ArticlePDF Available

Effects of a mindfulness-based intervention during pregnancy on prenatal stress and mood: Results of a pilot study

Authors:

Abstract

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=31) comparing women who received the intervention 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 significantly 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 nonpharmaceutical nature of this intervention makes it a promising candidate for use during pregnancy.
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 maternalinfant
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, 1831) 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 ve domains, in-
cluding affect intolerance, affect lability, cognitive dysregula-
tion, affect preoccupation, and reactivity. Chronbachs 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 0.800.87, 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 Cohens 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 (207%);
depression (2011%), positive affect (2012%), nega-
tive affect (2513%), affect regulation (97%), and
perceived stress (200%). 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 2025% 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 710% 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.
References
Altarac M, Strobino D (2002) Abuse during pregnancy and stress
because of abuse during pregnancy and birthweight. J Am Med
Womens Assoc 57: 208214
Alvarado R, Medina E, Aranda W (2002) The effect of psychosocial
variables during pregnancy and in birth weight and gestational age of
the newborn. Rev Med Chil 130: 561568 (in Spanish with summary
in English)
Astin JA (1997) Stress reduction through mindfulness meditation.
Effects on psychological symptomatology, sense of control, and
spiritual experiences. Psychother Psychosom 66: 97106
72
C. Vieten, J. Astin
Astin JA, Shapiro SL, Eisenberg DM, Forys KL (2003) Mind-body
medicine: state of the science, implications for practice. J Am Board
Fam Pract 16: 131–147
Bardacke N (2006) Mindfulness-Based Childbirth and Parenting
Education Program. Available at http:==www.mindfulbirthing.org
Bastani F, Hidarnia A, Montgomery KS, Aguilar-Vafaei ME,
Kazemnejad A (2006) Does relaxation education in anxious primi-
gravid Iranian women influence adverse pregnancy outcomes?: a
randomized controlled trial. J Perinat Neonatal Nurs 20: 138146
Bastani F, Hidarnia A, Kazemnejad A, Vafaei M, Kashanian M (2005) A
randomized controlled trial of the effects of applied relaxation
training on reducing anxiety and perceived stress in pregnant women.
J Midwifery Womens Health 50: 3640
Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR (2004)
Prevalence of depression during pregnancy: systematic review. Obstet
Gynecol 103: 698709
Bishop SR (2002) What do we really know about mindfulness-based
stress reduction? Psychosom Med 64: 7183
Bonari L, Bennett H, Einarson A, Koren G (2004) Risks of untreated
depression during pregnancy. Can Fam Physician 50: 3739
Boyles SH, Ness RB, Grisso JA, Markovic N, Bromberger J, CiFelli D
(2000) Life event stress and the association with spontaneous abortion
in gravid women at an urban emergency department. Health Psychol
19: 510514
Brown KW, Ryan RM (2003) The benefits of being present: mindfulness
and its role in psychological well-being. J Pers Soc Psychol 84: 822–848
Bullock LF, Wells JE, Duff GB, Hornblow AR (1995) Telephone
support for pregnant women: outcome in late pregnancy. N Z Med
J 108: 476478
Carlson LE, Speca M, Patel KD, Goodey E (2003) Mindfulness-based
stress reduction in relation to quality of life, mood, symptoms of
stress and immune parameters in breast and prostate cancer out-
patients. Psychosom Med 65: 571–581
Carlson LE, Ursuliak Z, Goodey E, Angen M, Speca M (2001) The
effects of a mindfulness meditation-based stress reduction program
on mood and symptoms of stress in cancer outpatients: 6-month
follow-up. Support Care Cancer 9: 112123
Cohen J (1994) The earth is round (p < 0.05). Am Psychol 49: 9971003
Cohen J (1988) Statistical power analysis for the behavioral sciences,
2nd edn. L Erlbaum Associates, Hillsdale, NJ
Cohen S, Kamarck T, Mermelstein R (1983) A global measure of
perceived stress. J Health Soc Behav 24: 385396
Da Costa D, Dritsa M, Larouche J, Brender W (2000) Psychosocial
predictors of labor=delivery complications and infant birth weight: a
prospective multivariate study. J Psychosom Obstet Gynaecol 21:
137148
Dejin-Karlsson E, Hanson BS, Ostergren PO, Lindgren A, Sjoberg NO,
Marsal K (2000) Association of a lack of psychosocial resources and
the risk of giving birth to small for gestational age infants: a stress
hypothesis. BJOG 107: 89–100
Dennis CL, Creedy D (2004) Psychosocial and psychological interven-
tions for preventing postpartum depression. Cochrane Database Syst
Rev 2004(4): CD001134
England P, Horowitz R (1998) Birthing from within: an extra-ordinary
guide to childbirth. Partera Press, Albequerque, NM
Field T, Diego MA, Hernandez-Reif M, Schanberg S, Kuhn C (2004)
Massage therapy effects on depressed pregnant women. J Psychosom
Obstet Gynaecol 25: 115122
Field T, Hernandez-Reif M, Hart S, Theakston H, Schanberg S, Kuhn C
(1999) Pregnant women benefit from massage therapy. J Psychosom
Obstet Gynaecol 20: 3138
Flynn HA, Blow FC, Marcus SM (2006) Rates and predictors of
depression treatment among pregnant women in hospital-affiliated
obstetrics practices. Gen Hosp Psychiatry 28: 289295
Folkman S, Moskowitz JT (2000) Positive affect and the other side of
coping. Am Psychol 55: 647654
Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G,
Swinson T (2005) Perinatal depression: a systematic review of
prevalence and incidence. Obstet Gynecol 106: 10711083
Gotlib IH, Whiffen VE, Mount JH, Milne K, Cordy NI (1989) Preva-
lence rates and demographic characteristics associated with depres-
sion in pregnancy and the postpartum. J Consult Clin Psychol 57:
269274
Grossman P, Niemann L, Schmidt S, Walach H (2004) Mindfulness-
based stress reduction and health benefits: a meta-analysis. J
Psychosom Res 57: 3543
Hann D, Winter K, Jacobsen P (1999) Measurement of depressive
symptoms in cancer patients: evaluation of the Center for Epidemio-
logical Studies Depression Scale (CES-D). J Psychosom Res 46:
437443
Hayes BA, Muller R (2004) Prenatal depression: a randomized con-
trolled trial in the emotional health of primiparous women. Res
Theory Nurs Pract 18: 165183
Hayes SC, Follette VM, Linehan MM (eds) (2004) Mindfulness and
acceptance: expanding the cognitive-behavioral tradition. Guilford
Press, New York
Hobel CJ, Dunkel-Schetter C, Roesch SC, Castro LC, Arora CP (1999)
Maternal plasma corticotropin-releasing hormone associated with
stress at 20 weeks’ gestation in pregnancies ending in preterm
delivery. Am J Obstet Gynecol 180: S257S263
Hodnett ED, Fredericks S (2003) Support during pregnancy for women
at increased risk of low birthweight babies. Cochrane Database Syst
Rev 2003(3): CD000198
Hoffman S, Hatch MC (2000) Depressive symptomatology during
pregnancy: evidence for an association with decreased fetal growth
in pregnancies of lower social class women. Health Psychol 19:
535543
Kabat-Zinn J (1990) Full catastrophe living: using the wisdom of your
body and mind to face stress, pain and illness. Dell, New York
Kabat-Zinn J (1982) An outpatient program in behavioral medicine for
chronic pain patients based on the practice of mindfulness meditation:
theoretical considerations and preliminary results. Gen Hosp Psychi-
atry 4: 3347
Kabat-Zinn J, Massion AO, Kristeller J, Peterson LG, Fletcher KE, Pbert
L, Lenderking WR, Santorelli SF (1992) Effectiveness of a medita-
tion-based stress reduction program in the treatment of anxiety
disorders. Am J Psychiatry 149: 936943
Kabat-Zinn J, Lipworth L, Burney R (1987) Four-year follow-up of a
meditation-based program for the self-regulation of chronic pain:
treatment outcomes and compliance. Clin J Pain 2: 159–173
Kurki T, Hiilesmaa V, Raitasalo R, Mattila H, Ylikorkala O (2000)
Depression and anxiety in early pregnancy and risk for preeclampsia.
Obstet Gynecol 95: 487490
Lobel M, DeVincent CJ, Kaminer A, Meyer BA (2000) The impact
of prenatal maternal stress and optimistic disposition on birth
outcomes in medically high-risk women. Health Psychol 19:
544–553
Lou HC, Hansen D, Nordentoft M, Pryds O, Jensen F, Nim J,
Hemmingsen R (1994) Prenatal stressors of human life affect fetal
brain development. Dev Med Child Neurol 36: 826832
Lu Q, Lu MC, Dunkel-Schetter C (2005) Learning from success and
failure in psychosocial intervention: an evaluation of low birth weight
prevention trials. J Health Psychol 10: 185195
Ma SH, Teasdale JD (2004) Mindfulness-based cognitive therapy for
depression: replication and exploration of differential relapse pre-
vention effects. J Consult Clin Psychol 72: 3140
Marcus SM, Flynn HA, Blow FC, Barry KL (2003) Depressive symp-
toms among pregnant women screened in obstetrics settings. J
Womens Health (Larchmt) 12: 373–380
Midmer D, Wilson L, Cummings S (1995) A randomized, controlled
trial of the influence of prenatal parenting education on postpartum
anxiety and marital adjustment. Fam Med 27: 200–205
Mindfulness during pregnancy
73
Miller JJ, Fletcher K, Kabat-Zinn J (1995) Three-year follow-up and
clinical implications of a mindfulness meditation-based stress reduc-
tion intervention in the treatment of anxiety disorders. Gen Hosp
Psychiatry 17: 192200
Monk C, Sloan RP, Myers MM, Ellman L, Werner E, Jeon J, et al. (2004)
Fetal heart rate reactivity differs by women’s psychiatric status: an
early marker for developmental risk? J Am Acad Child Adolesc
Psychiatry 43: 283290
Narendran S, Nagarathna R, Narendran V, Gunasheela S, Nagendra HR
(2005) Efficacy of yoga on pregnancy outcome. J Altern Complement
Med 11: 237244
Nelson DB, Grisso JA, Joffe MM, Brensinger C, Shaw L, Datner E
(2003) Does stress influence early pregnancy loss? Ann Epidemiol
13: 223229
Newman R, Chamberlain D (2005) Calm birth: new methods for
conscious childbirth. North Atlantic Books, Berkeley, Calif
Nielsen Forman D, Videbech P, Hedegaard M, Dalby Salvig J, Secher
NJ (2000) Postpartum depression: identification of women at risk.
BJOG 107: 12101217
Orr ST, James SA, Miller CA, Barakat B, Daikoku N, Pupkin M,
Engstrom K, Huggins G (1996) Psychosocial stressors and low
birthweight in an urban population. Am J Prev Med 12: 459466
Pagel MD, Smilkstein G, Regen H, Montano D (1990) Psychosocial
influences on new born outcomes: a controlled prospective study. Soc
Sci Med 30: 597604
Peterson GH (1994) An easier childbirth: a mother’s guide for birthing
normally. Shadow & Light, Berkeley, Calif
Radloff LS (1977) The CES-D scale: a self-report depression scale for
research in the general population. Appl Psychol Meas 1: 385–401
Reibel DK, Greeson JM, Brainard GC, Rosenzweig S (2001) Mindful-
ness-based stress reduction and health-related quality of life in a
heterogeneous patient population. Gen Hosp Psychiatry 23: 183192
Ritter C, Hobfoll SE, Lavin J, Cameron RP, Hulsizer MR (2000) Stress,
psychosocial resources, and depressive symptomatology during preg-
nancy in low-income, inner-city women. Health Psychol 19: 576585
Roth B, Robbins D (2004) Mindfulness-based stress reduction and
health-related quality of life: findings from a bilingual inner-city
patient population. Psychosom Med 66: 113–123
Rothberg AD, Lits B (1991) Psychosocial support for maternal stress
during pregnancy: effect on birth weight. Am J Obstet Gynecol 165:
403407
Sable MR, Wilkinson DS (2000) Impact of perceived stress, major life
events and pregnancy attitudes on low birth weight. Fam Plann
Perspect 32: 288294
Sale R (2006) Whole birth resources. Available at http:==www.
wholebirth.com
Segal Z, Williams M, Teasdale JD (2002) Mindfulness-based cogni-
tive therapy for depression: a new approach to preventing relapse.
Guilford Press, New York
Shapiro SL, Schwartz GE, Bonner G (1998) Effects of mindfulness-
based stress reduction on medical and premedical students. J Behav
Med 21: 581599
Speca M, Carlson LE, Goodey E, Angen M (2000) A randomized, wait-
list controlled clinical trial: the effect of a mindfulness meditation-
based stress reduction program on mood and symptoms of stress in
cancer outpatients. Psychosom Med 62: 613–622
Spielberger CD, Gorsuch I, Lushene RE (1970) Manual for the State-
Trait Anxiety Inventory. Consulting Psychologists Press, Palo Alto,
Calif
Teasdale JD, Segal Z, Williams M (2003) Mindfulness training and
problem formulation. Clin Psychol Sci Pract 10: 157160
Teasdale JD, Segal ZV, Williams JM, Ridgeway VA, Soulsby JM, Lau
MA (2000) Prevention of relapse=recurrence in major depression by
mindfulness-based cognitive therapy. J Consult Clin Psychol 68:
615623
Teixeira JM, Fisk NM, Glover V (1999) Association between maternal
anxiety in pregnancy and increased uterine artery resistance index:
cohort based study. BMJ 318: 153157
Urizar GG Jr, Milazzo M, Le HN, Delucchi K, Sotelo R, Munoz RF
(2004) Impact of stress reduction instructions on stress and cortisol
levels during pregnancy. Biol Psychol 67: 275–282
Wadhwa PD, Garite TJ, Porto M, Glynn L, Chicz-DeMet A, Dunkel-
Schetter C, Sandman CA (2004) Placental corticotropin-releasing
hormone (CRH), spontaneous preterm birth, and fetal growth
restriction: a prospective investigation. Am J Obstet Gynecol
191: 10631069
Wadhwa PD, Sandman CA, Garite TJ (2001) The neurobiology of
stress in human pregnancy: implications for prematurity and devel-
opment of the fetal central nervous system. Prog Brain Res 133:
131–142
Wadhwa PD, Dunkel-Schetter C, Chicz-DeMet A, Porto M, Sandman
CA (1996) Prenatal psychosocial factors and the neuroendocrine axis
in human pregnancy. Psychosom Med 58: 432446
Wadhwa PD, Sandman CA, Porto M, Dunkel-Schetter C, Garite TJ
(1993) The association between prenatal stress and infant birth weight
and gestational age at birth: a prospective investigation. Am J Obstet
Gynecol 169: 858865
Watson D, Clark LA (1994) Manual for the Positive and Negative Affect
Schedule (Expanded Form). University of Iowa, Iowa City, Iowa
Williams KA, Kolar MM, Reger BE, Pearson JC (2001) Evaluation of a
wellness-based mindfulness stress reduction intervention: a con-
trolled trial. Am J Health Promot 15: 422432
74
C. Vieten, J. Astin: Mindfulness during pregnancy
... The pandemic has led to a considerable increase in parenting stress, perceived loss of control, and frequent dayto-day challenges (7,(15)(16)(17)(18). Remaining engaged in the active process of mothering with very little support in the forms of domestic help, nannies, schools, and childcare centers under close to near-impossible situations on a daily basis resulted in a depletion of personal resources (10,19). ...
... Mindful parenting is defined as "paying attention to your child and your parenting in a particular way: intentionally, here and now, and nonjudgmentally" (44). Several researchers have agreed with the importance of mindful parenting and the benefits of engaging in this process (18,40,(46)(47)(48)(49). Mindfulness-based intervention programs have helped in reducing parental stress and mood disorders (18,47,50,51), boosting parental wellbeing, mindful parenting, and parent-child interaction (43,52), and improving parenting, coparenting, parental satisfaction, and family functioning (48, 50, 51, 53). ...
... Mindful parenting is defined as "paying attention to your child and your parenting in a particular way: intentionally, here and now, and nonjudgmentally" (44). Several researchers have agreed with the importance of mindful parenting and the benefits of engaging in this process (18,40,(46)(47)(48)(49). Mindfulness-based intervention programs have helped in reducing parental stress and mood disorders (18,47,50,51), boosting parental wellbeing, mindful parenting, and parent-child interaction (43,52), and improving parenting, coparenting, parental satisfaction, and family functioning (48, 50, 51, 53). ...
Article
Full-text available
Introduction With the global crisis of COVID-19 continuing, Indian mothers have not received adequate attention with respect to their challenges and mothering experiences. The current study explored mindful parenting practices in a cohort of Indian mothers of children aged 10 years and below that emerged in response to the challenges posed by COVID-19. Methods In-depth virtual interviews were conducted with 31 urban Indian mothers to explore their lived experiences of mothering during the global crisis and their engagements with mindful parenting practices. The data were thematically analyzed. Results and Discussion The study identified two overarching themes and nine subthemes. The first theme, pandemic-induced stress, included the sub-themes of increased workload, poor support system, lack of time for self, and emotional and physical distress. The second theme of mindful parenting included the sub-themes of awareness as a mother and around the child, acceptance toward self and the child, empathic understanding of self and the child, active engagement with the child, and emotional regulation. Increased workload on all fronts coupled with poor support and a lack of time for self-contributed to exacerbated emotional and physical stress in mothers. They addressed these concerns posed by their lived experiences by engaging in mindful parenting processes in their mothering practices. Mindfulness-based cognitive therapy, mindfulness-based stress reduction, and mindfulness-based parenting techniques could be explored as possible interventions for mothers to alleviate their distress while drawing attention to larger structural changes and policy-level interventions addressing social issues such as gender inequality and childcare concerns.
... Respecto a la ansiedad se encontraron cuatro RCTs 14,16,17,19 . En tres de ellos se observó una disminución significativa en los niveles de ansiedad post-intervención 14,16, 17 en comparación al grupo control, que en dos de ellos se mantuvo en el seguimiento 14,17 . ...
... Finalmente, cuatro estudios estudiaron los cambios en mindfulness 10,13,16,19 . Dos de ellos mostraron puntuaciones más elevadas de mindfulness post-intervención 10, 16 en comparación al grupo control y uno de ellos también en el seguimiento 16 , aunque en este estudio las diferencias con el grupo control no fueron significativas. ...
... Finalmente, cuatro estudios estudiaron los cambios en mindfulness 10,13,16,19 . Dos de ellos mostraron puntuaciones más elevadas de mindfulness post-intervención 10, 16 en comparación al grupo control y uno de ellos también en el seguimiento 16 , aunque en este estudio las diferencias con el grupo control no fueron significativas. En uno de los ...
... A total score of � 16 indicates clinical levels of depression. The CESD-R has been previously used in perinatal populations [64], [65], and has been demonstrated to have excellent psychometric properties [66]. ...
... An advantage of a continuous analytic approach is that it enabled us to consider subclinical levels of depression and anxiety, which are associated with functional and social impairment [64]. Findings suggest that higher levels of subclinical depression moderate down the benefits of maternal responsiveness, highlighting the importance of managing depression symptoms early before they reach clinical thresholds. ...
Article
Full-text available
High levels of maternal responsiveness are associated with healthy cognitive and emotional development in infants. However, depression and anxiety can negatively impact individual mothers' responsiveness levels and infants' expressive language abilities. Australian mother-infant dyads (N = 48) participated in a longitudinal study examining the effect of maternal responsiveness (when infants were 9- and 12-months), and maternal depression and anxiety symptoms on infant vocabulary size at 18-months. Global maternal responsiveness ratings were stronger predictors of infants' vocabulary size than levels of depression and anxiety symptoms. However, depression levels moderated the effect of maternal responsiveness on vocabulary size. These results highlight the importance of screening for maternal responsiveness-in addition to depression-to identify infants who may be at developmental risk. Also, mothers with elevated depression need support to first reduce their symptoms so that improvements in their responsiveness have the potential to be protective for their infant's language acquisition.
... The program is completely manualized session by session, and was inspired by previous mindfulness-based intervention programs (that also comprised self-compassion elements) [e.g. Mindfulness-Based Childbirth and Parenting [15]; Mindful Motherhood [16], and self-compassion focused [17] since mindfulnessbased interventions seem to reduce psychological distress and increase well-being [2] and prenatal self-compassion predicts lower levels of postnatal depression and anxiety [18]. ...
... Parenting program, showed statistically significant increases in mindfulness and positive affect, and decreases in anxiety, depression and negative affect in pregnancy (from pre to post-test). Our results go in the same direction, having the particularity of using an instrument specifically developed to assess perinatal depression [the PDSS-24/PDSS-21][25], thus conferring more accuracy to the screening and the outcomes when comparing to other studies which did not use instruments for the perinatal period.[16,17]. Additionally, a recent study which used a smartphone-based mindfulness training showed to improve maternal perinatal depression in women potentially at risk of perinatal depression in early pregnancy[40].The decrease in depressive symptoms and negative affect in pregnancy was an important outcomes, particularly considering that these are consistent risk factors for the development of perinatal depression, including postpartum depression. ...
Article
Full-text available
Cognitive behavioral therapies and mindfulness training during pregnancy have already been recognized as important tools in improving perinatal mental health [1]. Nevertheless, further randomized controlled trials (RCTs) are needed [2]. This study aimed to test the efficacy of Mother in Me (MiM), a prevention/ early intervention program for perinatal depression in a pilot RCT. 32 women with depressive symptomatology and/or risk factors for perinatal depression were randomly assigned to two experimental groups (EG-MiM 8-sessions) or equivalent control groups (Treatment as Usual-TAU), filling a set of self-report questionnaires to assess psychological distress, self-compassion and mindfulness at baseline (T0-during pregnancy), at post-intervention (T1) and at 5-weeks postpartum (T2). Pre/post-intervention scores showed a decrease in depressive symptoms, negative affect and antenatal anxiety, as well as an increase in self-compassion (EG). In the postpartum, we found that 50% of the participants improved from the depressive symptoms and that 40% experienced a decrease in negative affect. Qualitative results supported the perceived benefits of mindfulness and self-compassion. Even though our results were not as expressive as we might expect, there was a clinically reliable improvement in depressive symptoms in half of the experimental group. This encourages the team to improve the MiM, which is our next step, conducting a new RCT with the improved program.
... The joint pathway of stress factors, immune system, and adverse pregnancy outcomes Decades of research have shown that a pregnancy success relies on finely orchestrated immunological cross-talk between the mother and the fetus, with pregnancy complications being associated with feto-maternal immune dysfunction (43-45). In addition, exposing mice to stress has been shown to suppress their immune system (51), while immune dysregulation could also be observed in humans under chronic stress exposure (42). This connection between the immune system, stress, and APOs introduces the possibility of implementing targetable and measurable stress-based interventions. ...
Article
Full-text available
Psychosocial and stress-related factors (PSFs), defined as internal or external stimuli that induce biological changes, are potentially modifiable factors and accessible targets for interventions that are associated with adverse pregnancy outcomes (APOs). Although individual APOs have been shown to be connected to PSFs, they are biologically interconnected, relatively infrequent, and therefore challenging to model. In this context, multi-task machine learning (MML) is an ideal tool for exploring the interconnectedness of APOs on the one hand and building on joint combinatorial outcomes to increase predictive power on the other hand. Additionally, by integrating single cell immunological profiling of underlying biological processes, the effects of stress-based therapeutics may be measurable, facilitating the development of precision medicine approaches. Objectives The primary objectives were to jointly model multiple APOs and their connection to stress early in pregnancy, and to explore the underlying biology to guide development of accessible and measurable interventions. Materials and Methods In a prospective cohort study, PSFs were assessed during the first trimester with an extensive self-filled questionnaire for 200 women. We used MML to simultaneously model, and predict APOs (severe preeclampsia, superimposed preeclampsia, gestational diabetes and early gestational age) as well as several risk factors (BMI, diabetes, hypertension) for these patients based on PSFs. Strongly interrelated stressors were categorized to identify potential therapeutic targets. Furthermore, for a subset of 14 women, we modeled the connection of PSFs to the maternal immune system to APOs by building corresponding ML models based on an extensive single cell immune dataset generated by mass cytometry time of flight (CyTOF). Results Jointly modeling APOs in a MML setting significantly increased modeling capabilities and yielded a highly predictive integrated model of APOs underscoring their interconnectedness. Most APOs were associated with mental health, life stress, and perceived health risks. Biologically, stressors were associated with specific immune characteristics revolving around CD4/CD8 T cells. Immune characteristics predicted based on stress were in turn found to be associated with APOs. Conclusions Elucidating connections among stress, multiple APOs simultaneously, and immune characteristics has the potential to facilitate the implementation of ML-based, individualized, integrative models of pregnancy in clinical decision making. The modifiable nature of stressors may enable the development of accessible interventions, with success tracked through immune characteristics.
... Childbirth and Parenting (Vieten and Astin, 2008) and Mindfulness-Based ...
Thesis
Full-text available
The aim of this research is to explore mindfulness-in-action in moments of leadership performance and the degree to which it may enhance leadership excellence. To this end, this research answers two interrelated research questions. Firstly, what are the embodied experiences described by leaders that arise in the present moment of leadership and which they feel may hinder their ability to lead successfully? This question is explored through the analysis of a series of interviews with research participants. As an extension to my first research question, a group of leaders from various organisations were then taught mindfulness in an action-oriented way by means of a bespoke workshop that focused on utilising martial arts-based movements to teach the concept of mindfulness. My second research question explores to what extent mindfulness taught in an experiential, action-oriented way aids leaders in managing their leadership difficulties. Here the focus shifts to the leadership difficulties my research participants had previously described (i.e. in Research Question 1), as well as how, as leaders, they defined leadership before and after mindfulness-in-action training. The outcome of the research, via the analysis of interviews, was bolstered further by exploring participants’ trait or dispositional mindfulness through applying the Mindful Attention Awareness Scale both before and at two additional time points after the training. Overall, the analysis and findings of this research show that it is indeed possible to design and implement a training approach to mindfulness that is both experientially and action oriented, and which in turn has positive effects on moments of leadership performance. This research thus adds valuable insight in understanding leadership, learning and mindfulness, explored through moments of leadership performance.
Article
Full-text available
Perinatal Anxiety (PNA) is defined as anxiety occurring during pregnancy and up to 12 months post-partum and is estimated to affect up to 20% of women. Risk factors for PNA are multiple and can be classed as psychological, social and biological. PNA negatively impacts on the mother, child and family. PNA is not well-recognized and diagnosis of PNA can be challenging for clinicians. There is currently no validated case-finding or diagnostic test available for PNA. PNA has been less extensively researched than perinatal depression (PND). Clinical guidance currently recommends pharmacological and psychological therapies for the management of women with PNA, however the limited research available suggests that other intervention types may also be effective with some evidence on the effectiveness of non-pharmacological interventions in primary care for PNA. This article provides a mini-review of PNA, summarizing current evidence around PNA including risk factors, the impact of PNA, the process of diagnosis of PNA and focussing predominantly on available management options for PNA.
Chapter
In recent years, we have witnessed significant advances in obstetric anesthesia, providing greater safety for the mother and the fetus, as well as an improvement in pain management procedures during labor. This volume presents updates in obstetrics and gynecology that are reflective of the changes in the demographics and associated clinical presentations of gynecological pathologies. It compiles state of the art information on the subject in 20 chapters contributed by more than 50 experts in obstetric anesthesia. The main objective of this volume is to inform and update readers about the different aspects essential to the practice of anesthesia and analgesia during pregnancy, labor, cesarean section and puerperium. The contents also include information about the management of pregnant women with different pathologies and high-risk pregnancies. The authors believe that it is essential for all anesthesiologists to be aware of the latest advances and well-contrasted scientific evidence that will allow them to carry out their usual clinical activity. The volume approaches the subject in a clear and didactic way for the benefit of all professionals involved in this field, including anesthesiologists, gynecologists, obstetricians, surgeons, clinicians and allied healthcare service providers.
Article
Full-text available
Introduction: Educational stress is a negative psychological condition; with its cognitive and emotional components, threatens students' health. Aim: This study aimed to compare the effectiveness of the solution-focused brief therapy and mindfulness-based therapy to reduce educational stress in junior high school students. Method: Through the framework of a clinical trial plan with pre-test and post-test and quarterly post hoc test, this study was conducted. In a purposive sampling manner, sixty students; among the first year of junior high school male students in Tehran district 13thin the school year 2019-2020, were selected and then surveyed by Don, Hu and Zhou (2011) Adolescent Educational Stress Scale and were randomly divided into 3 groups of 20: control group, solution-focused treatment group and mindfulness treatment group. Then the intervention process was run on the experimental groups and after three months the follow-up test was rerun. The data were analyzed by using SPSS-26 and the covariance analysis and mixed-design analysis of variance tests. Results: This study brought light on the effectiveness of both treatments methods in reducing educational stress among students, but the mindfulness method (Eta2=0.357) worked better rather the brief solution-focused intervention method(Eta2=0.318) to reduce students' stress (P
Article
Pregnant and parenting women living with HIV (WLWH) face high levels of psychological stress and mental illness but lack tailored and acceptable psychosocial treatments. The research team sought to inform the adaptation of a mindfulness intervention for pregnant and parenting WLWH through focus groups exploring psychosocial treatment needs and mindfulness intervention preferences. The research team conducted focus groups with pregnant and parenting WLWH (n = 16) and case managers (n = 6) recruited from a community-based enhanced case management program. The research team utilised an iterative inductive approach to coding of the transcripts from these focus groups. Five themes emerged: stressors, signs of stress, coping, lack of access and acceptability of care, and motivation and trust in care engagement. These focus groups revealed a desire for a group intervention that could decrease isolation while protecting against involuntary disclosure of HIV status. Participants expressed openness to mindfulness skills for coping with stress. The focus group participants' preference for a non-stigmatising group intervention supports the potential of a mindfulness-based group intervention to reduce stress and improve the mental health of pregnant and parenting women living with HIV.
Article
QUESTION One of my patients who was taking an antidepressant for major depression is now pregnant and does not wish to take it any more. I believe she needs to continue her medication. She, however, is adamant about stopping it because she, believes it would put her baby at risk. Is there evidence that not treating depression during pregnancy puts babies at risk? ANSWER A growing body of literature investigating the effects of not,treating depression on mother and developing fetus suggests that untreated depression is associated with adverse fetal outcomes and a higher risk of maternal morbidity, including suicide ideation and attempts, and postpartum depression.
Article
After 4 decades of severe criticism, the ritual of null hypothesis significance testing - mechanical dichotomous decisions around a sacred .05 criterion - still persists. This article reviews the problems with this practice, including its near-universal misinterpretation of p as the probability that H0s false, the misinterpretation that its complement is the probability of successful replication, and the mistaken assumption that if one rejects H0 one thereby affirms the theory that led to the test. Exploratory data analysis and the use of graphic methods, a steady improvement in and a movement toward standardization in measurement, an emphasis on estimating effect sizes using confidence intervals, and the informed use of available statistical methods is suggested. For generalization, psychologists must finally rely, as has been done in all the older sciences, on replication.