Hindawi

Evidence-Based Complementary and Alternative Medicine

Volume 2020, Article ID 6835814, 6 pages
https://doi.org/10.1155/2020/6835814

Research Article
Comparing the Effect of Foot Massage with Grape Seed Oil and
Sweet Almond Oil on Physiological Leg Edema in Primigravidae:
A Randomized Clinical Trial

Maryam Navaee and Marzieh Rakhshkhorshid

Midwifery Department, Pregnancy Health Research Centre, Zahedan University of Medical Sciences, Zahedan, Iran

Correspondence should be addressed to Marzieh Rakhshkhorshid; [email protected]

Received 8 May 2019; Revised 7 August 2019; Accepted 29 August 2019; Published 13 January 2020

Academic Editor: Shao-Hsuan Kao

Copyright © 2020 Maryam Navaee and Marzieh Rakhshkhorshid. This is an open access article distributed under the Creative
Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.

Background. Leg edema is a prevalent problem in pregnancy causing activity restrictions for pregnant women. This study was
performed to compare the effect of foot massage using grape seed oil and sweet almond oil on physiological leg edema. Methods. A
randomized clinical trial was conducted on 90 primigravidae referred to public health centres of Zahedan, Iran. The participants’
gestational age was 30–40 weeks. The study was conducted from August 2016 to November 2017. The participants were randomly
assigned to three groups (massage with grape seed oil, massage with sweet almond oil, and without intervention). After de-
termining the extent of leg edema, foot massages were done for 20 minutes within 5 days in the two intervention groups. Then,
foot circumferences were measured on day 5 after the intervention. Foot circumferences for the control group were measured on
days 1 and 5. A nonelastic tape measure was used to measure the circumferences. To analyse the data, SPSS 21 software and
statistical tests including one-way ANOVA, Tukey’s test, and paired t-test were used. Results. The results from this study showed a
significant difference in the mean score change of foot circumferences between groups (P � 0.001). According to the results of
Tukey’s test, mean score changes of foot circumferences of both intervention groups were significantly different those of the
control group. However, this difference was not significant between the two intervention groups (P � 0.865). Conclusion. The
findings of this study confirmed the effectiveness of foot massage using grape seed and sweet almond oils to reduce pregnancy
physiological edema. Therefore, foot massage with appropriate oils can be used as a useful technique by trained midwives in
prenatal care centres or at pregnant women houses. This trial is registered with IRCT2015072723370N1.

1. Introduction long periods of standing and with each successive pregnancy

[3]. Since treatments to relieve common discomforts of
Anatomic and physiologic changes caused by pregnancy pregnancy such as edema should not threaten the mother
result in an array of symptoms affecting the lower extremity and fetus [5–7], many midwives and pregnant women seek
[1, 2]. The increasing weight of the growing uterus puts complementary therapies such as massage therapy [3, 8]. A
pressure on pelvic veins and on the inferior vena. This in- nonpharmacological intervention which is popular among
creases blood pressure in leg veins leading to venous in- healthcare providers is foot massage [9]. The technique in leg
sufficiency and leg edema. Leg edema can affect up to 80% of and foot edema works by moving extravascular fluid without
pregnant women and should not be considered a sign of disturbing intravascular fluid [10], increasing peripheral
pregnancy-induced hypertension or preeclampsia [3]. The blood flow, boosting oxygen, and therefore reducing edema
most common symptom of edema is the experience of [11].
substantial pain, as well as night cramps, numbness, and Using oil during a massage helps the hands of a masseur
tingling. In addition, legs may feel heavy and achy and move easily on the skin and causes the skin to minimize
possibly be unsightly [4]. Symptoms tend to worsen after dryness [12]. Grape seed oil and sweet almond oil are used in
2 Evidence-Based Complementary and Alternative Medicine

therapeutic massage [13]. These oils are good sources of termination of pregnancy or preterm labor, injury or serious
essential fatty acids and vitamin E, polyphenols, and fla- damage in the lower legs, development of preeclampsia
vonoids [14] and cause some type of improvement in var- during the study, and lack of participation in any massage
icose veins, hemorrhoids, and limb edema by improving session and foot circumference assessments. The researcher
blood circulation. In addition to their anti-inflammatory (MN) explained the aim of the study to the participants.
properties, they can be effective in relieving edema caused by Those who gave written consent were matched and then
problems such as rheumatoid arthritis [15]. Sweet almond randomly allocated to one of the three groups (massage with
oil contains vitamin E and riboflavonoids that, of course, grape seed oil, massage with sweet almond oil, and without
have little antioxidant effect [16]. However, its advantage intervention). Randomization was done using a random
compared to grape seed oil is that it is cheaper and more number table generated by a spreadsheet (Excel). The in-
accessible [17, 18]. tervention and control groups were matched statistically for
In general, studies on the effects of massage therapy on a age and gestational age, and thus, groups were formed with
variety of healthcare settings have shown that this therapy homogeneous distribution (P � 0.47 and P � 0.39,
could be used as an effective treatment in a series of dis- respectively).
comforts while causing no damage [19]. Çoban and Şirin in The intervention groups received usual health care and a
their study on the effect of foot massage with grape seed oil daily 20-minute foot massage with grape seed oil or
on edema during pregnancy found significant results in sweet almond oil. The control group received usual health
reducing edema and that the reduction was greater in the care. Usual health care included some advices about leg
right leg [20]. In a study conducted by Rahimikian et al. on edema such as “avoid hanging your legs during the day” and
the effect of foot massage on physiological edema with baby “when resting, hold your feet above the ground.”
oil, significant results were seen in reducing edema [21]. Participants were interviewed, observed, and examined
Since, to our knowledge, few studies have examined the to take sociodemographic information, medical history,
effects of foot massage on edema resulting from pregnancy blood pressure, and obstetric characteristics. They were
and no studies have compared the results of using different checked for kidney disease with a urine dipstick test. Then,
oils to select the best oils in massage, this study was per- the extent of leg edema was determined by pressing index
formed with the aim to “compare the effect of foot massage and middle fingers on the tibia bone for 30 seconds and
with grape seed oil and sweet almond oil on physiological leg estimating the depth of the created troughs. After that,
edema during pregnancy.” circumferences of 3 parts of each leg including the ankle,
instep, and foot/toe junction (as shown in Figure 1) were
measured by a nonelastic tape measure for each group while
2. Materials and Methods the subjects were sitting in an upright position. The ankle
circumference was measured medially and laterally above
This randomized clinical trial study was conducted on a
the malleoli, where the diameter was the smallest. The instep
number of primigravidae referred to health centres in
circumference was measured over the cuneiform and cuboid
Zahedan, Iran, from August 2016 to November 2017. The
bones distal to the heel, and the foot/toe junction circum-
sample size was calculated using the following formula
ference was measured at the distal end of the foot, at the
(equation (1)) based on a previous study [22]:
metatarsal-phalanges (MP) joint (where the toe joins the
2
z1 − (α/2) + z1 − β􏼁 s21 + s22 􏼁 foot). The second measurement of the circumferences was
sample size � . (1)
x1 − x2 􏼁
2 done on the fifth day of intervention for the three groups.
These measurements were took on an average of 15 minutes.
Using a power of 90% and taking into account the 95% The measurements were done by MR in a private room in the
confidence interval, the required sample size was calculated health centres while she was blind about the assignment of
to be 24 for each group (x1 � 4/7, x2 � 3/3, s1 � 1/7, and people to groups.
s2 � 1/2). Assuming 10% for attrition, 30 primigravidae were The intervention groups were given a 10-minute massage
needed for each group. on each foot (a total of 20 minutes of massage for each
In this study, a multistage sampling technique was used. person) by MN. Before each massage, the researcher washed
First, the city was divided into five geographical regions her hands and made them warm by rubbing them together.
including the north, south, east, west, and central. Five Five different movements of massage taken from the Çoban
health centres were chosen randomly from each region. and Şirin study were used in this study [20]. The participants
Initial screening was done on 207 women with a gestational were asked to hold their foot firmly, and then the masseur
age of 30 to 40 weeks, of whom 96 met the trial criteria and started massaging following five movements: (1) striking in
agreed to participate in this study. The inclusion criteria the entire foot from the toes to the ankle along the top of the
were 18–35 years of age, primigravid, normal singleton foot using the whole hand and returning under the foot to
pregnancy, and 1+ or 2+ pitting edema in feet. The exclusion the toes using less pressure, (2) kneading the foot from the
criteria were any underlying diseases or history of them (e.g., toes to the ankle using thumbs while supporting the foot
diabetes, hypertension, preeclampsia, and thrombophlebi- with the fingers underneath, (3) striking the skin surface
tis), history of infertility, drug abuse, existence of wound and between each tendon on the top of the foot one after another
skin lesions at the massage site, consumption of a specific using thumbs, (4) grasping the foot with both hands and
drug or diet to relieve edema during the study, emergency gently manipulating from side to side, and (5) holding the
Evidence-Based Complementary and Alternative Medicine 3

eating habits, activity and rest levels, and amount of fluid

and salt intake before the intervention. The results of the
average measurements of the participants’ left and right
Ankle ankles, insteps, and MP joints in the intervention and
Instep
control groups before and after the intervention are shown
MP joint
separately in Table 2. The paired t-test showed a significant
difference in the intervention and control groups before and
after the intervention in terms of the average circumferences
of ankles, insteps, and MP joints for both legs. Results of
evaluating the measured circumferences of both legs of each
participant during two consecutive measurements indicated
Figure 1: Lower leg circumference measurement (retrieved from reduction of the sizes in the two intervention groups and
the Çoban and Şirin study in 2010). MP joint: metatarsal-phalanges their increase in the control group.
joint. Results of the one-way ANOVA test showed a significant
difference between the three groups in terms of the average
changes in the measured circumferences (Table 3). Tukey’s
toes with one hand while the other hand supported the foot test that ran to test pairwise comparisons among means
and the toes were gently bent backward and forward. Each of indicated significant differences between both intervention
these movements was performed 10 times in the same order groups with the control group. However, the difference was
for each foot in turn in each session. The researcher reduced not significant between the two intervention groups.
the effects of the masseur’s hand fatigue on massaging and
pressure on each leg by changing massage sequences in each
session. The massage began from the right foot on the first
4. Discussion
day and from the left foot on the second day and continued The results of this study showed a significant difference
in the same way until the fifth day. The massage sessions between the average changes in the measured circumfer-
were held every day at 11 o’clock for 5 days. For convenience ences of feet in the three groups: the grape seed oil group, the
of pregnant women, the intervention sessions were held at sweet almond oil group, and the control group. Tukey’s test
the participants’ houses except the first and the fifth sessions that ran to compare the groups two by two indicated sig-
which were held at the health centres. Grape seed oil for one nificant differences between the grape seed oil group and the
intervention group and sweet almond oil for the other in- control group and also between the sweet almond oil group
tervention group were used. Each bottle contained 60 cc of and the control group. However, the difference was not
sweet almond oil or grape seed oil with a purity of 95% significant between the two intervention groups. This means
approved by a laboratory. Sweet almond oil and grape seed that massage with both oils led to reduction in the measured
oil were purchased directly from Barij Essence Pharma- circumferences of feet after five days of intervention com-
ceutical Company and Mahdarou Pharmaceutical Com- pared to that before the intervention. As it is shown in
pany, respectively. Table 3, despite the fact that the difference in the two in-
It should be noted that, before the intervention, massage tervention groups was not statistically significant, the mean
therapy was taught to the researcher (MN) by a reflexologist, reduction of edema in the sweet almond oil group (except
and after the specialist confirmation, the intervention began. right and left ankles) was slightly greater than that in the
SPSS version 21 was used for statistical analysis. Dis- grape seed oil group. Therefore, the research hypothesis
tribution of the data was tested using the Shapiro–Wilk test. regarding the greater effect of grape seed oil on reducing the
Data are presented as mean ± SD and frequency (per- amount of edema in comparison with sweet almond oil was
centage). The chi-square, Fisher’s exact test, and one-way rejected.
ANOVA were used to compare proportions between the Rahimikian et al. in a study on the effects of foot massage
three groups. Within-group changes were assessed using a on physiological edema of pregnancy confirmed the effec-
paired t-test. Between-group differences were assessed using tiveness of massage in reducing feet edema. The differences
one-way ANOVA and Tukey’s test. A P value less than 0.05 in mean changes in the massage group in the right ankle, left
was considered to be statistically significant. ankle, right instep, left instep, right MPJ, and left MPJ were
reported as − 0.036, − 0.025, − 0.020, − 0.025, 0.032, and
3. Results − 0.037, respectively [21]. The current study and Rahimikian
et al.’s study were similar in terms of the number of days of
There were 30 participants in each group. Four participants massage and the method of massage. However, there were
from the intervention groups and two from the control some differences between these two studies in the case that
group withdrew from the study before completing it. The Rahimikian et al.’s study compared two groups: massage and
reasons for withdrawal are listed in Figure 2. Descriptive control. Plus, they used baby oil for massage. Grape seed oil
statistics for the three groups’ means, standard deviations, and sweet almond oil containing antioxidants, vitamins E
and ranges are expressed in Table 1. and B, amino acids, and flavonoids when compared with
The three groups were not significantly different in terms baby oil, a neutral oil, can be more effective in improving
of demographic characteristics, obstetric characteristics, blood flow and consequently reducing edema [23]. Thus, it
4 Evidence-Based Complementary and Alternative Medicine

207 women assessed according to

inclusion and exclusion criteria

111 were not eligible

for participation

96 women were eligible and

randomized

2 withdrew: one did not

2 withdrew: one attend to the centre for 2 withdrew: they
Grape seed Sweet almond
for leg fracture measurement and Control group did not attend to
oil group oil group
and another another did not present n = 32 the centre for
n = 32 n = 32
for travelling at home for taking measurement
massage

Completed study Completed study Completed study

n = 30 n = 30 n = 30

Figure 2: Recruitment and retention of participants in the study.

Table 1: Demographic characteristics by groups.

Grape seed oil group Sweet almond oil group
Control group (n � 30)
Characteristics (n � 30) (n � 30)
Mean SD Mean SD Mean SD
Age (years) 25.3 4.06 26.7 5.01 25.63 4.77
Gestational age (weeks) 34.17 2.36 34.01 2.57 33.42 1.59

Table 2: Average scores of lower leg circumferences by groups.

Group
Variable Sweet almond Grape seed Control
Mean ± SD n Mean ± SD n Mean ± SD n
Ankle 23.1 ± 2.5 30 23.1 ± 1.9 30 23 ± 1.6 30
Right foot Instep 23.6 ± 1.7 30 23.6 ± 1.3 30 23.4 ± 1.1 30
MPJ 23.0 ± 1.3 30 23.0 ± 1.3 30 22.7 ± 1.2 30
The amount of edema before intervention
Ankle 23.2 ± 2.5 30 23.1 ± 2.0 30 22.9 ± 1.6 30
Left foot Instep 23.6 ± 1.7 30 23.4 ± 1.4 30 23.2 ± 1.2 30
MPJ 23.0 ± 1.3 30 22.8 ± 1.2 30 22.5 ± 1.0 30
Ankle 22.5 ± 2.4 30 23.5 ± 2.0 30 22.1 ± 1.5 30
Right foot Instep 23.1 ± 1.7 30 23.9 ± 1.5 30 23.0 ± 1.1 30
MPJ 22.5 ± 1.3 30 23.2 ± 1.4 30 22.2 ± 1.1 30
The amount of edema on day 5 after intervention
Ankle 22.5 ± 2.5 30 23.5 ± 2.0 30 22.1 ± 1.6 30
Left foot Instep 23.0 ± 1.6 30 23.7 ± 1.5 30 22.9 ± 1.1 30
MPJ 22.5 ± 1.3 30 23.1 ± 1.2 30 22.1 ± 1.0 30
MPJ: metatarsal-phalanges joint.

can be concluded that the more effective the oils used in a study was that they had two types of interventions: massage
massage, the greater the reduction in edema and its resultant and foot elevation. Also, Rahimikian et al. used baby oil for
discomforts will be. massaging. The results of this study indicated much more
In another study conducted by Rahimikian et al., re- impact of massage on reducing edema, compared to
garding the effectiveness of massage and foot elevation in Rahimikian et al.’s study. Massage in the present study was
physiological edema, similar results to those of the previous more effective than that in Rahimikian et al.’s study which
study were obtained [24]. The differences in mean changes in may be due to differences in geographical location and
the massage group in the right ankle, left ankle, right instep, climatic conditions in the two studies. Rahimikian et al.’s
left instep, right MPJ, and left MPJ were reported as − 0.042, study was conducted in the north of Iran with a warm and
− 0.045, − 0.042, − 0.046, 0.042, and − 0.046, respectively. The humid climate, while the present study was conducted in the
difference between Rahimikian et al.’s study and the current southeast of Iran with a warm and dry climate. Humidity
Evidence-Based Complementary and Alternative Medicine 5

Table 3: Differences in mean foot measurements across the three groups (between day 1 and day 5).
Group
Result of ANOVA test Variable
Control Sweet almond Grape seed
F � 61.57
Ankle 0.396 − 0.713 − 0.776
P � 0.001
F � 28.24
Right foot Instep 0.240 − 0.460 − 0.440
P � 0.001
F � 21.35
MPJ 0.266 − 0.496 − 0.476
P � 0.001
Mean measurement changes
F � 50.67
Ankle 0.403 − 0.770 − 0.770
P � 0.001
F � 39.59
Left foot Instep 0.306 − 0.523 − 0.366
P � 0.001
F � 17.11
MPJ 0.280 − 0.440 − 0.363
P � 0.001
MPJ: metatarsal-phalanges joint.

causes the fluctuation of body fluids and swelling of tissues and vegetables), lack of exercise, and lower economic levels
[25]. [27]. Another possible reason for more amount of foot
Mollart in a comparative study on the effect of re- edema in women in Zahedan is the high prevalence of the
flexology techniques (lymphatic reflexology and relaxing iron deficiency anemia [28]. Leg edema is one of the clinical
reflexology) versus rest on the amount of edema showed that signs of anemia [29].
rest is more effective than reflexology techniques, focusing On reviewing the literature, no articles examining the
on a specific pressure point, in reducing feet edema [22]. The effect of sweet almond oil or other effective oils on edema
duration of the intervention was 15 minutes per session. The were found, and most studies dealt with lubricant gel or baby
participants’ legs were massaged for a few minutes to make body oil. However, the impressive issue in this study was a
them warm before the intervention. Also, grape seed oil was very good effect of both grape seed and sweet almond oils on
used for massage in the lymphatic reflexology group which reducing edema. Sweet almond oil and grape seed oil are rich
was more effective in reducing edema compared to the in vitamin E, vitamin B, amino acids, and flavonoids which
relaxing reflexology group for whom no oil was used. with their strong antioxidant properties result in repairing
However, the difference was not significant. The differences damaged vessels and improving environmental blood flow
in mean changes in the reflexology with grape seed oil group [18]. The study of historical documents shows that massage
in the right ankle, left ankle, right instep, left instep, right is the oldest form of physical therapy that has been used by
MPJ, and left MPJ were − 0.06, − 0.10, − 0.03, − 0.04, 0.03, and humans. Massaging helps return venous blood flow through
− 0.29, respectively. These differences were much less the pumping action caused by muscle compression. This
compared to the differences in mean changes in the current may lead to edema reduction in lower extremities [21]. So, it
study. The reasons behind this could be the difference in is better to use an effective oil to increase the impact of
methods, frequency, and duration of the massage. massage on reducing much more amount of edema in a
Çoban and Şirin in a study on the effect of foot massage shorter time.
on physiological edema showed a 20-minute foot massage
with body oil is effective in reducing feet edema [20]. The
Çoban and Şirin study was conducted on 80 pregnant 4.1. Limitations of the Study. Lack of access to a number of
women in five 15-minute sessions and significantly reduced participants at the designated time in 5 consecutive days was
n average of every measured area in feet except left leg a limitation of this study. Therefore, for these participants,
circumference in the massage group compared to the massages were done an hour earlier or later than the first
control group. In the Coban and Şirin study, baby oil was day.
used. Differences in mean changes in the Coban and Şirin
study were lower than those in the current study. These 5. Conclusion
differences may be because of applying different types of
oils and different massage sequences in the two studies. In The findings of this study confirmed the effectiveness of foot
the current study, massage began from the right foot on the massage using grape seed and sweet almond oils to reduce
first day and from the left foot on the second day and pregnancy physiological edema. Therefore, foot massage
continued in the same way until the fifth day. Further with appropriate oils can be used as a useful technique by
reasons for the differences in the amount of edema re- trained midwives in prenatal care centres or at pregnant
duction between the current study (Table 3) and other women houses. As recommendations for future researches,
studies may be more amount of foot edema in women in studying the durability of the massage effect after the
Zahedan. This may be due to ethnicity [26], prolonged massage therapy sessions as well as training pregnant
standing and lack of adequate rest, lack of proper diet women for doing the massages themselves can be
(excess salt consumption and inadequate intake of fruits mentioned.
6 Evidence-Based Complementary and Alternative Medicine

Data Availability [12] S. Enzer, Reflexology: A Tool for Midwives, Soul to Sole Re-
flexology, Sydney, Australia, 2000.
No data were used to support this study. [13] M. Michalak, “The use of carrier oils in aromatherapy massage
and their effect on skin,” Archives of Physiotherapy & Global
Researches, vol. 22, no. 3, pp. 23–31, 2018.
Ethical Approval [14] F. K. Khalifa, F. A. Khalil, H. A. Barakat, and M. M. Hassan,
“Protective role of wheat germ and grape seed oils in
This study was approved by the Ethics Committee of Zahedan
chlorpyrifos-induced oxidative stress, biochemical and his-
University of Medical Sciences (IR.ZAUMS.REC.1394.149). tological alterations in liver of rats,” Australian Journal of
Basic and Applied Sciences, vol. 5, no. 10, pp. 54–66, 2011.
Consent [15] J. Hulme, H. Waterman, and V. F. Hillier, “The effect of foot
massage on patients’ perception of care following laparo-
Informed consent form was obtained from the participants scopic sterilization as day case patients,” Journal of Advanced
after explaining the study objectives and after confidentiality Nursing, vol. 30, no. 2, pp. 460–468, 1999.
of data was guaranteed by the researchers. [16] M. M.-L. Grundy, K. Lapsley, and P. R. Ellis, “A review of the
impact of processing on nutrient bioaccessibility and di-
gestion of almonds,” International Journal of Food Science &
Conflicts of Interest Technology, vol. 51, no. 9, pp. 1937–1946, 2016.
[17] S. Y. Chang, “Effects of aroma hand massage on pain, state anxiety
The authors declare that there are no conflicts of interest and depression in hospice patients with terminal cancer,” Journal
regarding the publication of this paper. of Korean Academy of Nursing, vol. 38, no. 4, pp. 493–502, 2008.
[18] T. M. F. Marzouk, A. M. R. El-Nemer, and H. N. Baraka, “The
Acknowledgments effect of aromatherapy abdominal massage on alleviating
menstrual pain in nursing students: a prospective randomized
Special thanks are due to participants and respected staff of cross-over study,” Evidence-Based Complementary and Al-
health centres in Zahedan. Financial support for this study ternative Medicine, vol. 2013, Article ID 742421, 6 pages, 2013.
was provided by the Zahedan University of Medical Sciences. [19] T. Field, “Massage therapy research review,” Complementary
Therapies in Clinical Practice, vol. 24, pp. 19–31, 2016.
[20] A. Çoban and A. Şirin, “Effect of foot massage to decrease
References physiological lower leg oedema in late pregnancy: a ran-
domized controlled trial in Turkey,” International Journal of
[1] F. G. Cunningham, K. J. Leveno, S. L. Bloom, C. Y. Spong, Nursing Practice, vol. 16, no. 5, pp. 454–460, 2010.
J. S. Dashe, and B. L. Hoffman, Williams Obstetrics, McGraw- [21] F. Rahimikian, A. Shadmehr, A. Mehran, and M. Kiani, “Effect of
Hill Education, New York, NY, USA, 24th edition, 2014. foot massage on physiological edema during pregnancy,” Journal
[2] P. Ponnapula and J. S. Boberg, “Lower extremity changes of Knowledge & Health, vol. 9, no. 4, pp. 1–7, 2015.
experienced during pregnancy,” The Journal of Foot and Ankle [22] L. Mollart, “Single-blind trial addressing the differential ef-
Surgery, vol. 49, no. 5, pp. 452–458, 2010. fects of two reflexology techniques versus rest, on ankle and
[3] R. M. Smyth, N. Aflaifel, and A. A. Bamigboye, “Interventions foot oedema in late pregnancy,” Complementary Therapies in
for varicose veins and leg oedema in pregnancy,” Cochrane Nursing and Midwifery, vol. 9, no. 4, pp. 203–208, 2003.
Database of Systematic Reviews, vol. 10, pp. 1–42, 2015. [23] S. Derakhshan, “Grape seed oil,” Flour and Food Industry
[4] O. A. Saliba J, H. A. Rollo, O. Saliba, and M. L. Sobreira, Magazine, vol. 44, pp. 56–64, 2011.
“Graduated compression stockings effects on chronic venous [24] F. Rahimikian, M. Kiani, A. Shadmehr, M. Kiani, M. Kiani,
disease signs and symptoms during pregnancy,” Phlebology: and Z. Niazi, “The effectiveness of massage and feet elevation
The Journal of Venous Disease, Article ID 268355519846740, on physiological edema of pregnancy: a comparison,” Payesh,
2019. vol. 14, no. 6, pp. 703–710, 2015.
[5] H. Spiby, “Giving complementary therapy with midwifery care for [25] B. Yang, B. Li, C. Xu et al., “Comparison of electrical im-
the 1990s,” Midwives Chronicle, vol. 106, no. 1261, pp. 38–40, 1993. pedance tomography and intracranial pressure during de-
[6] P. McCabe, “Complementary therapy in nursing practice: hydration treatment of cerebral edema,” NeuroImage:
policy development in Australia,” Australian Journal of Ho- Clinical, vol. 23, article 101909, 2019.
listic Nursing, vol. 3, no. 1, p. 4, 1996. [26] J. Xiao, F. Shen, Q. Xue et al., “Is ethnicity a risk factor for
[7] D. Tiran, “The use of complementary therapies in midwifery developing preeclampsia? An analysis of the prevalence of
practice: a focus on reflexology,” Complementary Therapies in preeclampsia in China,” Journal of Human Hypertension,
Nursing and Midwifery, vol. 2, no. 2, pp. 32–37, 1996. vol. 28, no. 11, pp. 694–698, 2014.
[8] M. Mitchell, “Women’s use of complementary and alternative [27] F. Montazerifar, M. Karajibani, M. Sotoudeh, and B. E. Amrollahi,
medicine in pregnancy: a search for holistic wellbeing,” Evaluation of Nutritional Status in Pregnant Women in Iranshahr,
Women and Birth, vol. 27, no. 4, pp. 276–280, 2014. Zahedan University of Medical Sciences, Zahedan, Iran, 2014.
[9] M. Y. Wang, P. S. Tsai, P. H. Lee, W. Y. Chang, and [28] F. Gorgani, F. Majlessi, M. K. Momeni, A. Tol, and A. Rahimi
C. M. Yang, “The efficacy of reflexology: systematic review,” Foroshani, “Prevalence of anemia and some related factor in
Journal of Advanced Nursing, vol. 62, no. 5, pp. 512–520, 2008. pregnant woman referred to health centers affiliated to
[10] Y. Watanabe, M. Koshiyama, and N. Yanagisawa, “Treatment Zahedan University of Medical Sciences in 2013,” Razi Journal
of leg and foot edema in women,” Women’s Health—Open of Medical Sciences, vol. 22, no. 141, pp. 47–58, 2016.
Journal, vol. 3, no. 2, pp. 69–74, 2017. [29] M. Goonewardene, M. Shehata, and A. Hamad, “Anaemia in
[11] K. C. Richards, R. Gibson, and A. L. Overton-McCoy, “Effects of pregnancy,” Best Practice & Research Clinical Obstetrics &
massage in acute and critical care,” AACN Clinical Issues: Advanced Gynaecology, vol. 26, no. 1, pp. 3–24, 2012.
Practice in Acute & Critical Care, vol. 11, no. 1, pp. 77–96, 2000.