The Effect of Yoga Applied to Primiparous Pregnant Women on Postpartum Depression and Maternal Attachment: A Randomised Controlled Trial.

Pregnancy is a physiological process for women; however, it is also a period that requires physical, mental, and social adaptation and is characterized by psychosocial changes, with a high risk of exposure to factors that may cause stress and anxiety. The extent to which pregnancy, considered a transition and adaptation period, is perceived as stressful varies greatly among individuals, and both the causes and perception of stress may differ between primiparous and multiparous women. Primiparous pregnant women experience many new and undefined emotions simultaneously and are unable to predict the events they may encounter during childbirth. Therefore, identifying and managing stress factors in the early stages is essential to support a positive pregnancy experience.Studies have shown that pregnant women generally perceive their prenatal stress levels as moderate to high, and that primiparous women experience higher levels of prenatal stress compared to multiparous women. Stress experienced during pregnancy may lead to numerous adverse effects on maternal, fetal, and neonatal health. It is suggested that stress during pregnancy is associated with postpartum depression. In addition, serious health problems such as depression and anxiety are commonly observed during pregnancy.Postpartum depression, also known as peripartum depression, is characterized by the onset of major depressive episode symptoms during the peripartum period. Its prevalence generally ranges between 10% and 20%, depending on the population and the timing and method of postpartum assessment. In our country, this rate varies between 12.5% and 28.1%. Postpartum depression affects mother-infant interactions such as breastfeeding, bonding, and maternal role functioning. By influencing the maternal role, postpartum depression negatively affects maternal attachment. Mothers with depressive symptoms tend to have lower levels of attachment and reduced sensitivity toward their infants.Maternal attachment refers to the emotional and behavioral bond established by the mother with her infant. This attachment process begins in the prenatal period and continues after birth as a reciprocal interaction between the mother and the baby. The mother-infant attachment process develops throughout pregnancy, childbirth, and the postpartum period and may be influenced by negative experiences related to these stages. As the level of postpartum depression increases, maternal attachment decreases. Mothers with postpartum depression have lower levels of maternal attachment compared to healthy mothers, and first-time motherhood has been associated with moderately impaired maternal bonding.Maternal attachment may begin during the prenatal period and is closely related to postpartum bonding. In the final trimester of pregnancy, women may experience ambivalent emotions toward their baby, feel discomfort related to pregnancy, desire the baby but fear childbirth, and experience higher levels of anxiety compared to earlier trimesters. Since maternal attachment is shaped through satisfactory and adequate interaction between the mother and the infant, it plays a significant role in reducing and minimizing symptoms of postpartum depression. Yoga, which has therapeutic effects on depression, stress, and anxiety, has been shown to positively influence the reduction of perceived maternal stress during pregnancy.Yoga is a mind-body practice that includes postures (asanas), deep breathing techniques (pranayama), and meditation. Asanas are specific physical positions that strengthen, purify, and balance the endocrine, nervous, and circulatory systems. When practiced regularly, asanas provide numerous physical and psychological benefits. Yoga is an adaptable form of exercise that can be easily modified and, when practiced regularly during pregnancy, can provide benefits for both the mother and the fetus.

Yoga during pregnancy has various psychological and physiological effects. It influences the release of beta-endorphins and neurotransmitters, leading to physiological and neurophysiological changes. By affecting the release of dopamine and serotonin, which are responsible for emotional regulation, it promotes relaxation. Regular yoga practice during the second and third trimesters has been found to be more effective than antenatal exercises in reducing anxiety and depression. Additionally, prenatal yoga has been reported to be effective in reducing depressive symptoms both during pregnancy and in the postpartum period.The prenatal and postnatal periods are distinct yet interconnected stages that play critical roles in the transition from pregnancy to early parenthood. These periods are important due to the associated risks of stress and postpartum depression. Therefore, women may consider yoga as an effective approach to facilitate adaptation to pregnancy and to cope with pregnancy-related challenges.