Original Research
Yoga in Pregnancy
An Examination of Maternal and Fetal Responses to 26 Yoga
Postures
Rachael L. Polis, DO, Debra Gussman, MD, MBA,
OBJECTIVE: To examine the acute maternal and fetal
effects of yoga postures and suspected contraindicated
postures in a prospective cohort of healthy pregnant
women in the third trimester.
METHODS: This was a prospective study that evaluated
pregnant women between 35 0/7 and 37 6/7 weeks of
gestation in a one-on-one yoga session. A baseline
nonstress test, vital signs, and pulse oximetry were
performed. Participants then assumed 26 yoga postures.
Vital signs, pulse oximetry, tocometry, and continuous
fetal heart rate monitoring were obtained in each
posture. Postsession nonstress test, vital signs, and pulse
oximetry were obtained. Participants were contacted 24
hours postsession.
RESULTS: Twenty-five healthy pregnant women were
evaluated. Ten reported regular yoga practice, eight were
familiar with yoga, and seven had no yoga experience.
Yoga groups were similar in age, race, body mass index,
gestational age, and parity. Presession and postsession
nonstress tests were reactive. Presession and postsession
data showed no change in maternal heart rate, temper-
ature, pulse oximetry, or fetal heart rate. During the 26
yoga postures, vital signs, pulse oximetry, and uterine
tocometry remained normal in all women and in all
postures. The fetal heart rate across all 26 postures was
normal. There were no falls or injuries during the total
From the Department of Obstetrics and Gynecology and Office of Clinical
Research, Jersey Shore University Medical Center, Neptune, New Jersey.
Presented at the American College of Obstetricians and Gynecologists Annual
Clinical and Scientific Meeting, May 2–6, 2015, San Francisco, California.
The authors thank Dr. Paulina Osial for her assistance with data collection, Dr.
Jonathan Baum for editorial assistance, and all the women who participated in
this study.
Corresponding author: Rachael L. Polis, DO, Jersey Shore University Medical
Center, Department of Obstetrics and Gynecology, 1945 Route 33, Neptune, NJ
07753; e-mail: rleighpolis@gmail.com.
Financial Disclosure
The authors did not report any potential conflicts of interest.
© 2015 by The American College of Obstetricians and Gynecologists. Published
by Wolters Kluwer Health, Inc. All rights reserved.
ISSN: 0029-7844/15
VOL. 126, NO. 6, DECEMBER 2015
Copyright ª by The American College of Obstetricians
and Gynecologists. Published by Wolters Kluwer Health, Inc.
Unauthorized reproduction of this article is prohibited.
and Yen-Hong Kuo, PhD
cumulative 650 poses. No participants reported
decreased fetal movement, contractions, leakage of fluid,
or vaginal bleeding in the 24-hour follow-up.
CONCLUSION: All 26 yoga postures were well-tolerated
with no acute adverse maternal physiologic or fetal heart
rate changes.
(Obstet Gynecol 2015;126:1237–41)
DOI: 10.1097/AOG.0000000000001137
LEVEL OF EVIDENCE: III
Y
oga is increasing in popularity in the United States
and has become a mainstream form of exercise
practiced by more than 20 million Americans in 2012
as compared with approximately 16 million in 2008.1
Women are interested in participating in yoga during
their pregnancy.2 The American College of Obstetri-
cians and Gynecologists recommends pregnant
women should be encouraged to engage in regular
moderate intensity physical activity in the absence
of contraindications.3 Research supports moderate-
intensity physical activity during pregnancy.4 In
2008, the U.S. Department of Health and Human
Services provided physical activity guidelines includ-
ing those for pregnant women.5 Yoga was listed as an
example of a health-enhancing physical activity and
has been described as a moderate-intensity exercise.5,6
Many studies have examined the benefits of yoga
in pregnancy.7–11 However, there are no evidence-
based studies examining maternal and fetal safety in
specific yoga postures (PubMed; 1979 to May 2015;
English Language; search terms: “yoga,” “pregnancy,”
and “exercise”). Popular yoga web sites have advised
there are certain postures that are contraindicated in
pregnancy such as Child’s Pose, Corpse Pose, Down-
ward Facing Dog, and Happy Baby Pose.12,13 We
could not identify any scientific evidence to support
these concerns (PubMed; 1949 to May 2015; English
Language; search terms: “yoga,” “Child’s Pose,”
“Corpse Pose,” “Downward Facing Dog,” and
OBSTETRICS & GYNECOLOGY 1237
“Happy Baby Pose”). The purpose of our study was to
evaluate acute maternal and fetal responses to com-
mon yoga postures, including suspected contraindi-
cated postures.
MATERIALS AND METHODS
We conducted a prospective study to evaluate acute
maternal and fetal responses to a single session of
yoga postures in pregnancy. Pregnant women
between 35 0/7 and 37 6/7 weeks of gestation and
age 18–42 years old with an uncomplicated gestation
were recruited. Participants were excluded for chronic
hypertension, preeclampsia or gestational hyperten-
sion, ruptured membranes, premature labor during
current pregnancy, placenta previa after 26 weeks of
gestation or placenta accreta, second- or third-
trimester bleeding, incompetent cervix or cervical
cerclage, multiple gestations, fetal growth restriction,
oligohydramnios, diabetes or gestational diabetes,
body mass index (BMI, calculated as weight [kg]/
height [m]2) greater than 35, and any other medical
contraindications to exercise.
The study was presented at the Jersey Shore
University Medical Center, Department of Obstetrics
and Gynecology, monthly meeting with a request for
physicians and midwives to identify pregnant women
for recruitment. Once an interested woman was
identified, the primary investigator or subinvestigator
contacted the participant and reviewed her medical
and obstetric history. The Meridian Health institu-
tional review board approved the protocol and all
participants were provided written informed consent.
Participation in the study was voluntary.
The one-on-one yoga session was conducted in
a labor room on the labor and delivery unit at Jersey
Shore University Medical Center. A certified yoga
instructor, obstetrics and gynecology resident, and
board-certified obstetrician–gynecologist were in
attendance during the yoga session. Participants first
completed a nonstress test. Maternal vital signs and
pulse oximetry were assessed.
The 26 postures selected for this study are a group of
standard postures found in a typical yoga class (Appendix
1, available online at http://links.lww.com/AOG/A715).
Postures included standing, sitting, and supine position-
ing and incorporated twisting, balancing, bending, and
stretching. Postures in the prone position were excluded
to avoid pressure on the gravid uterus. Inversion postures
such as head or handstand were excluded because of fall
risk.
Maternal and fetal well-being was continuously
monitored using blood pressure (BP), heart rate, pulse
oximetry, uterine tocometry, and fetal heart tracing
1238 Polis et al Yoga in Pregnancy
Copyright ª by The American College of Obstetricians
and Gynecologists. Published by Wolters Kluwer Health, Inc.
Unauthorized reproduction of this article is prohibited.
during the 26 yoga postures. Safety parameters were
based on established exercise criteria. By protocol, if
values were outside the established range, the study
would be terminated. Systolic BP was not to exceed
a peak value of 200 mm Hg and diastolic not to
exceed a peak of 100 mm Hg.14 Each participant’s
estimated maximum heart rate was calculated and this
number was used to determine the maximum allow-
able pulse rate.15 Pulse oximetry values of less than
94% precluded continuation in the study. Fetal heart
tracings were interpreted based on the American Col-
lege of Obstetricians and Gynecologists clinical man-
agement guidelines for intrapartum fetal heart rate
tracings.16 The fetal heart rate baseline was measured
continuously using the normal 110–160 beats
per minute range.16 Sessions were to be discontinued
per request for evidence of maternal intolerance,
abnormal fetal heart tracing, or regular contractions.
To avoid injury, modifications were used to assist
women in the yoga postures. Some yoga postures
(Extended Side Angle Pose, Extended Triangle Pose,
Warrior III, Tree Pose, Garland Pose, Eagle Pose, and
Half Moon Pose) incorporated modifications with the
use of blocks, chairs, and the wall to aid in body
alignment and safety. The flow from each posture was
continuous with each posture held for a total of
2 minutes. The postures were released sooner if the
participant reported discomfort. Time was allowed for
resting between postures if the participant needed
a break.
At the completion of the yoga session, a nonstress
test, vital signs, and pulse oximetry were reevaluated.
Participants were contacted through e-mail 24 hours
after the yoga session. They were asked about fetal
movement, contractions, leakage of fluid, vaginal
bleeding, discomfort after exercise, and overall yoga
experience.
Because there was no prior study to explore this
topic, we aimed to recruit 25 participants so that the
upper limit of a one-sided 95% confidence interval for
the chance of having an adverse event (eg, abnormal
fetal heart rate tracing) would be 11.3%.17
Mean and standard deviation were used to
summarize participant characteristics and measure-
ments, which were continuous variables. Frequency,
percentage, median, and quartiles were used to
summarize the discrete variables. Shapiro-Wilk test
was used to test the normality of continuous variables.
Wilcoxon signed-rank test was used to compare the
changes of continuous variables from the baseline to
the end of the yoga postures. Kruskal-Wallis one-way
analysis of variance by rank was used to compare the
continuous or discrete variables among groups.
OBSTETRICS & GYNECOLOGY
Fisher’s exact test was used to compare the categorical
variables among groups. The two-sided P values from
all tests were reported. A P value of #.05 indicated
statistical significance. The statistical software package
R language was used for data analysis.
RESULTS
Thirty women were enrolled in the study. Five were
excluded for regular contractions on tocometry at the
initial nonstress test. Twenty-five women completed the
yoga session. Ten (40%) participated in a regular yoga
practice, eight (32%) were familiar with yoga, and seven
(28%) had no yoga experience. All participants com-
pleted the 26 postures. Table 1 identifies the character-
istics of all participants and pregnant women were
grouped based on their yoga experience. All groups were
similar in age, parity, race, gestational age, and BMI.
Presession diastolic BP, maternal heart rate,
temperature, and pulse oximetry were normal and
all nonstress tests reactive (Table 2). No statistically
significant differences among the groups were noted.
There was a statistically significant difference in sys-
tolic BP among yoga groups.
There were no falls or injuries during the total
cumulative 650 postures. Maternal vital signs, pulse
oximetry, and uterine tocometry remained normal in
all participants and in all postures. No participant had
a systolic BP greater than 200 mm Hg, exceeded her
maximum allowable pulse rate, had a pulse oximetry
value of less than 94% shown (see Appendix 2,
available online at http://links.lww.com/AOG/A716),
or had regular contractions.
The baseline fetal heart rate during postures was
110–160 beats per minute. There were fetal acceler-
ations above baseline with the fetal heart rate reach-
ing above 180 beats per minute but no sustained
tachycardia (Appendix 3, available online at
http://links.lww.com/AOG/A717). There was no
fetal bradycardia or decelerations.
In the suspected contraindicated yoga postures
(Child’s Pose, Corpse Pose, Downward Facing Dog,
and Happy Baby Pose), maternal vital signs, pulse
oximetry, and tocometry were normal. The fetal heart
tracing remained category 1 in these postures.
All participants’ postsession nonstress tests were
reactive. Table 3 shows the postsession maternal vital
signs, pulse oximetry, and fetal heart rate. Postses-
sion systolic BP, maternal heart rate, temperature,
and pulse oximetry were normal and fetal heart rate
was reactive. There were no persistent elevation in
systolic or diastolic BPs, no maternal sustained tachy-
cardia, no fever, and no oxygen desaturation. It took
approximately 2 hours for participants to complete
the study. The level of yoga experience was not asso-
ciated with the time it took to complete all postures.
There was no statistical difference among groups in
the total time the yoga session took to complete (reg-
ular yoga practice 115611 minutes, familiarity with
yoga 110613 minutes, no yoga experience
115613 minutes, P5.758).
All participants responded to an e-mail sent 24
hours after the yoga session. No participants felt
unsafe during the session. No participants reported
leakage of fluid, vaginal bleeding, contractions, or
decreased fetal movement. Twenty-two (88%) partic-
ipants used only positive descriptions for their yoga
experience. The remaining three (12%) participants
commented on muscle soreness.
DISCUSSION
We have conducted a prospective study to evaluate
yoga postures in pregnant women by assessing
maternal and fetal status. Healthy pregnant women
with a normal BMI in the third trimester were able to
complete a single yoga session with no evidence of
acute adverse maternal physiologic or fetal heart rate
changes. Postures that have been reported to be
contraindicated in pregnancy were also studied.12,13

Table 1. Characteristics of Study Population

All Participants Regular Yoga Practice Yoga Familiarity No Yoga Experience

Variable (n525) (n510) (n58) (n57) P

Age (y) 31.763.1 32.263.4 30.362.0 32.763.5 .304

Race, white 25 (100) 10 (100) 8 (100) 7 (100) 1.000
Parity 1 (0, 1) 1 (0.25, 1) 1 (0, 1) 1 (0, 2) .912
Gestational age 35.860.6 35.960.6 36.060.8 35.660.5 .406
(wk)
BMI (kg/m2) 23.364.1 23.164.4 24.465.1 22.361.9 .642
BMI, body mass index.
Data are mean6standard deviation, frequency (%), or median (first quartile, third quartile) unless otherwise specified.
P values for comparison among groups with different levels of yoga experience.

VOL. 126, NO. 6, DECEMBER 2015 Polis et al Yoga in Pregnancy 1239

Copyright ª by The American College of Obstetricians

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Table 2. Maternal and Fetal Variables Pre–Yoga Session

All Participants Regular Yoga Practice Yoga Familiarity No Yoga Experience

Variable (n525) (n510) (n58) (n57) P

Maternal heart rate (bpm) 88610 9169 82611 89610 .249

Blood pressure (mm Hg)
Systolic 11569 11068 11866 12069 .038
Diastolic 6967 6567 7265 7067 .102
Pulse oximetry (%) 9861 9861 9861 9861 .271
Temperature (˚F) 9861 9861 9860 9860 .569
Fetal heart rate (bpm) 139612 13868 143618 13669 .641
bpm, beats per minute.
Data are mean6standard deviation unless otherwise specified.
P values for comparison among groups with different levels of yoga experience.

We found that Child’s Pose, Corpse Pose, Downward
Facing Dog, and Happy Baby were not associated
with acute adverse maternal or fetal responses.
All of the participants’ vital signs and pulse oxi-
metry were normal and no session was terminated for
evidence of maternal distress. The presession systolic
BP and the postsession diastolic BP showed a statistical
significance among groups. However, this was not
clinically significant. The fetal heart rate remained
normal in all participants and in all postures. From
this study, we conclude none of the 26 yoga postures
had a negative acute effect on maternal or fetal status.
There were no falls or injuries. Modifications
used included a chair, block, or wall. In balancing
postures such as Warrior III, Tree Pose, Eagle Pose,
and Half Moon Pose, a chair or wall was used. A
block was used to aid in alignment and balance with
postures such as Extended Side Angle Pose, Extended
Triangle Pose, and Garland Pose. We recommend
that these modifications be used by women in their
third trimester to avoid falls and possible injuries.
This study has several strengths. Most exercise
studies evaluate maternal and fetal well-being at the
completion of the session. We were able to monitor
maternal and fetal measurements continuously through-
out the study. Our assessments were of objectively
measured parameters. All women were positioned in
the same postures, in the same order, in the same time
interval, using the same modifications, and were all able
to complete the yoga sequence. No participants were
lost to follow-up 24 hours after the study.
There are some limitations to our study. Our
population was small, uniform, and the participants
were self-selected. Our session imperfectly mimicked
an actual yoga class because postures were held longer
to allow for monitoring and data collection. However,
even a longer time for a posture did not create any
concern for the maternal and fetal status, which
actually strengthens our study. Although we strove
to alternate between challenging and restorative
postures, the pattern of repeating postures typically
found in a yoga class was not studied. The average
BMI in our study population was only 23.3, which
does not represent the general pregnancy population,
of whom more than half are overweight or obese.18
Data were not collected on amniotic fluid index, bio-
physical profile, or uterine artery Dopplers. We did
not follow participants past 24 hours.

Table 3. Maternal and Fetal Variables Post–Yoga Session

All Participants Regular Yoga Practice Yoga Familiarity No Yoga Experience

Variable (n525) (n510) (n58) (n57) P

Maternal heart rate (bpm) 88614 93614 83617 8769 .402

Blood pressure (mm Hg)
Systolic 117612 114611 121617 11968 .577
Diastolic 6967 7268 6464 7066 .027
Pulse oximetry (%) 9961 9961 9861 9961 .433
Temperature (˚F) 9861 9861 9861 9861 .925
Fetal heart rate (bpm) 139610 14168 139611 138613 .834
bpm, beats per minute.
Data are mean6standard deviation unless otherwise specified.
P values for comparison among groups with different levels of yoga experience.

1240 Polis et al Yoga in Pregnancy OBSTETRICS & GYNECOLOGY

Copyright ª by The American College of Obstetricians

and Gynecologists. Published by Wolters Kluwer Health, Inc.
Unauthorized reproduction of this article is prohibited.
 In conclusion, yoga was well tolerated with no
acute adverse changes in maternal and fetal well-
being. Child’s Pose, Corpse Pose, Downward Facing
Dog, and Happy Baby were completed without
adverse changes in our study cohort.
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