Haruna Megumi, Matsuzaki Masayo, Ota Erika, Shiraishi Mie, Hanada Nobutsugu, Mori Rintaro
Department of Midwifery and Women's Health, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Tokyo, Japan, 113-0033.
Cochrane Database Syst Rev. 2019 Apr 27;4(4):CD011337. doi: 10.1002/14651858.CD011337.pub2.
Hypertension (high blood pressure) in pregnancy carries a high risk of maternal morbidity and mortality. Although antihypertensive drugs are commonly used, they have adverse effects on mothers and fetuses. Guided imagery is a non-pharmacological technique that has the potential to lower blood pressure among pregnant women with hypertension. Guided imagery is a mind-body therapy that involves the visualisation of various mental images to facilitate relaxation and reduction in blood pressure.
To determine the effect of guided imagery as a non-pharmacological treatment of hypertension in pregnancy and its influence on perinatal outcomes.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register, and two trials registers (October 2018). We also searched relevant conference proceedings and journals, and scanned the reference lists of retrieved studies.
We included randomised controlled trials (RCTs). We would have included RCTs using a cluster-randomised design, but none were identified. We excluded quasi-RCTs and cross-over trials.We sought intervention studies of various guided imagery techniques performed during pregnancy in comparison with no intervention or other non-pharmacological treatments for hypertension (e.g. quiet rest, music therapy, aromatherapy, relaxation therapy, acupuncture, acupressure, massage, device-guided slow breathing, hypnosis, physical exercise, and yoga).
Three review authors independently assessed the trials for inclusion, extracted data, and assessed risk of bias for the included studies. We checked extracted data for accuracy, and resolved differences in assessments by discussion. We assessed the certainty of the evidence using the GRADE approach.
We included two small trials (involving a total of 99 pregnant women) that compared guided imagery with quiet rest. The trials were conducted in Canada and the USA. We assessed both trials as at high risk of performance bias, and low risk of attrition bias; one trial was at low risk for selection, detection, and reporting bias, while the other was at unclear risk for the same domains.We could not perform a meta-analysis because the two included studies reported different outcomes, and the frequency of the intervention was slightly different between the two studies. One study performed guided imagery for 15 minutes at least twice daily for four weeks, or until the baby was born (whichever came first). In the other study, the intervention included guided imagery, self-monitoring of blood pressure, and thermal biofeedback-assisted relaxation training for four total hours; the participants were instructed to practice the procedures twice daily and complete at least three relief relaxation breaks each day. The control groups were similar - one was quiet rest, and the other was quiet rest as bed rest.None of our primary outcomes were reported in the included trials: severe hypertension (either systolic blood pressure of 160 mmHg or higher, or diastolic blood pressure of 110 mmHg or higher); severe pre-eclampsia, or perinatal death (stillbirths plus deaths in the first week of life). Only one of the secondary outcomes was measured.Low-certainty evidence from one trial (69 women) suggests that guided imagery may make little or no difference in the use of antihypertensive drugs (risk ratio 1.27, 95% confidence interval 0.72 to 2.22).
AUTHORS' CONCLUSIONS: There is insufficient evidence to inform practice about the use of guided imagery for hypertension in pregnancy.The available evidence for this review topic is sparse, and the effect of guided imagery for treating hypertension during pregnancy (compared with quiet rest) remains unclear. There was low-certainty evidence that guided imagery made little or no difference to the use of antihypertensive drugs, downgraded because of imprecision.The two included trials did not report on any of the primary outcomes of this review. We did not identify any trials comparing guided imagery with no intervention, or with another non-pharmacological method for hypertension.Large and well-designed RCTs are needed to identify the effects of guided imagery on hypertension during pregnancy and on other relevant outcomes associated with short-term and long-term maternal and neonatal health. Trials could also consider utilisation and costs of health service.
妊娠期高血压（高血压）会带来较高的孕产妇发病和死亡风险。虽然常用抗高血压药物，但它们对母亲和胎儿有不良影响。引导式意象是一种非药物技术，有可能降低妊娠期高血压妇女的血压。引导式意象是一种身心疗法，涉及可视化各种心理图像以促进放松和降低血压。
确定引导式意象作为妊娠期高血压的非药物治疗方法的效果及其对围产期结局的影响。
我们检索了Cochrane妊娠与分娩小组试验注册库以及两个试验注册库（2018年10月）。我们还检索了相关会议论文集和期刊，并浏览了检索到的研究的参考文献列表。
我们纳入了随机对照试验（RCT）。我们本会纳入采用整群随机设计的RCT，但未找到此类研究。我们排除了半随机对照试验和交叉试验。我们寻找在孕期进行各种引导式意象技术的干预研究，并与不干预或其他高血压非药物治疗方法（如安静休息、音乐疗法、芳香疗法、放松疗法、针灸、指压、按摩、设备引导的慢呼吸、催眠、体育锻炼和瑜伽）进行比较。
三位综述作者独立评估试验是否纳入、提取数据并评估纳入研究的偏倚风险。我们检查提取数据的准确性，并通过讨论解决评估中的差异。我们使用GRADE方法评估证据的确定性。
我们纳入了两项小型试验（共涉及99名孕妇），将引导式意象与安静休息进行了比较。试验在加拿大和美国进行。我们将两项试验均评估为存在较高的实施偏倚风险和较低的失访偏倚风险；一项试验在选择、检测和报告偏倚方面风险较低，而另一项试验在相同领域的风险不明确。我们无法进行荟萃分析，因为两项纳入研究报告了不同的结果，且两项研究中干预的频率略有不同。一项研究每天至少进行两次15分钟的引导式意象，持续四周，或直至婴儿出生（以先到者为准）。在另一项研究中，干预包括引导式意象、血压自我监测和热生物反馈辅助放松训练，总共四小时；参与者被指示每天练习两次这些程序，每天至少完成三次缓解性放松休息。对照组相似——一组是安静休息，另一组是卧床安静休息。纳入试验均未报告我们的任何主要结局：重度高血压（收缩压160 mmHg或更高或舒张压110 mmHg或更高）；重度子痫前期或围产期死亡（死产加出生后第一周内的死亡）。仅测量了一项次要结局。来自一项试验（69名女性）的低确定性证据表明，引导式意象在抗高血压药物的使用方面可能几乎没有差异或没有差异（风险比1.27，95%置信区间0.72至2.22）。
没有足够的证据为妊娠期高血压使用引导式意象的实践提供参考。关于本综述主题的现有证据稀少，引导式意象治疗妊娠期高血压（与安静休息相比）的效果仍不清楚。有低确定性证据表明引导式意象在抗高血压药物的使用方面几乎没有差异或没有差异，因不精确性而降级。两项纳入试验均未报告本综述的任何主要结局。我们未找到任何将引导式意象与不干预或与另一种高血压非药物方法进行比较的试验。需要开展大型且设计良好的RCT，以确定引导式意象对妊娠期高血压以及与孕产妇和新生儿短期及长期健康相关的其他相关结局的影响。试验还可考虑卫生服务的利用情况和成本。
