Music Interventions for Anxiety in Pregnant Women: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Chien-Ju Lin, Yu-Chen Chang, Yu-Han Chang, Yu-Hsuan Hsiao, Hsin-Hui Lin, Shu-Jung Liu, Chi-An Chao, Hsuan Wang, Tzu-Lin Yeh, Chien-Ju Lin, Yu-Chen Chang, Yu-Han Chang, Yu-Hsuan Hsiao, Hsin-Hui Lin, Shu-Jung Liu, Chi-An Chao, Hsuan Wang, Tzu-Lin Yeh

Abstract

Prenatal anxiety is extremely common and may result in adverse effects on both the mother and the baby. Music interventions have been used to reduce anxiety in various medical patients and in pregnant women during childbirth. This study aims to assess the clinical efficacy of music interventions in women during pregnancy rather than during labor. Seven databases were searched from inception to September 2019 without language restrictions. We included only randomized controlled trials that compared music intervention and control groups for anxiety reduction in pregnant women. We used the revised Cochrane risk-of-bias tool (RoB 2.0) for quality assessment. Finally, 11 studies with 1482 participants were included. The pooled meta-analysis results showed that music interventions significantly decreased anxiety levels (standardized mean difference (SMD), -0.42; 95% confidence interval (CI), -0.83 to -0.02; I2 = 91%). Moreover, subgroup analysis showed that listening to music at home had significant anxiolytic benefits (SMD, -0.28; 95% CI, -0.47 to -0.08; I2 = 0%). However, meta-regression revealed a nonsignificant trend for increase in the anxiety-reducing effects of music interventions with increasing maternal age. In conclusion, music interventions may be beneficial in reducing anxiety and may be applied in pregnant women.

Keywords: music interventions; pregnancy; prenatal anxiety.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the study selection process. CINAHL, Cumulative Index to Nursing and Allied Health Literature; NDLTD, the net worked digital library of theses and dissertations.
Figure 2
Figure 2
Forest plot of pooled anxiety scores after the intervention, comparing the music group and the control group (overall meta-analysis). SD, standard deviation; SMD, standardized mean difference; CI, confidence interval.
Figure 3
Figure 3
Forest plot of pooled anxiety scores after the intervention, comparing the music group and the control group (Subgroup analysis by the timing of interventions). SD, standard deviation; SMD, standardized mean difference; CI, confidence interval.
Figure 4
Figure 4
Meta-regression bubble plot of correlation between standardized mean difference of anxiety scores and age. Each bubble represents a study and bubble size represents the sample size of the study. The regression line shows a nonsignificant trend for the increased anxiolytic effect of music interventions with increasing maternal age (p = 0.37).

References

    1. Dennis C.L., Falah-Hassani K., Shiri R. Prevalence of antenatal and postnatal anxiety: Systematic review and meta-analysis. Br. J. Psychiatry. 2017;210:315–323. doi: 10.1192/bjp.bp.116.187179.
    1. Rees S., Channon S., Waters C.S. The impact of maternal prenatal and postnatal anxiety on children’s emotional problems: A systematic review. Eur. Child Adolesc. Psychiatry. 2019;28:257–280. doi: 10.1007/s00787-018-1173-5.
    1. Staneva A., Bogossian F., Pritchard M., Wittkowski A. The effects of maternal depression, anxiety and perceived stress during pregnancy on preterm birth: A systematic review. Women Birth. 2015;28:179–193. doi: 10.1016/j.wombi.2015.02.003.
    1. Glover V. Maternal depression, anxiety and stress during pregnancy and child outcome; what needs to be done. Best Pract. Res. Clin. Obstet. Gynaecol. 2014;28:25–35. doi: 10.1016/j.bpobgyn.2013.08.017.
    1. Dubber S., Reck C., Muller M., Gawlik S. Postpartum bonding: The role of perinatal depression, anxiety and maternal-fetal bonding during pregnancy. Arch. Womens Ment. Health. 2015;18:187–195. doi: 10.1007/s00737-014-0445-4.
    1. Littleton H.L., Breitkopf C.R., Berenson A.B. Correlates of anxiety symptoms during pregnancy and association with perinatal outcomes: A meta-analysis. Am. J. Obstet. Gynecol. 2007;196:424–432. doi: 10.1016/j.ajog.2007.03.042.
    1. Sujan A.C., Rickert M.E., Oberg A.S., Quinn P.D., Hernandez-Diaz S., Almqvist C., Lichtenstein P., Larsson H., D’Onofrio B.M. Associations of maternal antidepressant use during the first trimester of pregnancy with preterm birth, small for gestational age, autism spectrum disorder, and attention-deficit/hyperactivity disorder in offspring. JAMA. 2017;317:1553–1562. doi: 10.1001/jama.2017.3413.
    1. Yonkers K.A., Gilstad-Hayden K., Forray A., Lipkind H.S. Association of panic disorder, generalized anxiety disorder, and benzodiazepine treatment during pregnancy with risk of adverse birth outcomes. JAMA Psychiatry. 2017;74:1145–1152. doi: 10.1001/jamapsychiatry.2017.2733.
    1. Freeman M.P., Goez-Mogollon L., McInerney K.A., Davies A.C., Church T.R., Sosinsky A.Z., Noe O.B., Viguera A.C., Cohen L.S. Obstetrical and neonatal outcomes after benzodiazepine exposure during pregnancy: Results from a prospective registry of women with psychiatric disorders. Gen. Hosp. Psychiatry. 2018;53:73–79. doi: 10.1016/j.genhosppsych.2018.05.010.
    1. Guetin S., Portet F., Picot M.C., Pommie C., Messaoudi M., Djabelkir L., Olsen A.L., Cano M.M., Lecourt E., Touchon J. Effect of music therapy on anxiety and depression in patients with alzheimer’s type dementia: Randomised, controlled study. Dement. Geriatr. Cogn. Disord. 2009;28:36–46.
    1. Bradt J., Dileo C., Potvin N. Music for stress and anxiety reduction in coronary heart disease patients. Cochrane Database Syst. Rev. 2013;12 doi: 10.1002/14651858.CD006577.pub3.
    1. Bradt J., Dileo C., Magill L., Teague A. Music interventions for improving psychological and physical outcomes in cancer patients. Cochrane Database Syst. Rev. 2016;8 doi: 10.1002/14651858.CD006911.pub3.
    1. Bradt J., Dileo C., Shim M. Music interventions for preoperative anxiety. Cochrane Database Syst. Rev. 2013;6 doi: 10.1002/14651858.CD006908.pub2.
    1. Corbijn van Willenswaard K., Lynn F., McNeill J., McQueen K., Dennis C.-L., Lobel M., Alderdice F. Music interventions to reduce stress and anxiety in pregnancy: A systematic review and meta-analysis. BMC Psychiatry. 2017;17 doi: 10.1186/s12888-017-1432-x.
    1. Cao S., Sun J., Wang Y., Zhao Y., Sheng Y., Xu A. Music therapy improves pregnancy-induced hypertension treatment efficacy. Int. J. Clin. Exp. Med. 2016;9:8833–8838.
    1. Garcia-Gonzalez J., Ventura-Miranda M.I., Requena-Mullor M., Parron-Carreño T., Alarcon-Rodriguez R. State-trait anxiety levels during pregnancy and foetal parameters following intervention with music therapy. J. Affect. Disord. 2018;232:17–22. doi: 10.1016/j.jad.2018.02.008.
    1. Liu Y.-H., Lee C.S., Yu C.-H., Chen C.-H. Effects of music listening on stress, anxiety and sleep quality for sleep-disturbed pregnant women. Women Health. 2016;56:296–311. doi: 10.1080/03630242.2015.1088116.
    1. Toker E., Kömürcü N. Effect of turkish classical music on prenatal anxiety and satisfaction: A randomized controlled trial in pregnant women with pre-eclampsia. Complement. Ther. Med. 2017;30:1–9. doi: 10.1016/j.ctim.2016.11.005.
    1. Liberati A., Altman D.G., Tetzlaff J., Mulrow C., Gotzsche P.C., Ioannidis J.P., Clarke M., Devereaux P.J., Kleijnen J., Moher D. The prisma statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: Explanation and elaboration. Ann. Intern. Med. 2009;151:65–94. doi: 10.7326/0003-4819-151-4-200908180-00136.
    1. Spielberger C.D., Gorsuch R.L., Lushene R., Vagg P.R., Jacobs G.A. STAI Manual for the Stait-Trait Anxiety Inventory (“Self-Evaluation Questionnaire”) Consulting Psychologists Press; Palo Alto, CA, USA: 1983.
    1. Chang M., Chen C., Huang K. Effects of music therapy on psychological health of women during pregnancy. J. Clin. Nurs. 2008;17:2580–2587. doi: 10.1111/j.1365-2702.2007.02064.x.
    1. Yang M., Li L., Zhu H., Alexander I., Liu S., Zhou W., Ren X. Music therapy to relieve anxiety in pregnant women on bedrest: A randomized, controlled trial. MCN Am. J. Matern. Child Nurs. 2009;34:316–323. doi: 10.1097/01.NMC.0000360425.52228.95.
    1. Hamilton M. The assessment of anxiety states by rating. Br. J. Med. Psychol. 1959;32:50–55. doi: 10.1111/j.2044-8341.1959.tb00467.x.
    1. A Revised Cochrane Risk-of-Bias Tool for Randomized Rrials (Rob 2.0) [(accessed on 21 September 2019)]; Available online: .
    1. Rstudio Software. [(accessed on 21 September 2019)]; Available online: .
    1. Higgins J.P., Thompson S.G., Deeks J.J., Altman D.G. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–560. doi: 10.1136/bmj.327.7414.557.
    1. Egger M., Davey Smith G., Schneider M., Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–634. doi: 10.1136/bmj.315.7109.629.
    1. Kafali H., Derbent A., Keskin E., Simavli S., Gözdemir E. Effect of maternal anxiety and music on fetal movements and fetal heart rate patterns. J. Matern.-Fetal Neonatal Med. 2011;24:461–464. doi: 10.3109/14767058.2010.501122.
    1. Guerrero J.M., Castano P.M., Schmidt E.O., Rosario L., Westhoff C.L. Music as an auxiliary analgesic during first trimester surgical abortion: A randomized controlled trial. Contraception. 2012;86:157–162. doi: 10.1016/j.contraception.2011.11.017.
    1. Wu J., Chaplin W., Amico J., Butler M., Ojie M.J., Hennedy D., Clemow L. Music for surgical abortion care study: A randomized controlled pilot study. Contraception. 2012;85:496–502. doi: 10.1016/j.contraception.2011.09.018.
    1. Nwebube C., Glover V., Stewart L. Prenatal listening to songs composed for pregnancy and symptoms of anxiety and depression: A pilot study. BMC Complement. Altern. Med. 2017;17:256. doi: 10.1186/s12906-017-1759-3.
    1. Teckenberg-Jansson P., Turunen S., Pölkki T., Lauri-Haikala M.-J., Lipsanen J., Henelius A., Aitokallio-Tallberg A., Pakarinen S., Leinikka M., Huotilainen M. Effects of live music therapy on heart rate variability and self-reported stress and anxiety among hospitalized pregnant women: A randomized controlled trial. Nord. J. Music Ther. 2019;28:7–26. doi: 10.1080/08098131.2018.1546223.
    1. García González J., Ventura Miranda M.I., Requena Mullor M., Parron Carreño T., Alarcón Rodriguez R., García González J., Parron Carreño T., Alarcón Rodriguez R. Effects of prenatal music stimulation on state/trait anxiety in full-term pregnancy and its influence on childbirth: A randomized controlled trial. J. Matern. Fetal Neonatal Med. 2018;31:1058–1065. doi: 10.1080/14767058.2017.1306511.
    1. Lin H.H., Chang Y.C., Chou H.H., Chang C.P., Huang M.Y., Liu S.J., Tsai C.H., Lei W.T., Yeh T.L. Effect of music interventions on anxiety during labor: A systematic review and meta-analysis of randomized controlled trials. PeerJ. 2019;7 doi: 10.7717/peerj.6945.
    1. Kuhlmann A.Y.R., de Rooij A., Kroese L.F., van Dijk M., Hunink M.G.M., Jeekel J. Meta-analysis evaluating music interventions for anxiety and pain in surgery. Br. J. Surg. 2018;105:773–783. doi: 10.1002/bjs.10853.
    1. Abdelhakim A.M., Samy A., Abbas A.M. Effect of music in reducing patient anxiety during colposcopy: A systematic review and meta-analysis of randomized controlled trials. J. Gynecol. Obstet. Hum. Reprod. 2019 doi: 10.1016/j.jogoh.2019.07.007. in press.
    1. Bowen A., Bowen R., Maslany G., Muhajarine N. Anxiety in a socially high-risk sample of pregnant women in Canada. Can. J. Psychiatry. 2008;53:435–440. doi: 10.1177/070674370805300708.
    1. Lee A.M., Lam S.K., Sze Mun Lau S.M., Chong C.S., Chui H.W., Fong D.Y. Prevalence, course and risk factors for antenatal anxiety and depression. Obstet. Gynecol. 2007;110:1102–1112. doi: 10.1097/01.AOG.0000287065.59491.70.
    1. Rubertsson C., Hellstrom J., Cross M., Sydsjo G. Anxiety in early pregnancy: Prevalence and contributing factors. Arch. Womens Ment. Health. 2014;17:221–228. doi: 10.1007/s00737-013-0409-0.
    1. Fancourt D., Ockelford A., Belai A. The psychoneuroimmunological effects of music: A systematic review and a new model. Brain Behav. Immun. 2014;36:15–26. doi: 10.1016/j.bbi.2013.10.014.
    1. Thoma M.V., La Marca R., Bronnimann R., Finkel L., Ehlert U., Nater U.M. The effect of music on the human stress response. PLoS ONE. 2013;8 doi: 10.1371/journal.pone.0070156.

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