Reviewed: Effati-Daryani F, Mohammad-Alizadeh-Charandabi S, Mirghafourvand M, Taghizadeh M, Mohammadi A. Effect of lavender cream with or without foot-bath on anxiety, stress and depression in pregnancy: a randomized placebo-controlled trial. J Caring Sci. 2015;4(1):63-73.

Editor’s note: Although the original journal article is marred with typographical and grammatical errors, the reported methodology is rigorous.

Maternal anxiety, stress, and depression during pregnancy can have a negative effect on the health of both mother and child. Lavender (Lavandula angustifolia, Lamiaceae) flower essential oil has been shown to decrease anxiety, stress, and depression. Foot bathing has also been found to improve autonomic function, sleep quality, and relaxation. The purpose of this randomized, double-blind, placebo-controlled study was to compare the effects of lavender cream and foot bathing on anxiety, stress, and depression in pregnant women.

Healthy pregnant women (n=141, aged 18-40 years) at 25-28 weeks gestation participated in this study conducted at Tabriz University of Medical Sciences in Tabriz, Iran. Patients were excluded if they had a history of chronic disease; were taking medication (e.g., sedatives) that might interfere with the interventions; smoked; had a history of infertility; had a recent unwanted pregnancy; had allergic reactions to herbal medicines in the past; were obese (i.e., a body mass index ≥ 30); had inflammation at the site of cream application; were illiterate; worked a night shift; lived outside of Tabriz city; or had current severe depression, anxiety, or stress (defined by scores of ≥ 10 on the anxiety sub-scale, ≥ 17 on the stress sub-scale, or ≥ 14 on the depression sub-scale of the Depression Anxiety Stress Scales-21 [DASS-21]). The sample size was calculated to detect a reduction of at least 43% in mean anxiety scores and 40% in mean depression scores on the DASS-21.

Patients were randomly assigned to three groups as follows: placebo, lavender cream (Barij Essence Pharmaceutical Company; Kashan, Iran), and lavender cream plus foot bath. The lavender cream contained 1.25% lavender essential oil; the placebo was the base cream consisting of stearic acid, acetyl alcohol, Vaseline®, and glycerin. Patients were instructed to rub 2 g of lavender or placebo cream on their legs for 10-20 minutes, 1.5 hours before bedtime for eight weeks. The lavender-plus-foot-bath group was told to soak their feet in 40-42°C tap water, at a depth of 5 cm above the ankle, for 30 minutes after applying the cream. To facilitate blinding, patients only knew that the effect of an herbal cream was being investigated; the name of the plant was not mentioned.

The patients completed the DASS-21 questionnaire at baseline, week four, and week eight. Based on their responses, anxiety, stress, and depression sub-scores were calculated. To assess compliance, patients were asked to keep a daily diary of treatment application and to return cream tubes after four and eight weeks.

At baseline, the groups had similar characteristics. Compliance was comparable among all three groups. No serious side effects were reported. One patient in the lavender-plus-foot-bath group and three patients in the placebo group were lost to follow-up.

At four weeks, a significant improvement in stress and anxiety scores (P<0.05 for both) was observed in the lavender group compared to placebo. The lavender-plus-foot-bath group had significantly improved stress scores compared to placebo (P<0.05).

At eight weeks, there were significant improvements in anxiety, stress, and depression scores in the lavender group (P<0.05 for all), and in the lavender-plus-foot-bath group (P<0.05 for all), compared to placebo. There were no significant differences in DASS-21 scores between the lavender group and the lavender-plus-foot-bath group.

Acknowledged limitations of the study include the lack of a placebo-plus-foot-bath treatment arm, the lack of physiological measures of stress (e.g., saliva cortisol levels), and that the results cannot be generalized to pregnant women with psychological disorders. In addition, this study used only one instrument (DASS-21) to measure anxiety, stress, and depression.

The authors conclude that lavender cream with or without foot bathing for eight weeks significantly improved anxiety, stress, and depression in pregnant women. They recommend further studies to assess the effect of lavender on pregnant women with psychological disorders and women with postpartum depression. It is important to note that this study applies to the topical use of lavender essential oil. Future studies should consider the use of a natural carrier oil rather than a petroleum-based carrier.

—Heather S. Oliff, PhD