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Arch Womens Ment Health (2008) 11: 67–74
DOI 10.1007/s00737-008-0214-3
Printed in The Netherlands
Original contribution
Effects of a mindfulness-based intervent ion during pregnancy
on prenatal stress and mood: results of a pilot study
C. Vieten, J. Astin
California Pacific Medical Center Research Institute, San Francisco, California, U.S.A.
Received 4 January 2007; Accepted 8 November 2007; Published online 3 March 2008
# Springer-Verlag 2008
Summary
Stress and negative mood during pregnancy increase risk for poor
childbirth outcomes and postnatal mood problems and may interfere
with mother–infant attachment and child development. However,
relatively little research has focused on the efficacy of psychosocial
interventions to reduce stress and negative mood during pregnancy. In
this study, we developed and pilot tested an eight-week mindfulness-
based intervention directed toward reducing stress and improving
mood in pregnancy and early postpartum. We then conducted a small
randomized trial (n ¼ 31) comparing women who received the inter-
vention during the last half of their pregnancy to a wait-list control
group. Measures of perceived stress, positive and negative affect,
depressed and anxious mood, and affect regulation were collected prior
to, immediately following, and three months after the intervention
(postpartum). Mothers who received the intervention showed signifi-
cantly reduced anxiety (effect size, 0.89; p <0.05) and negative affect
(effect size, 0.83; p < 0.05) during the third trimester in comparison to
those who did not receive the intervention. The brief and nonpharma-
ceutical nature of this intervention makes it a promising candidate for
use during pregnancy.
Keywords: Mindfulness; depression; anxiety; pregnancy; stress
Introduction
As many as 18% of pregnant women are depressed
during their pregnancy, with 13% having an episode
of major depression, and 14% having a new episode
of depression during pregnancy (Gavin et al. 2005).
Bennett et al. (2004) found prevalence rates of depres-
sion to be 7% in the first trimester, 13% in the second
trimester, and 12% in the third trimester. Pregnant wom-
en have increased subclinical depressive symptoms,
even when potential pregnancy-related confounders such
as appetite, somatic symptoms, and sleeping patterns are
controlled (Gotlib et al. 1989).
Numerous prospective studies in both animals and
humans indicate that high stress and mood disturbance
during pregnancy are associated with a variety of nega-
tive maternal and infant outcomes (Wadhwa et al. 2001;
Bonari et al. 2004) including low birth weight (Altarac
and Strobino 2002; Wadhwa et al. 2004), reduced dura-
tion of gestation and preterm birth (Dejin-Karlsson et al.
2000; Alvarado et al. 2002), bacterial vaginosis during
pregnancy (Culhane et al. 2001), increased risk for chro-
mosomally normal spontaneous abortion (Boyles et al.
2000), lower Apgar scores (Pagel et al. 1990), smaller
head circumference (Lou et al. 1994), and neuroendo-
crine dysregulation (Wadhwa et al. 1996). Stress is a
significant predictor of substance use during pregnancy
(Nelson et al. 2003), more difficult labor and delivery
(Nielsen Forman et al. 2000; Ritter et al. 2000), and
postpartum depression (Da Costa et al. 2000). However,
pregnant women frequently do not receive screening,
prevention or treatment for mood and stress concerns
(Marcus et al. 2003; Flynn et al. 2006).
A recent systematic review of 16 trials that examined
the effects of providing social and emotional support to
women at risk for delivering low-birth-weight babies
concluded that providing psychosocial support to at-risk
Correspondence: C. Vieten, California Pacific Medical Center
Research Institute, Rm. 514, 2200 Webster Street, San Francisco, CA
94115, U.S.A.
e-mail: vietenc@sutterhealth.org
women was not associated with improvements in physi-
ological perinatal outcomes, though there was a re-
duction in rates of caesarean section (Hodnett and
Fredericks 2003). However, Lu et al. (2005) have argued
that methodological limitations of previous studies make
it premature to conclude that psychosocial interventions
are ineffective in preventing negative outcomes such as
low birth weight.
Some psychosocial interventions have shown promise
for improving outcomes. For example, Bullock et al.
(1995) found that pregnant women who received weekly
telephone support evidenced reduced trait anxiety, less
depressed mood, and higher self-esteem. In another trial,
pregnant women who received psychosocial support and
counseling during pregnancy were more likely to have
full-term births (Rothberg and Lits 1991). A couples
intervention consisting of didactic sessions, role-play-
ing, and values clarification exercises had a significant
positive impact on postpartum anxiety, postpartum mar-
ital satisfaction, and postpartum adjustment (Midmer
et al. 1995). Receiving stress reduction instructions at
a prenatal care visit reduced stress, negative affect, and
morning cortisol levels in 42 predominantly low-income
Latina women (Urizar et al. 2004).
Mind–body interventions have shown promise for re-
ducing stress and improving mood in many populations,
including pregnant women (Astin et al. 2003). Narendran
et al. (2005) found that a program incorporating yoga,
breathing exercises, and meditation improved birth
weight and reduced preterm birth and pregnancy compli-
cations in comparison with matched controls. In a ran-
domized controlled trial (n ¼ 110), Bastani et al. (2005)
found that relaxation training reduced anxiety and per-
ceived stress in pregnant women. They also found that
in anxious pregnant women, relaxation training reduced
rates of low birth weight, caesarean section, and instru-
mental extractions, but not preterm birth (Bastani et al.
2006). Massage, while not a mind–body intervention per
se, has shown promise for reducing stress, depression,
anxiety, pain, and birth complications in pregnant women
(Field et al. 1999), as well as increasing dopamine and
serotonin and decreasing urinary cortisol and norepineph-
rine (Field et al. 2004). In lay practice, many mind–body
programs have been developed that show anecdotal prom-
ise for improving perinatal stress and mood (Peterson
1994; England and Horowitz 1998; Newman and
Chamberlain 2005; Bardacke 2006; Sale 2006) but there
have been few studies examining their efficacy.
Mindfulness-Based Stress Reduction (MBSR), a pro-
gram developed by Kabat-Zinn and colleagues (1982),
has demonstrated promise with an array of stress-related
and chronic medical conditions in diverse populations
(Grossman et al. 2004; Roth and Robbins 2004).
MBSR is typically taught in the form of an 8- to 10-
week, group-based educational program focused on the
development of mindfulness. Mindfulness, a set of skills
derived from contemplative traditions such as Buddhism,
involves the cultivation of moment-to-moment, nonjudg-
mental awareness of one’s present moment experience.
While mindfulness practice can induce states of relaxa-
tion, it is not a relaxation technique per se as the focus
in mindfulness is developing the capacity to simply ob-
serve or witness changing mental and physiological
states without necessarily trying to alter those states
and achieve some desired (e.g., relaxed or calm) state
of mind.
Studies in nonclinical populations suggest that partic-
ipation in MBSR can lessen psychosomatic symptom-
atology and mood disturbance, increase sense of control,
and reduce medical symptoms (Astin 1997; Shapiro et al.
1998; Williams et al. 2001). In clinical populations, par-
ticipation in MBSR has decreased mood disturbance
and stress symptoms (Speca et al. 2000) and improved
quality of life and sleep in diverse patient populations
(Carlson et al. 2001, 2003).
Recently, MBSR has been modified and studied as
a treatment to prevent relapse in clinical depression.
Teasdale et al. (2000) reported that for patients who
had three or more previous episodes of depression, par-
ticipation in a program that combined elements of
MBSR with cognitive therapy (termed Mindfulness-
Based Cognitive Therapy, MBCT) (Segal et al. 2002)
reduced the rate of relapse to approximately half that
of patients receiving standard treatment. This result
was recently replicated (Ma and Teasdale 2004). The
positive effects of MBSR on mood disturbance and psy-
chosomatic symptomatology including chronic pain
(Kabat-Zinn et al. 1987, 1992) and anxiety and panic
disorders (Miller et al. 1995) are also supported by data
from several uncontrolled trials (Reibel et al. 2001;
Bishop 2002).
The brief and nonpharmaceutical nature of mindful-
ness-based interventions make them particularly good
candidates for intervention during pregnancy. We con-
ducted the current study to develop a mindfulness-based
intervention for pregnant women and to test the hypoth-
esis that participation in this intervention would reduce
stress, negative affect, and depressive and anxious symp-
toms during pregnancy and early postpartum. Our theory
was that the training would increase mindfulness and
68
C. Vieten, J. Astin
improve ability to regulate negative affect, and that im-
provement in these variables would be associated with
reduced stress and improved mood. In addition, positive
affect is a domain that has received increasing attention
as a predictor of health outcomes independent of the
influence of negative affect on outcomes (Folkman and
Moskowitz 2000). We explored the effects of mind-
fulness training on positive affect, an outcome that
seems particularly important in the perinatal period for
both maternal psychological health and maternal–infant
interactions.
Method
Participants
We included women in the second and third trimesters who were
between twelve and thirty weeks gestation at the start of the
intervention and were able to speak and read English. Additional
inclusion criteria were an affirmative response to the question
‘‘Have you had a history of mood concerns for which you
sought some form of treatment, such as psychotherapy, counsel-
ing, or medication?’’ This method of selecting for women with
‘‘mood concerns’’ rather than a more formal screening for de-
pression or anxiety was a result of our experience recruiting
participants for the initial feasibility group, where we found that
pregnant women were reluctant to identify themselves as de-
pressed or anxious, even in the past. We had a very low response
when our recruitment materials mentioned ‘‘dealing with anx-
ious or depressed mood’’. However, when we recruited partici-
pants with recruitment materials referring to ‘‘dealing better
with stress and difficult moods’’, we received an adequate re-
sponse. This method of inclusion resulted in a sample of parti-
cipants of whom 35% reported being treated for a psychiatric
disorder in the past, 32% had taken psychotropic medications in
the past, 52% exceeded a score of 14 on the Perceived Stress
Scale upon enrollment, and 31% exceeded a score of 16 on the
Center for Epidemiologic Studies Depression Scale (CES-D).
Exclusion criteria were (1) a history of mental disorders that
had a psychotic, dissociative, hallucinatory, or delusional com-
ponent or (2) an inability to attend each of the classes or partici-
pate in the assessments.
Women had a mean age of 33.9 (standard deviation [SD],
3.8), all were married, 74% were White, 13% Hispanic, 7%
Asian, 3% mixed race, and 3% East Indian. Mean household
income was USD 89,677 (SD, USD 17,792) annually, and mean
educational level was 17 (SD, 1.4).
Intervention
An intervention was developed to train pregnant women in
mindfulness. We began by reviewing and compiling intervention
elements of MBSR (Kabat-Zinn 1990) and MBCT (Segal et al.
2002), theoretical and clinical work on working with mood
concerns during pregnancy (Peterson 1994), and acceptance-
based psychological approaches such as Acceptance and
Commitment Therapy (Hayes et al. 2004). From this detailed
review, we developed the Mindful Motherhood intervention
using a ‘‘problem formulation’’ approach (Teasdale et al. 2003),
which calls for tailoring interventions to match the population
and problem being addressed. We detailed the symptoms we
hoped to alleviate with the intervention, as well as the skills
we hoped to enhance, and then selected or developed inter-
vention components that would address each of these areas.
Through an iterative process of revision among the investigators
and consultants, we developed a provisional treatment manual
by group consensus.
The Mindful Motherhood intervention incorporates three ap-
proaches to cultivating mindfulness: (1) mindfulness of thoughts
and feelings through breath awareness and contemplative prac-
tices, (2) mindfulness of the body through guided body aware-
ness meditation and mindful hatha yoga, and (3) presentation of
psychological concepts that incorporate mindfulness such as
acceptance and cultivation of an observing self. Each of these
elements accounted for approximately one-third of the interven-
tion. The intervention contained approximately equal parts edu-
cation, discussion, and experiential exercises, with more weight
on education in the early sessions, and more on discussion and
experiential exercises in the later sessions. Adaptations of typi-
cal mindfulness-based intervention components included, for
example, (1) inclusion of awareness of the developing fetus
and belly during the body scan meditation; (2) use of explana-
tory examples and exercises having to do with pregnancy and
early parenting such as mindfulness regarding pain or sleep
issues during pregnancy, anxiety about labor, or dealing with a
difficult-to-console infant; and (3) greater inclusion of walking
and moving mindfulness practices and forms of mindful move-
ment that have been tailored for pregnant women such a prenatal
yoga. An intervention manual is available from the authors.
Participants were provided with weekly readings relevant to
the material presented in class, as well as a compact disc with
three 20 min guided meditations, which they were encouraged to
utilize daily. The training was 2 h in duration per week for 8
weeks and was facilitated by a licensed clinical psychologist
trained in mindfulness-based interventions, as well as a certified
prenatal yoga instructor. Group sizes ranged from 12 to 20
women (and their infants in the postnatal wait-list control
group), and groups were held in the multipurpose rooms of a
large urban hospital, as well as a local synagogue.
Procedures
Participants were recruited through physicians’ offices, child-
birth education classes, advertisements, and flyers at other loca-
tions pregnant women frequent. The study took place at a large
private non-profit hospital in San Francisco, California. All pro-
cedures and materials were approved by the Institutional Review
Board.
We tested the provisional intervention for feasibility with 12
women and refined it on the basis of (1) participant feedback
regarding what they found useful and not useful about the inter-
vention (data collected by written questionnaire at the end of the
intervention, during the postintervention measures, as well as
informally throughout the course of the group) and (2) group
facilitator feedback regarding the order, content, and participant
response to intervention components (facilitators kept a journal,
Mindfulness during pregnancy
69
answering a set of questions for each group session). We
reviewed this feedback carefully, identified potential changes
to the intervention, and then proposed these changes to our
investigative and facilitator team who accepted or rejected
changes by consensus.
We then conducted a randomized wait-list controlled trial
using the refined intervention, recruitment, and measurement
strategies. We received 78 phone calls, and 46 women were
found to be eligible for the study. The 32 women who called
and were not eligible for the study either did not speak or read
English (4), were not between 12 and 30 weeks gestation (16),
had not had a history of mood concerns for which they sought
some form of treatment (9), or had a history of psychosis (3). An
additional 9 women did not want to or could not participate in a
mindfulness class due to not wanting to be randomized, personal
preference, scheduling conflicts, or location of the class. Three
women enrolled and dropped out prior to the start of the inter-
vention due to changes in work schedule or difficulty with the
location of the class. The remaining 34 women were random-
ized: 15 to the experimental group from which 2 dropped out, 1
due to a death in the family and 1 due to severe hyperemesis
gravidarum. Nineteen women were assigned to a wait-list con-
trol group, and one dropped out after the baseline assessment for
personal reasons, leaving an overall n of 31 for the pilot study
analyses. Those in the experimental group attended the group
during their second and=or third trimester. Women were at a
mean time of gestation of 25 (SD, 4.0; range, 18–31) weeks at
the baseline measurement point.
The baseline assessment occurred for all participants during
the two weeks prior to the start of the intervention for the
experimental group. Then, women in the experimental group
attended the intervention for 2 h per week over eight weeks,
for a total of eight groups. Women in the experimental group
attended a mean number of 7.2 (SD, 1.1) sessions and reported
in weekly diaries engaging for a mean time of 76.9 (SD, 25.6)
min per week in formal mindfulness practice. The second as-
sessment for all participants (experimental and control) occurred
in the week following the end of the experimental group inter-
vention (eight–ten weeks following the baseline assessment).
Follow-up (postnatal) assessments of all participants occurred
three months later, and the wait-list control group then received
the intervention. Data were collected between September 2004
and May 2006.
Measures
Demographic information was collected at baseline. At each
assessment point, measures of perceived stress, depression, anx-
iety, positive and negative affect, affect regulation, and mindful-
ness were collected. Perceived stress was measured using the
Perceived Stress Scale (PSS), the most widely used psychologi-
cal instrument for measuring the perception of stress (Cohen
et al. 1983). The PSS has demonstrated high alpha reliability
in pregnant populations (Lobel et al. 2000), and higher scores on
the measure have been associated with lower birth weight babies
(Sable and Wilkinson 2000) as well as elevated levels of corti-
cotropin-releasing hormone and preterm birth (Hobel et al. 1999).
Depression was measured by CES-D (Radloff 1977; Hann et al.
1999). In pregnant populations, higher scores on the CES-D
have been associated with restricted fetal growth (Hoffman
and Hatch 2000) and spontaneous preterm birth (Orr et al.
1996). Anxiety was measured using the State–Trait Anxiety
Inventory (STAI) (Spielberger et al. 1970). This measure has
been used widely in pregnant populations and shown to be
predictive of higher fetal heart rate reactivity (Monk et al.
2004), greater uterine artery resistance (Teixeira et al. 1999),
preeclampsia (Kurki et al. 2000), and gestational age at birth
(Wadhwa et al. 1993). Positive and negative affect that may not
manifest in clinical depression or anxiety symptoms was mea-
sured by the Positive and Negative Affect Schedule – Extended
(PANAS-X) (Watson and Clark 1994). Internal consistency reli-
abilities for the PANAS are between 0.83 and 0.90 for positive
affect and between 0.85 and 0.90 for negative affect. Affect
regulation was measured by the affect regulation measure
(ARM) (Vieten et al. unpubl), which assesses impairments in
the ability to regulate negative affect across five domains, in-
cluding affect intolerance, affect lability, cognitive dysregula-
tion, affect preoccupation, and reactivity. Chronbach’s alpha
coefficients of internal consistency range from 0.81 to 0.90 for
the ARM scales, and test–retest reliabilities over 8 weeks ranged
from 0.69 to 0.84. Mindfulness was measured by the Mindful
Attention Awareness Scale (MAAS), which measures the ex-
tent to which individuals are able to maintain awareness of
present-moment experience (Brown and Ryan 2003). The MAAS
has demonstrated Chronbach’s alpha of 0.80–0.87, test–retest
reliability intraclass correlation of 0.81, and good convergent,
discriminant, incremental, and predictive validity. Adherence to
the intervention was assessed by two means: number of sessions
attended and weekly diaries of number of minutes spent prac-
ticing mindfulness in each day between sessions.
Data analysis
The primary outcome was between-group differences in change
from preintervention to postintervention. ANCOVAs with base-
line values entered as covariates were performed to assess for
between-group differences. It is now recommended by most
statisticians and methodologists that investigators report effect
sizes, particularly in cases where sample sizes are small and
statistical power is likely to be an issue (Cohen 1994). Effect
sizes for all outcomes were calculated using Cohen’s d,orthe
difference between two means divided by the pooled standard
deviation for those means.
Results
At the postintervention (third trimester) assessment, wo-
men participating in the mindfulness group showed sta-
tistically significant decreases in state anxiety ( p<0.05)
and negative affect ( p <0.04) compared with wait-list
controls. Changes in the expected direction were ob-
served in the intervention group on all other variables
(Table 1). Effect sizes (Cohen’s d), in order of strength,
were as follows: negative affect, 0.90; state anxiety,
0.85; depression, 0.80; positive affect, 0.73; mindful-
70
C. Vieten, J. Astin
ness, 0.68; affect regulation, 0.50; and perceived stress,
0.39.
Differences observed between treatment and wait-list
controls at 3-month follow-up were not statistically sig-
nificant. As shown in Table 2, while improvements were
still evident for most variables, the percent change
among treated subjects decreased for anxiety (20–7%);
depression (20–11%), positive affect (20–12%), nega-
tive affect (25–13%), affect regulation (9–7%), and
perceived stress (20–0%). While changes in mindful-
ness increased somewhat from 5 to 9% at 3-month
follow-up, between-group changes remained nonsignif-
icant (p ¼ 0.07).
Discussion
The results suggest that mindfulness training during
pregnancy resulted in a significantly greater decline in
anxiety and negative affect among participants in the
mindfulness intervention when compared with a group
that did not receive mindfulness training. The control
group showed no improvement in mood at the postin-
tervention assessment (and significant increase in de-
pression and decrease in positive affect), whereas the
experimental group showed 20–25% improvement on
anxiety, negative affect, positive affect, and stress post
intervention. Large effect sizes (as defined by Cohen
[1988]) were observed for depression and positive affect
despite these changes not reaching statistical significance
( p<0.05), leading us to suspect that the small sample
size may have afforded inadequate power (Cohen 1994).
While these findings are only preliminary given the small
sample size, the observed effect sizes may have clinical
relevance. For example, in terms of depression, the ob-
served effect size of 0.8 means that the mean of the
treated group is better than the scores of 79% of the
control group. Taken together, these results indicate that
further research with a larger sample is warranted.
In terms of depression, while scores on the CES-D at
postintervention remained above the clinical cutoff of 16
in treated subjects, it should be noted that mean baseline
values for this group were 20. The mean of the control
group on the other hand increased from 14.2 to 17.2 at
the postintervention assessment. Furthermore, it should
be noted that during pregnancy, CES-D scores are typi-
cally inflated due to three somatically oriented questions
that are commonly endorsed in pregnancy (item 2: I did
not feel like eating; my appetite was poor; item 11: My
sleep was restless; and item 20: I could not get going).
When used as a screening for pregnant or early postpar-
tum women, these items are often removed as they may
confound the depression construct. We opted to leave
these questions in for ease of comparison to standard
clinical comparisons.
Between-group differences were not significantly dif-
ferent at the three-month postnatal follow-up. However,
whereas the control group showed no change from
baseline to the three-month follow-up, the experimental
group retained 7–10% of their improvements from base-
Table 1. Changes within groups from baseline to 10 weeks, and differences in changes between groups controlling for baseline values
Measure Value for group Between-
group
Effect
size
Intervention (n ¼ 13) Control (n ¼ 18) ANCOVA
Baseline 10 wks Change Baseline 10 wks Change
Mean SD Mean SD Mean SD Mean SD Mean SD Mean SD F (2,24) pd
Perceived stress 20.1 5.1 15.9 5.7 3.5 5.7 17.1 5.0 16.9 4.6 0.71 6.2 0.90 0.35 0.39
State anxiety 43.8 12.4 35.4 9.1 6.9 7.6 35.6 10.9 35.6 8.4 0.35 7.5 4.32 0.04 0.85
Depression 20.4 8.4 16.2 7.3 3.6 5.2 14.2 5.4 17.2 7.4 4.6 7.3 3.84 0.06 0.80
Negative affect 24.2 5.7 18.2 4.3 5.6 4.5 21.2 5.7 19.9 5.7 0.21 4.5 4.84 0.03 0.90
Positive affect 27.8 7.5 32.4 7.4 2.8 7.9 32.6 6.1 29.5 5.6 3.0 4.9 3.24 0.08 0.73
Affect regulation 167.1 22.6 152.8 24.0 13.2 16.5 146.3 21.2 143.6 22.2 0.78 13.3 1.51 0.23 0.50
Mindfulness 3.6 0.76 3.8 0.82 0.19 0.45 3.8 0.57 3.6 0.72 0.23 0.64 2.75 0.11 0.68
Table 2. Improvement on primary outcomes
Variable % improvement from baseline at:
8 weeks 3 months
Intervention Control Intervention Control
Anxiety 20 0 7 1
Depression 20 21 11 0
Perceived stress 20 0 0 0
Positive affect 20 10 12 7
Negative affect 25 6 13 1
Mindfulness 5 59 0
Affect regulation 9 2 7 1
Mindfulness during pregnancy
71
line on all measures but perceived stress. This trend
toward some retention of improvement is worth explor-
ing in a larger sample.
Because mindfulness change scores were not signi-
ficantly greater in the experimental group than those
in the control group, we did not test the extent to
which mindfulness mediated improvement in outcomes.
However, the moderate effect size (d ¼ 0.68, p ¼ 0.11)
between groups prevents the conclusion that the inter-
vention did not increase mindfulness. In addition, the
number of sessions attended and minutes of practice
per week were not significantly correlated with improve-
ments (change scores) or outcomes. The small sample
size made even relatively large correlations nonsignifi-
cant, but more importantly, there was no discernible
pattern of correlations between attendance and adher-
ence and outcomes. The mediating effects of mindful-
ness and attendance and adherence on outcomes should
be studied in a larger sample.
Hayes and Muller (2004) suggest that prenatal mood
should be treated as a distinct entity, and not only pre-
cursory to postnatal mood. The literature indicates pre-
natal maternal distress has a distinct and direct impact
on childbirth and child development outcomes (Wadhwa
et al. 2001), and therefore improvements in mood and
stress during pregnancy have value in their own right.
However, obviously the hope is that the benefit of psy-
chosocial interventions will extend into the postnatal
period. Dennis and Creedy (2004) suggest that postpar-
tum interventions have the most promise for influencing
postpartum depression. We found that our intervention
was feasible in our wait-list control group where women
attended mindfulness training with their infants. It is
possible that this intervention would be best adminis-
tered during both the prenatal and postnatal periods to
sustain its beneficial effects.
Our study is limited by a small sample size, limited
generalizability due to lack of a socioeconomically or
ethnically representative sample, reliance on self-report
measures, lack of structured interview to assess diagnos-
tic status, and a wait-list control design that does not
control for time and attention. While utilizing a wait-list
control (in which the control group is receiving only the
standard of care) has some benefits for studying psycho-
social interventions, lack of an active control group
(such as simple group support or education) leaves open
the possibility that intervention effects were simply due
to the time and attention paid to the experimental group
as opposed to mindfulness or other therapeutic aspects
of the intervention. Now that within-subjects improve-
ments in stress and mood have been demonstrated in
comparison to standard of care, future studies should
include an active control group.
Notably, during the course of the study, we learned
that when screening potential participants, pregnant
women were more willing to admit to having issues with
‘‘stress and mood’’ than ‘‘anxiety and depression’’, even
though many of these women did in fact score above
cutoff points on both depression and anxiety measures.
We speculate that this is partly due to perceived social
stigma, and our experience in this regard may have
implications not only for how pregnant women are
recruited and screened for studies on stress and mood
during pregnancy, but also for how pregnant women are
screened and assessed for mood problems in clinical
settings. It is possible that using more benign language
such as ‘‘stress’’, ‘‘difficult mood’’, or ‘‘mood concerns’’
may be more useful in screening than inquiring directly
about depression or anxiety.
In summary, our results suggest that a mindfulness-
based intervention provided during pregnancy reduced
negative affect and anxiety and holds promise for reduc-
ing depression and improving positive affect in a preg-
nant population. A slight trend toward improvements
extending into the postpartum period in the group that
received mindfulness training warrants further research.
Expanding the intervention to bridge between the prena-
tal and postpartum periods by providing booster sessions
postnatally could have value. It remains to be seen what
mediates the changes observed, and whether improve-
ments in mood and stress as a result of participating in
mindfulness-based interventions will result in improved
childbirth and child development outcomes.
Acknowledgments
This work was supported by a grant from the Bella Vista
Foundation. We thank Amy Beddoe, Lisa Bialy, Raymond
Buscemi, Mary Costello, Jnana Gowan, Sharifa Krongold,
Daniel Rechstaffen, and Jessica Welborn for their assistance
with this project.
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