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Background Antenatal depression and anxiety are associated with adverse obstetric and mental health outcomes, yet practicable nonpharmacological therapies, particularly for the latter, are lacking. Yoga incorporates relaxation and breathing techniques with postures that can be customized for pregnant women. This study tested the efficacy of yoga as an intervention for reducing maternal anxiety during pregnancy. Methods Fifty‐nine primiparous, low‐risk pregnant women completed questionnaires assessing state (State Trait Anxiety Inventory; STAI‐State), trait (STAI‐Trait), and pregnancy‐specific anxiety (Wijma Delivery Expectancy Questionnaire; WDEQ) and depression (Edinburgh Postnatal Depression Scale; EPDS) before randomization (baseline) to either an 8‐week course of antenatal yoga or treatment‐as‐usual (TAU); both groups repeated the questionnaires at follow‐up. The yoga group also completed pre‐ and postsession state anxiety and stress hormone assessments at both the first and last session of the 8‐week course. Results A single session of yoga reduced both subjective and physiological measures of state anxiety (STAI‐S and cortisol); and this class‐induced reduction in anxiety remained at the final session of the intervention. Multiple linear regression analyses identified allocation to yoga as predictive of greater reduction in WDEQ scores (B = −9.59; BCa 95% CI = −18.25 to −0.43; P = .014; d = −0.57), while allocation to TAU was predictive of significantly increased elevation in EPDS scores (B = −3.06; BCa 95% CI = −5.9 to −0.17; P = .042; d = −0.5). No significant differences were observed in state or trait anxiety scores between baseline and follow‐up. Conclusion Antenatal yoga seems to be useful for reducing women's anxieties toward childbirth and preventing increases in depressive symptomatology.

The treatment of perinatal depression is a public-health priority because of its high prevalence and association with disability and poor infant development. We integrated a cognitive behaviour therapy-based intervention into the routine work of community-based primary health workers in rural Pakistan and assessed the effect of this intervention on maternal depression and infant outcomes. We randomly assigned 40 Union Council clusters in rural Rawalpindi, Pakistan, in equal numbers to intervention or control. Married women (aged 16–45 years) in their third trimester of pregnancy with perinatal depression were eligible to participate. In the intervention group, primary health workers were trained to deliver the psychological intervention, whereas in the control group untrained health workers made an equal number of visits to the depressed mothers. The primary outcomes were infant weight and height at 6 months and 12 months, and secondary outcome was maternal depression. The interviewers were unaware of what group the participants were assigned to. Analysis was by intention to treat. The study is registered as ISRCTN65316374. The number of clusters per group was 20, with 463 mothers in the intervention group and 440 in the control group. At 6 months, 97 (23%) of 418 and 211 (53%) of 400 mothers in the intervention and control groups, respectively, met the criteria for major depression (adjusted odds ratio (OR) 0·22, 95% CI 0·14 to 0·36, p<0·0001). These effects were sustained at 12 months (111/412 [27%] vs 226/386 [59%], adjusted OR 0·23, 95% CI 0·15 to 0·36, p<0·0001). The differences in weight-for-age and height-for-age Z scores for infants in the two groups were not significant at 6 months (−0·83 vs −0·86, p=0·7 and −2·03 vs −2·16, p=0·3, respectively) or 12 months (−0·64 vs −0·8, p=0·3 and −1·10 vs −1·36, p=0·07, respectively). This psychological intervention delivered by community-based primary health workers has the potential to be integrated into health systems in resource-poor settings. Wellcome Trust.

Experience of domestic violence has negative mental health consequences for women. The association of cumulative and specific forms of domestic violence, particularly emotional violence and controlling behavior, with common mental disorders and stress has rarely been studied in pregnant women. The aim of this study is to evaluate associations of specific and multiple forms of lifetime domestic violence and controlling behavior with distress and cortisol level during pregnancy in rural Bangladeshi women. In this observational sub-study of larger MINIMat trial, 3504 pregnant women were interviewed using a shortened Conflict Tactic Scale about their lifetime experience of domestic violence including physical, sexual, emotional domestic violence and controlling behavior. Women's levels of emotional distress were assessed using the self-reported questionnaire (SRQ-20) developed by WHO, and levels of morning salivary cortisol were measured in a subsample (n = 1300) of women during week 28-32 of pregnancy. Regression analyses were used to estimate the associations of lifetime physical, sexual, emotional domestic violence and controlling behavior with levels of distress and cortisol during pregnancy. The prevalence of lifetime domestic violence was 57% and emotional distress was 35% in these pregnant women. All forms of domestic violence were associated with higher levels of emotional distress. Women who experienced either emotional violence or controlling behavior had the highest levels of emotional distress. There was a dose-response relationship between cumulative number of the different forms of domestic violence and women's levels of emotional distress. There was no association between women's experience of domestic violence and level of morning salivary cortisol. Including emotional violence and controlling behavior as major types of violence in future research and health interventions is warranted. Furthermore, the extent of the negative impacts of domestic violence on pregnant women, multiple forms of violence and their cumulative effects need to be investigated.

Background Studies showed that pregnant women generally value routine ultrasounds in the first two trimesters because these provide reassurance and a chance to see their unborn baby. This, in turn, might help to decrease maternal anxiety levels and increase the bond with the baby. However, it is unclear whether pregnant women hold the same positive views about a third trimester routine ultrasound, which is increasingly being used in the Netherlands as a screening tool to monitor fetal growth. The aim of this study was to explore pregnant women’s experiences with a third trimester routine ultrasound. Methods We held semi-structured interviews with fifteen low-risk pregnant women who received a third trimester routine ultrasound in the context of the Dutch IUGR RIsk Selection (IRIS) study. The IRIS study is a nationwide cluster randomized controlled trial carried out among more than 13,000 women to examine the effectiveness of a third trimester routine ultrasound to monitor fetal growth. For the interviews, participants were purposively selected based on parity, age, ethnicity, and educational level. We performed thematic content analysis using MAXQDA. Results Most pregnant women appreciated a third trimester routine ultrasound because it provided them confirmation that their baby was fine and an extra opportunity to see their baby. At the same time they expressed that they already felt confident about the health of their baby, and did not feel that their bond with their baby had increased after the third trimester ultrasound. Women also reported that they were getting used to routine ultrasounds throughout their pregnancy, and that this increased their need for another one. Conclusions Pregnant women seem to appreciate a third trimester routine ultrasound, but it does not seem to reduce anxiety or to improve bonding with their baby. Women’s appreciation of a third trimester routine ultrasound might arise from getting used to routine ultrasounds throughout pregnancy. We recommend to examine the psychological impact of third trimester routine ultrasounds in future studies. Results should be taken into consideration when balancing the gains, which are as yet not clear, of introducing a third trimester routine ultrasound against unwanted side effects and costs.

Objective To investigate the relationship between third-trimester antenatal depression (AND) and the number of pregnancies, considering the possible moderating role of dysmenorrhea. Methods A total of 1,178 pregnant women in their third trimester were included in this cross-sectional observational study. The pregnant women were categorized into those with and without dysmenorrhea. Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS), a validated instrument for perinatal depression screening applicable to both antenatal and postnatal populations. Regression analysis and simple slope analysis to evaluate the moderating effect of dysmenorrhea. Results The non-dysmenorrhea group exhibited significantly higher age, pre-pregnancy BMI, number of pregnancies or deliveries, and lower EPDS scores than the dysmenorrhea group ( p  < 0.05). In both groups, an inverse relationship was observed between educational levels and EPDS scores ( p  < 0.001). For the non-dysmenorrhea group, age was inversely related to the EPDS scores ( p  < 0.001). Within the dysmenorrhea group, the number of Pregnancies and the count of deliveries demonstrated a positive association with EPDS scores ( p  < 0.001). A negative correlation with EPDS scores was found for both age and the educational levels of the husbands ( p  < 0.05). Dysmenorrhea was linked to a positive correlation with EPDS scores ( p  < 0.001). Furthermore, the interaction between the number of pregnancies and the presence of dysmenorrhea also demonstrated a positive correlation with EPDS scores ( p  < 0.05). Conclusion In conclusion, there is a significant positive link between the number of pregnancies and AND, with further exacerbation by dysmenorrhea. Highlights Dysmenorrhea worsens antenatal depression (AND) in pregnancy. Higher pregnancies/deliveries link to increased AND in dysmenorrhea. Age lowers AND in non-dysmenorrhea group. Dysmenorrhea and pregnancies interact to raise AND risk.

Objectives Some studies indicate cognitive defects during pregnancy, but the factors affecting these defects have not been addressed. Therefore, the present study aims to determine the impressive factors in executive function during pregnancy. Materials and methods This study was conducted on pregnant women referred to Imam Hossein and Taleghani Hospital in Tehran between October 2019 and October 2021. Eligible people completed the Brain Executive Function Questionnaire of the adult self-report form at the following three points of follow-up: the first trimester of pregnancy, the third trimester of pregnancy, and postpartum. The executive performance scores of the studied subjects and the influencing factors were reported. Results In this study, 210 pregnant women with a mean age of 28.70 ± 7.08 years filled out the questionnaire three times. The Global Executive Composite (GEC) of the study subjects in the third trimester of pregnancy was significantly higher than in the first trimester of pregnancy and after delivery (a higher score indicates a greater impairment of the brain’s executive function), which indicates lower executive function during the third trimester. The GEC of the study subjects after delivery was significantly higher than in the first trimester of pregnancy. The level of education of the subjects was the covariate of the changes in the study subjects’ executive performance. Conclusion Score of the postpartum period in comparison to the first trimester was significantly decreased, yet. Also, the changes in the executive function of the brain during pregnancy were influenced by the level of education, including better function and lower decline in the high-educated group. Graphical Abstract

Poor dietary intake has been linked to depression during pregnancy, but little research has examined this in Hispanic populations. We examined third-trimester associations of study-derived dietary patterns with odds of prenatal depression and depressive symptoms in pregnant, low-income Hispanic women. Participants (N = 587) were drawn from the Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) cohort in Los Angeles, CA. Diet was assessed using a 24-h recall tool. Women were assigned quartile rankings based on adherence to two previously derived dietary patterns: vegetables, oils, and fruit (VOF; healthier) and solid fats, refined grains, and cheese (SRC; less healthy). Depressive symptoms were defined using the Center for Epidemiological Studies-Depression Scale score, and a dichotomized depression outcome was defined as Center for Epidemiological Studies-Depression Scale scores ≥16. Eighteen percent of participants were classified as depressed at the third-trimester visit. Women with the greatest adherence to the healthier dietary pattern (VOF) had 59% lower odds of depression (OR = 0.41, 95% CI: 0.19, 0.86) relative to women with the lowest adherence to this dietary pattern, after adjustment for covariates. Additionally, women with moderately high (third quartile) adherence to the VOF dietary pattern had 16.9% lower depressive symptoms (95% CI: -30.5%, -0.8%) compared with women with the lowest VOF adherence. Women with the highest VOF adherence had similar, non-statistically significant lower depressive symptoms (Beta = -10.4%, 95% CI: -25.7%, 8.1%). Our results indicate that there are important relationships between a healthy diet and lower depression in late pregnancy, and suggest that nutritional counseling and improved neighborhood access to healthy food may be important for maternal mental health. •A healthy diet was associated with lower depression in Hispanic, low-income women.•Consuming vegetables, healthy oils, and fruit may protect against prenatal depression.•Data-driven dietary patterns could improve culturally tailored nutrition counseling. [Display omitted]

Prenatal physical activity (PA) has well-established benefits for maternal mental health. However, PA levels are generally low among pregnant individuals and were even lower during the COVID-19 pandemic. Since walking is the most popular form of prenatal PA, we aimed to examine associations between walking in the third trimester of pregnancy and mental health symptoms of depression, anxiety, pregnancy-related anxiety and perceived stress during the pandemic. Relevant pandemic-related factors (e.g., COVID-19 waves, population density) associated with walking were also studied. Pregnant individuals were recruited across Quebec (Canada) between October 2020 and September 2022, as part of the Resilience and Perinatal Stress during the Pandemic (RESPPA) study. Analyses were conducted on data collected via online questionnaires during the third trimester (n = 1086). Results revealed that higher levels of walking were significantly associated with lower symptoms of generalized anxiety (β = −0.06, p = 0.035), and perceived stress (β = −0.07, p = 0.007). Living in a more densely populated area, living with fewer children at home and having a university degree were associated with higher levels of walking. Those who completed their questionnaire in the second pandemic wave also reported higher levels of walking. Our results highlight the potential of walking in the third trimester to support maternal mental health.

Childbirth has been linked to postpartum impairment. However, controversy exists regarding the onset and prevalence of post-traumatic stress disorder (PTSD) after childbirth, with seminal studies being limited by methodological issues. This longitudinal prospective study examined the prevalence of PTSD following childbirth in a large sample while controlling for pre-existing PTSD and affective symptomatology. Pregnant women in their third trimester were recruited over a 12-month period and interviewed to identify PTSD and anxiety and depressive symptoms during the last trimester of pregnancy, 4-6 weeks postpartum, 12 weeks postpartum and 24 weeks postpartum. Of the 1067 women approached, 933 were recruited into the study. In total, 866 (93%) were retained to 4-6 weeks, 826 (89%) were retained to 12 weeks and 776 (83%) were retained to 24 weeks. Results indicated that, uncontrolled, 3.6% of women met PTSD criteria at 4-6 weeks postpartum, 6.3% at 12 weeks postpartum and 5.8% at 24 weeks postpartum. When controlling for PTSD and partial PTSD due to previous traumatic events as well as clinically significant anxiety and depression during pregnancy, PTSD rates were less at 1.2% at 4-6 weeks, 3.1% at 12 weeks and 3.1% at 24 weeks postpartum. This is the first study to demonstrate the occurrence of full criteria PTSD resulting from childbirth after controlling for pre-existing PTSD and partial PTSD and clinically significant depression and anxiety in pregnancy. The findings indicate that PTSD can result from a traumatic birth experience, though this is not the normative response.

Recently, the US Preventive Services Task Force has advocated to screen pregnant and postpartum women for depression. However, we questioned the meaning of a single elevated depression score: does it represent just one episode of depression or do these symptoms persist throughout the entire pregnancy? This study assessed depressive symptoms at each trimester in a cohort of 1813 pregnant women and evaluated whether women with different patterns of depressive symptoms showed other characteristics. Depending on the trimester, elevated depression scores were prevalent in 10–15% of the pregnant women. Up to 4% reported persistent symptoms of depression throughout pregnancy. Different patterns of depressive symptoms were observed, for which persistent symptoms were related to other characteristics than incidentally elevated symptoms. Besides a previous history of mental health problems as best overall predictor, incidentally elevated depression scores were related to major life events. Furthermore, persistently depressive symptoms were related to unplanned pregnancy and multiparity. An EDS assessment at 12 weeks of gestation including three additional items (history of mental health problems, unplanned pregnancy and multiparity) enabled us to identify 83% of the women with persistent depressive symptoms. A depression screening strategy in pregnant women should take into account the potential chronicity of depressive symptoms by repeated assessments in order to offer an intervention to the most vulnerable women.