Massage To Improve Uterine Artery Blood Flow
Condition: Pregnancy; Depression
MeSH terms: Depression
Study type: Interventional

Summary: 
      This project will investigate the effects of massage therapy on depressed pregnant women. The
      investigators expect that massage therapy will improve blood flow from the mother to the
      fetus and reduce prematurity and depression.
    

Detailed description: 
      Prenatal depression has been associated with adverse neonatal outcomes including preterm
      birth and low birthweight. Potential underlying mechanisms for prenatal depression effects on
      prematurity and low birthweight involve the elevated sympathetic nervous system SNS and
      Hypothalamic Pituitary Adrenal HPA Axis function noted in depressed pregnant women. These may
      lead to increased uterine artery resistance and the resulting limited blood flow, oxygen and
      nutrients to the fetus. Moderate pressure massage therapy may reduce this problem in
      depressed pregnant women by decreasing SNS and HPA axis function, resulting in decreased
      uterine artery resistance, increased oxygen and nutrients to the fetus and lower prematurity
      and low birthweight. An alternative model being explored here is that moderate pressure
      massage may increase progesterone/estriol ratios, which counteract the negative cortisol
      effects on gestational age. Eighty pregnant women with depression symptoms will be recruited
      at approximately 20 weeks gestation and randomly assigned to a moderate pressure massage
      therapy or to a SHAM light pressure massage touch/attention control group. The women will
      receive 20-minute weekly massage therapy sessions from 20 to 30 weeks gestation. At 20 and 30
      weeks gestation, depressed symptoms will be assessed using the CES-D, and saliva samples will
      be collected to assay alpha amylase as an SNS marker, cortisol as an HPA axis marker and
      progesterone and estriol levels. Maternal Doppler ultrasound will be conducted to assess the
      uterine artery resistance index as an estimate of uterine artery blood flow. Upon delivery,
      the mothers' medical charts will be reviewed to record gestational age and birthweight. The
      investigators are hypothesizing that the moderate pressure massage group will elicit an
      increase in progesterone/estriol ratios and decreases in alpha amylase and cortisol levels,
      which in turn will lead to reduced uterine artery resistance and a lower incidence of
      prematurity and low birthweight.
    

Intervention name(s): Moderate Pressure Massage; Light Pressure Massage
Intervention type(s): Procedure; Procedure
Intervention description(s): The massage therapy will begin with the mother in a side-lying position, with pillows positioned behind her back and between her legs for support. The massage is given in the following sequence and repeated twice (10 minutes on each side for 20 minutes total) on the following areas: 1) Head and neck: 2) Back: 3) Arms: and 4) Legs. The effective moderate pressure (measured by a pressure meter) is 8 db or a slight indentation in the skin.; The light pressure massage group will receive light pressure massage in contrast to the treatment group who will receive moderate pressure massage. As with moderate pressure massage, each session will begin with the mother in a side-lying position, with pillows positioned behind her back and between her legs for support. The massage is given in the following sequence and repeated twice (10 minutes on each side for 20 minutes total) on the following areas: 1) Head and neck: 2) Back: 3) Arms: and 4) Legs.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Pregnancy; Depression; Massage