregnancy-induced hypertension (PIH), a potentially serious complication of pregnancy in which normotensive women develop hypertension, proteinuria, and edema of unknown etiology late in gestation. Forty-five women with symptoms of PIH were randomly assigned to one of three treatment conditions: bed rest alone (the most common obstetrical treatment), bed rest with individualized compliance enhancement training, or a four-session biobehavioral treatment consisting of bed rest, compliance enhancement training, and individualized thermal biofeedback-assisted relaxation training. Results indicated that while blood pressure for the bed rest and compliance enhancement groups continued to rise and pose an increasing health risk to maternal and fetal well-being, subjects in the biobehavioral group maintained their blood pressure at a significantly lower, and presumably safer, level. The biobehavioral treatment is hypothesized to affect blood pressure levels in subjects with mild PIH through the mediation of the sympathetic nervous system, decreasing peripheral vascular resistance and cardiac output. The results of this investigation suggest that the biobehavioral intervention may be an effective adjunct to bed rest in the treatment of mild PIH remote from term.

Promoting Health and Well-being in Lives of People Living with HIV and AIDS

“…Interventions through changing the behavioural aspects, like relaxation, adherence to medication, compliance enhancement, bio-feedback techniques, health behaviour practices, exercise, etc., have been carried out to measure its effect on the biological parameters and patho-physical mechanisms (e.g., cardiovascular mechanisms, weight control, cortisol level, immune parameters, etc.). Bio-behavioural interventions have used different behavioural and cognitive nonpharmacologic techniques, like bio-feedback, relaxation (Moser et al, 2004;Lundervold & Poppen, 2004), compliance enhancement training, thermal bio-feedback (Somers et al, 2005), behavioural education processes (Moss et al, 1991), exercise, cognitive behaviour therapy (Sheps et al, 2003), yogic breathing and meditation intervention (Brazier et al, 2006). Bio-behavioural models and analyses have been used to explain cancer stress and disease course, headache and hypertension (Schwartz et al, 1979).…”

Management of hypertension in pregnancy

“…No clinically important benefits were apparent in two small trials of psychosocial support11 (80 women) or biobehavioural training12 (45women). Data do not allow for reliable conclusions to be drawn about the benefits and risks of restricted activity with or without admission to hospital for mild hypertension later in pregnancy.…”

Effects of Guided Imagery on Blood Pressure in Pregnant Women with Hypertension: A Pilot Randomized Controlled Trial

“…A later randomized controlled trial ( n = 50) of biofeedback plus relaxation with guided imagery and self‐monitoring of blood pressure, versus education to enhance compliance with bedrest, or bedrest (usual care) for pregnant women with hypertension found that mean arterial pressure at the last prenatal visit before delivery increased in both the education and control groups, compared with baseline, and significantly decreased in the intervention group ( F [1, 28] = 7.18, p < 0.025). The experimental group also had significantly lower absolute blood pressure when compared with the other groups ( F [2, 42] = 9.30, p < 0.001), but actual blood pressure values were not reported (22). However, many relaxation techniques require an extended time to learn (12), and thus may not be ideal for use during pregnancy.…”