Review Article

Yoga and Pranayama during High-Risk Pregnancy

GM Kavya*, Susheela Sharma**
Abstract
Yoga is a philosophy and a way of life where art and science meet. It is the art of knowing
oneself and knowing the eternal truth. It is the study of functioning of body, mind and
intellect in the process of attaining freedom. Ayurveda is the ancient medicine healing
system for body, mind and spirit. Yoga and Ayurveda have long been linked together as
two complementary systems of human development. A women’s body is biologically
created for certain specific functions. She has to undergo the four stages of life-
childhood, adolescence, middle age and old age. A woman who has looked after her
health will reap the reward by having a healthy pregnancy and delivery. It is absolutely
essential for a pregnant woman to maintain her physical and mental well being both for
herself and for the sake of the child within.

A high-risk pregnancy is the one with a significant probability for a poor maternal or fetal
outcome. The small family system in present generation and increasing trend of elderly
pregnancies are causing more and more complications in antenatal period and during
delivery. The incidence of high risk pregnancies is increasing in higher rate. The practice of
Yoga and pranayama in such a crucial condition makes the journey of pregnancy a very
easier one. It helps to combat the dangers of pregnancy, and prevents unavoidable tragic
consequences. In fact regular practice of yoga is very much advised to lead a healthy life,
and have a healthy pregnancy. During high-risk pregnancy yogic postures and breathing
techniques do miracle. They prevent the possible complications and protect the
pregnancy. Yoga and pranayama are healthy ways of life. The same healthy way of life is
needed when the pregnancy condition becomes a risky one.

Keywords: Antenatal care, Awareness, High risk pregnancy, Pranayama, Yogasana.

Introduction
Yoga is an extraordinary spiritual science of self High-risk complications occur in only about 8 to 10%
development and self realization that shows us how of all pregnancies. However, these complications
to develop our full potential in our many sided lives 1. result in 70 to 80% of the mortality and morbidity
Practice of Yoga and Pranayama has a tremendous related to pregnancy. Therefore, special care is
effect on every person and makes one morally and needed to ensure the best possible outcome for both
mentally strong. A person’s approach to life becomes the mother and the child11. With screening it is
more positive and tolerant 2. expected that 50% of high-risk cases would be
identified. Incidences of patients with bad obstetric
Pregnancy, itself, is not a high-risk condition as it is a history, elderly prime, precious pregnancy etc were
normal part of reproductive life. Most pregnancies increasing day by day. Improved perinatal care has
have a healthy and happy outcome. When any emerged from the collaborative efforts of many
pregnancy is complicated by factors that may specialties like obstetrics, neonatal pediatrics,
adversely affect the outcome of pregnancy it is anesthesiology and radiology. The common goal is to
termed a high-risk pregnancy. These pregnancies are maximize the quality of fetal, neonatal and infant life
at “high risk” for developing problems and having in such a manner as to give an optimum chance for a
poor outcome. child’s physical, mental and emotional development.
*
Ph D Scholar, Prasuti Deptt, National Institute of Ayurveda, Jaipur-302002. India.
**
Associate Prof & HOD, Prasuti Deptt, National Institute of Ayurveda, Jaipur-302002. India.
Correspondence to: Dr GM Kavya, Prasuti Deptt, National Institute of Ayurveda, Jaipur-302002. India.
E-mail Id: dr.kavyajain@gmail.com

© ADR Journals 2015. All Rights Reserved.

Kavya GM et al. J. Adv. Res. Ayur. Yoga Unani Sidd. Homeo. 2015; 2(3&4)

Here collaboration of ancient branch of yogic science pregnant lady8. They are Hypertension, Diabetes,
in this risky condition works for the betterment of Renal disease, Arthritis, Thyroid disease during
human life. Yoga and Pranayama claims to be pregnancy, pregnancy with previous LSCS patients,
beneficial for many diseases and problems. But pregnancy in immune compromised patients, elderly
generally there is a lack of research, which shows that gravida etc. They need special attention and care
yoga can actually help. Even the few studies which during their antenatal period.12
have been done have not been sufficient in the public
eye, and there is a need to highlight the miraculous Practice of particular Yogasana and Pranayama
role of yoga and Pranayama in human life. So there is during this problematic condition is helpful for a
need for more and more research works and articles successful outcome. Under the guidance of a yoga
in this direction. teacher, yogasanas can be practiced during the
complete period of pregnancy. The yogic exercises
All pregnancies and deliveries are potentially at risk. It and breathing technique that should be followed in
is essential to identify the high-risk factor in a normal pregnancy are:
S. No. Yogasana 1st Trimester 2nd Trimester 3rd Trimester
1. Tadasana (Mountain pose)  
2. Vruksasana (Tree pose)  
3. Trikonasana (Triangle pose)  
4. Virabhadrasana (Warrior pose)  
5. Parshvakonasana (Extended side angle pose)  
6. Kati chakrasana, Parshva chrakasana  
7. Utthita Hasta Padangusthasana  
8. Bhujangasana (In ropes)  
9. Parshvottanasana   
1
Table 1.Some of the Standing Poses

S. No. Yogasana 1st Trimester 2nd Trimester 3rd Trimester

1. Siddhasana (Perfect sitting pose)   
2. Swasthikasana   
3. Vajrasana   
4. Virasana (Hero pose)   
5. Gomukhasana   
6. Dandasana (Staff pose)  
7. Paschimottanasana  
8. Janusirsasana (Head to knee pose)  
9. Upavissta konasana (Open legs forward bend)   
10. Badda konasana (Bound angle sitting pose)   
1
Table 2.Some of the Sitting Poses

S. No. Yogasana 1st Trimester 2nd Trimester 3rd Trimester

1. Padottanasana (Spread legs forward bend)   
2. Adhomukha swhanasana (Downward facing dog)   
3. Chaturanga dandasana (Plank pose)   
4. Marjarasana (Cat pose)   
Table 3.Some of the Inverted Poses1

S. No. Yogasana 1st Trimester 2nd Trimester 3rd Trimester

1. Uttanasana  
2. Supta Padangushthasana   
3. Makarasana  
4. Savasana (Relaxation pose)   
1
Table 4.Some of the Lying Down Poses

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J. Adv. Res. Ayur. Yoga Unani Sidd. Homeo. 2015; 2(3&4)
Pranayama
For an expectant mother, practicing pranayama is as
important as performing the asanas. Pranayama and
the asana together bestow physical and mental
health both to mother and fetus.
Pranayama should be practiced in the complete
pregnancy period. Swastikasana and Vajrasana are
the best poses for breathing techniques to be
followed. Technically speaking, it is a process of
inhalation, exhalation and retention.
Some of the pranayama specially advised during
pregnancy are:
 Anuloma and Viloma Pranayama
 Nadi shodhana Pranayama
 Ujjai Pranayama
 Bhramari Pranayama
 Shitali Pranayama
 Sheetakari Pranayama
 Suryabhedana Pranayama
 Chandrabhedana Pranayama
Discussion
Pregnancy, the relationship between a mother and
her fetus, is a unique symbiotic union. Many more
women are now getting married late and starting
pregnancy at a relatively advancing age and this poses
special risks both for mother and fetus11. Some of
high-risk conditions were considered here, they were
dealt with critical analysis, by knowing
pathophysiology and their consequences on the
maternal and fetal condition.
Yoga and pranayama should be practiced based on
the current health status of the pregnant women.
Supine and inverted poses in particular can decrease
edema of the legs, because they improve the draining
of the retained fluid from the limbs.
At the same time, they are done in a way that opens
the rib cage and facilitates breathing. They improve
the blood flow from the periphery to the trunk, so the
blood flow to the vital organs of the mother and the
fetus is also improved.
The changes in the mother’s digestive tract are caused
by the fetus, which is crowding her abdominal organs
and exerting pressure on her diaphragm and also by
29
Kavya GM et al.
the progesterone in her body. As a pregnancy-
supporting hormone, it limits contractions during
pregnancy. It also, however, limits the peristalsis of
the smooth muscles of the digestive tract.
Yoga asanas can help with difficulties such as heart-
burn and constipation and also prevent the formation
of gallstones or stagnation of urine in ureter. Supine
positions or twists are helpful because of their
stimulating effect on the entire digestive tract.
Now let us deal with them one by one:
Pregnancy in Asthma Patients
Some amount of breathlessness is common during
pregnancy, due to the effect of progesterone and fall
in arterial CO2 pressure. Mechanical and biochemical
changes of pregnancy influence maternal respiration
function and gaseous exchange. Asthma during
pregnancy is due to hyper-responsiveness of the
airway to a number of irritants. It is characterized by
limitation of airflow, generally marked during
expiration than inspiration. Incidence is 3-4% of all
pregnant women9.
The course of the disease is very much unpredictable.
Progesterone and cortisol cause bronchodilator
effect, where as prostaglandins and thromboxane
cause bronchoconstriction. Asthma during pregnancy
causes pre term labor, PROM, Pre-eclampsia, IUGR,
low birth weight babies, and neonatal hypoxia.
Increase of maternal risk is in the form of status
asthamaticus, one of acute emergency conditions.
Intra uterine fetal growth retardation may result from
episodes of hypoxemia in the mother. 5-7% of infants
born to asthmatic mothers are likely to develop
asthma in the first year of life and more than 50% of
them will develop asthma in adult life.
Yogasana Pranayama
specially advised specially advised
Trikonasana Naadi shodhana
Bhujangasana with ropes Ujjai
Padangusthasana Bhramari
Vajrasana Suryabhedana
Gomukhasana
Makarasana
Paschimottanasna
Shavasana etc.
Table 5.Asanas advised for Pregnant women with
Asthma
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Kavya GM et al.
Hypertensive Disorders in Pregnancy
It is one of the common medical complications of
pregnancy and contributes significantly to maternal
and peri-natal morbidity and mortality.
The clinical features are elevated blood pressure,
abnormal weight gain, presence of edema, and
proteinuria. The definitive treatment of preeclampsia
is to prevent development of maternal or fetal
complications from disease progression. Regular,
reliable measurement of blood pressure and weight
gain of pregnant lady from early gestation is therefore
of great importance8.
Uncontrolled hypertension and preeclampsia is so
dangerous that it may affect the regular growth and
development of the fetus causing IUGR, and even
cause silent fetal demise. Pregnant mother is at the
risk of eclampsia, and there is an increased rate of
maternal death. Even after delivery of these
hypertensive pregnant ladies, there is a chance of
recurrent preeclampsia in subsequent pregnancy and
residual hypertension for the life time.
Along with regular ANC, practice of Yogasana and
Pranayama is of great help in maintaining regular
blood pressure. Pregnant women follow regular
practice of all these yogic procedures which bring the
neurohumoral pattern to normalcy7. In addition, they
also improve the functional efficiency of all the organs
and tissues by improving their microcirculation. Doing
shavasana in left lateral position lessens the effect of
venacaval compression. It increases renal blood flow,
improves the placental perfusion, and reduces the
blood pressure.
Yogasana Pranayama
specially advised specially advised
Tadasana Naadi shodhana
Shareera sanchalana Ujjai
Bhujangasana Bhramari
Vajrasana Sheetali
Swasthikasana Sheetakari
Siddhasana Chandrabhedana
Paschimottanasana
Shavasana
Table 6.Asanas advised for Hypertensive Disorders in
Pregnancy
Gestational Diabetes Mellitus
Diabetes mellitus is an endocrine disease involving
faulty carbohydrate metabolism. Its association with
pregnancy has become an increasingly common
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J. Adv. Res. Ayur. Yoga Unani Sidd. Homeo. 2015; 2(3&4)
observation during the last decade. Abnormal glucose
tolerance is the common cause for bad obstetric
history. Risk of miscarriage, polyhydramnios, preterm
labor etc are maternal complications due to diabetes.
Fetal macrosomia, hypoglycemia, malformations, IUD,
respiratory distress syndrome are some of the fetal
complications9.
The management directs towards maintaining
euglycemia state. Diet and Yogasana help in glucose
control. Yogasana for 30min two times daily aids in
achieving good glycemic control and improves
cardiovascular function.6,7 Good metabolic control can
prevent insulin therapy and even foresaid
complications. The solution lies in maintaining
metabolic milieu of diabetic pregnant ladies as close
as possible to normal with multidisciplinary support.
Yogasana Pranayama
specially advised specially advised
Padangustasana Naadishodhana
Bhujangasana with ropes Bhramari
Vajrasana Suryabhedana
Gomukhasana Chandrabhedana
Paschimottanasana
Makarasana
Shavasana
Table 7.Asanas advised for Gestational Diabetes
Mellitus
Thyroid Disorder during Pregnancy
Thyroid hormone is the most necessary one for the
normal development of the fetal brain and nervous
system. During the 1st trimester, the fetus depends on
the mother’s supply of thyroid hormone, which it gets
through the placenta. Higher level of thyroid hormone
in the blood, increased thyroid size and other
symptoms are common to both pregnancy and
thyroid disorders.11
Pregnancy induces changes in thyroid function, but
can also lead to thyroid disease. Uncontrolled
hyperthyroidism can be dangerous to the mother and
can cause health problems, such as fatigue, insomnia,
nervousness, irritability, loss of weight, and
congestive heart failure. Uncontrolled hypothyroidism
during pregnancy threatens the mother’s health and
leads to fatigue, depression, excessive weight gain,
cold intolerance, muscle cramps, and constipation
problems with memory or concentration. Not only
maternal health is affected by the thyroid
abnormality, even the fetus suffers with poor weight
gain and developmental disability.
30
J. Adv. Res. Ayur. Yoga Unani Sidd. Homeo. 2015; 2(3&4) Kavya GM et al.

Yogasana Pranayama Pregnancy in Obese Patients

specially advised specially advised
Bhujangasana with ropes Naadishodhana Obese pregnant lady is considered as one of the
Trikonasana Ujjai patients of highrisk group. These ladies have got
Marjarasana Bhramari adverse effects on obstetric performances. They
Vajrasana Suryabhedana require adequate antenatal supervision. BMI more
than 25 and 30 are overweight and obese
Paschimottanasana Chandrabhedana
respectively. They are prone for medical
Uttanasana
complications like hypertension and diabetes. There is
Makarasana
increased incidence of abnormal uterine contraction,
Supta padangustasana
prolonged labor, shoulder dystocia etc. More chance
Shavasana
of operative interference and performing caesarean
Table 8.Asanas advised for Thyroid Disorder during
section on such a huge maternal body is still a difficult
Pregnancy
task.11 Complications never end here, there is
Cardiac Disease during Pregnancy increased chance of puerperal venous thrombosis and
lactation failure. So keen observation on pre-
A normal heart has got enough reserve power so that
pregnancy BMI is needed. Obese pregnant woman,
extra load of pregnancy can be well tackled, while a
with BMI > 29 should not gain more than 7kg weight
damaged heart with a poor reserve fails combat the
during her whole pregnancy period.8 In this scenario
period of pregnancy and even stress of labor.
diet control, yoga and pranayama help a lot.
Pregnant ladies with heart disease should be
supervised in a tertiary care hospital. Yogasana Pranayama
specially advised specially advised
Physician and obstetrician should monitor maternal
Tadasana Naadishodhana
cardiac function and fetal condition at frequent
intervals in order to determine if the physiological Bhujangasana with ropes Ujjai
changes elicited by pregnancy are exceeding the Trikonasana Bhramari
functional capacity of the heart9,11. Katichakrasana Suryabhedana
Parsvachakrasana Chandrabhedana
Cardiac disease of Grade I and II are advised to Veerabhadrasana
practice particular special yogasanas after proper Parshva konasana
evaluation of their fitness with their cardiologist. In Vajrasana
fact yoga and pranayama are beneficial in such paschimottanasana
patients a lot. The most important treatment measure Gomukhasana
for attenuating the impact of pregnancy upon a Badda konasana
diseased heart is bed rest. Bed rest increases the Navasana
venous return to the heart, improves renal perfusion, Uttanapadasana
induces increase in urine output and promotes Makarasana
elimination of water. Bed rest also reduces the Table 10.Asanas advised for Pregnancy in Obese
metabolic needs of several organs, especially muscle; Patients
the blood flow to these organs at rest decreases
markedly, ameliorating the work load on the heart. Renal Calculi during Pregnancy
Renal functions tend to deteriorate during pregnancy.
Yogasana Pranayama
There is an increased risk of preterm birth,
specially advised specially advised
intrauterine growth restriction, pregnancy induced
Vajrasana Naadishodhana pranayama
hypertension, increased perinatal mortality and
Swasthikasana Ujjai
impaired outcome, especially in known case of
Gomukhasana Bhramari
Urinary tract calculi. There will be pressure symptoms
Marjarasana Sheetali
in the abdomen, repeated uterine irritability
Shavasana Shetkari throughout pregnancy depending on the size and
Yoga nidra Suryabhedana location of the calculi in the urinary tract.9,11 Supine
Table 9.Asanas advised for Cardiac Disease during with foot end raised and inverted poses in particular
Pregnancy can decrease edema of the legs, because they
improve the draining of the retained fluid from the
limbs.

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Kavya GM et al. J. Adv. Res. Ayur. Yoga Unani Sidd. Homeo. 2015; 2(3&4)

Yogasana Pranayama A HIV +ve pregnant lady is advised to maintain good

specially advised specially advised health. Counseling is the foremost ideal step here.
Vajrasana Naadishodhana These patients must have enough sleep and must
Paschimottanasana Bhramari avoid stress and fatigue. As CD4 counts decline and
Badda konasana viral load climbs they become susceptible to an array
Padottanasana of infections. Prevention of opportunistic infections is
Adhomukha swhanasana also critical goal for obstetrician9,10.
Chaturanga dandasana
Incidence of spontaneous abortions, a high rate of
Uttanapadasana
preterm delivery, a higher rate of genital ulcer, genital
Table 11.Asanas advised for Renal Calculi during
warts, positive syphilis serology vertical transmission
Pregnancy
and postpartum endometritis is noted in these
Pregnancy in Patients of Known Case of universally protected patients.
Rheumatoid Arthritis One of the most effective treatment is the
Rheumatoid arthritis is an autoimmune disease. management of anxiety through the practice of yogic
Pregnancy in these patients will worsen the disease as exercises. Immunity of the body improves by such
it is an immunosuppresive condition. Continuation of healthy practice of life.3,4 All the yogic postures and
pregnancy maintaining symptom free condition breathing techniques explained trimester wise can be
becomes the motto here. Major and minor joints of practiced, considering the health status of the HIV +ve
the body were the victims here.10,11 If there are more pregnant lady.
sensitive areas in the body, more will be the effect of
Pregnancy with Previous LSCS
practice of yoga on that particular area. Thus the
joints in the body, which are supposed to be the place Pregnancy with previous caesarean section is again
for mobility, will be more stiff and swollen due to another high- risk case. There is always a chance of
affliction of the disease. These sensitive painful joints uterine scar dehiscence and uterine rupture.8,9 In such
become efficient in performing their function after cases, pregnant lady should concentrate on poses
the practice of yoga. which protect the pregnancy and prevent the
complications of pregnancy4,5.
Yogasana Pranayama
specially advised specially advised Pregnant lady should be healthy and she should not
Shareera sanchalana Naadishodhana develop complications like Gestational Hypertension
Tadasana Bramari or Diabetes mellitus during present pregnancy. She
Bhujangasana with ropes Suryabhedana has to practice Yoga and Pranayama to avoid
Trikonasana Chandrabhedana pregnancy induced complications. Here we should not
Katichakrasana concentrate on yogasana which acts on pelvic floor
Parshva chakrasana muscles, as the delivery is by repeat caesarian section.
Marjarasana
Vajrasana Conclusion
Svastikasana
Pregnancy and delivery are natural phenomena. It is
Gomukhasana
part and parcel of mother hood of every woman.
Paschimottanasana
Present day scenario is so complicated that there is
Makarasana
addition of new conditions like late conception,
Table 12.Asanas advised for Pregnancy in Patients of
conceived after infertility treatment, bad obstetric
known case of Rheumotoid arthritis
history, risky pregnancy etc. To overcome all these
Pregnancy in HIV Patients lifestyle caused consequences, the only way out is to
follow a healthy lifestyle. Follow ayurveda, practice
The risk of HIV infection to women is rising yoga and pranayama.
worldwide. Currently, almost half of new HIV
infections are occurring in the reproductive age group Only a healthy couple can plan for healthy progeny.
of women. More and more adolescent and younger Preconceptional care and regular antenatal care bring
females are becoming victims of HIV. This is indeed a fruitful results. Practice of Yoga and Pranayama
serious social problem. should be a part of Dinacharya and Garbhini
paricharya. Successful antenatal care should be

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J. Adv. Res. Ayur. Yoga Unani Sidd. Homeo. 2015; 2(3&4)
complimented by our age old practice of Yoga and
Pranayama.
There are mistaken notions about yoga for pregnant
women. Some women fear that it may lead to
miscarriage. This is however nothing but an old wives’
tale. Women should begin to practice yoga before
conception to improve maternal health and ensure
sound health for future generations. Yogasanas are
however non-violent, improve blood circulation and
strengthen the body. These are meant to avoid
problems occurring during high-risk pregnancy and
delivery.
The prognosis rate of these high-risk pregnancies
itself is very poor, both mother and fetus are at a
higher risk of mortality and morbidity. Rather 8-10%
of all pregnancies may turn into high-risk
complications. With all careful and standard
management protocol, the success rate is not sure. So
indeed this situation needs precaution and protection
by practice of Yoga and Pranayama.
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