Maternal–fetal outcomes and safety of Ayurvedic interventions in hypertensive disorders of pregnancy: A systematic review
Wiku Andonotopo, I Nyoman Hariyasa Sanjaya, Anak Agung Gede Putra Wiradnyana, Anak Agung Ngurah Jaya Kusuma, Aloysius Suryawan, Theresia Monica Rahardjo, Julia Windi Gunadi, Waskita Ekamaheswara Kasumba AndanaputraAbstract
BACKGROUND:
Hypertensive disorders of pregnancy (HDP), particularly gestational hypertension and preeclampsia, remain important causes of maternal and perinatal morbidity. Ayurveda and related integrative approaches are used in maternal care, yet their relevance to HDP is uncertain because direct clinical evidence is sparse and much of the literature is mechanistic or contextual.
OBJECTIVE:
To systematically examine maternal–fetal outcomes, safety, and biological plausibility of Ayurveda-related interventions relevant to HDP, while distinguishing direct clinical evidence from indirect and contextual evidence.
MATERIALS AND METHODS:
This preferred reporting items for systematic reviews and meta-analyses 2020-guided systematic review searched PubMed, Scopus, Embase, Web of Science, Cochrane Library, AYUSH Research Portal, DHARA, and IndMED from inception to May 2025. Eligibility was structured using Population, Intervention, Comparator, Outcomes, and Study Design (PICOS). Thirty sources formed the qualitative evidence corpus. Primary clinical evidence was considered separately from mechanistic studies and secondary contextual sources; reviews and guidelines were not treated as independent patient-level outcome data. Heterogeneity precluded meta-analysis.
RESULTS:
Direct clinical evidence was notably limited. The principal randomized evidence evaluated yoga added to standard antenatal care among women at increased risk of gestational hypertension, while other literature mainly informed biological plausibility, pregnancy safety, or clinical context. Proposed mechanisms involved oxidative stress, endothelial dysfunction, inflammation, vascular regulation, and placental function. Evidence supporting herbal or other Ayurveda-specific treatment of established HDP was insufficient, and pregnancy-specific safety reporting remained inconsistent.
CONCLUSION:
Current evidence does not establish Ayurveda as an effective treatment for HDP or justify replacing standard obstetric management. Rather, this preliminary synthesis organizes the available evidence and identifies data needed for subsequent investigation. The contributors’ work therefore represents an initial evidence-mapping effort to support future prospective studies, standardized interventions, and maternal–fetal pharmacovigilance.