Mindfulness skills during pregnancy: Prospective associations with mother's mood and neonatal birth weight

Highlights

• Mindfulness skills predict less depressive symptoms later in pregnancy.

• Depressive symptoms of the mother are not associated with neonatal birth weight.

• Mindful nonreacting in pregnant mothers predicts neonatal healthy birth weight.

Abstract

Objectives

Mindfulness skills have been associated with better mood and several health related outcomes. Because depressed mood during pregnancy has been related to worse child outcomes, the aim was to examine the association of mindfulness skills during pregnancy with the mother's depressive symptoms, gestational age, and neonatal birth weight.

Methods

A subsample of 905 pregnant women who participated in the longitudinal cohort HAPPY study (Holistic Approach to Pregnancy and the first Postpartum Year) completed the 12-item Three Facet Mindfulness-Questionnaire-Short Form at 22 weeks of gestation. The Edinburgh Depression Scale was completed to assess depressive symptoms at 12, 22 and 32 weeks. The obstetric medical records were examined for gestational age and birth weight.

Results

Mindfulness skills Acting with Awareness and Nonjudging at 22 weeks were associated with less depressive symptoms at 22 weeks and at 32 weeks. When controlled for depressive symptoms at 22 weeks, the association was still significant for Nonjudging predicting depressive symptoms at 32 weeks (Beta = − 0.12, p < 0.01). Regarding the obstetric medical records, only Nonreacting was (positively) associated with birth weight (Beta = 0.09, p < 0.01). Controlling for gestational age, sex, parity, depressive symptoms, and health behavior, Nonreacting predicted a normal birth weight (OR = 1.12, 95% CI = 1.06–1.19), in contrast to low birth weight.

Conclusion

It seems that different mindfulness skills during pregnancy are important in predicting mother's depressive symptoms compared to the prediction of child's birth weight. Potential mechanisms are discussed.

Introduction

Distressed mood during pregnancy, especially depressive symptom severity, has been related to worse birth outcomes, such as pre-term birth and low birth weight [1], [2], [3], [4]. Although evidence is not consistent [5], reviews and meta-analyses suggest a negative effect on gestational age and birth weight, the strength being dependent on the country and whether premature births are included [6], [7]. The mechanism may involve effects of distress on the maternal cardiovascular system [5], [8], increased activation of the maternal hypothalamus-pituitary-adrenal (HPA) system [9], and maternal inflammatory processes [10]. Specifically, regarding the cardiovascular system, maternal abnormal autonomic drive to the heart has been shown to be associated with a larger risk of hypertension and pre-eclampsia, which are risk factors for unfavorable term outcomes, such as pre-term birth [11], [12]. Activation of the maternal HPA system facilitates the onset of labor and has been shown to be negatively related to fetal neurodevelopmental maturation independent of gestational age [10], [13]. Finally, maternal inflammatory processes, which are enhanced by infection or depression, increase the risk of pre-term birth and possibly other unfavorable neonatal outcomes [14].

Mindfulness has been defined as the nonjudgmental attention to phenomena occurring in the present moment [15], [16]. As a habitual tendency, it has been associated with better mood, and lower symptoms of depression and anxiety [15], [17], [18], also in pregnant women [19]. More importantly, mindfulness-based interventions have been shown to decrease symptoms of anxiety and depression in various populations with a medium to large effect size as reported in meta-analyses [20], [21]. In pregnant women, only a small number of trials have been performed to date, showing some promising results regarding decrease of symptoms of anxiety and depression [22]. However, studies were often uncontrolled and applying unconventional intervention formats, precluding clear conclusions in this population at the moment [23].

Also, mindfulness and mindfulness-based interventions have been associated with decreased blood pressure and cortisol levels [24], [25], [26], [27], [28], suggesting that mindfulness may also have beneficial physiological effects that may be relevant during pregnancy. Indeed, recently it has been shown that a higher score on general mindfulness skills was associated with a more favorable trajectory of heart rate variability during pregnancy [29]. Specifically, the heart rate variability component driven by the parasympathetic nervous system was higher across trimesters and the typical decrease in this index over the course of the pregnancy was less pronounced.

Therefore, the aim of the current study was to examine the association of mindfulness skills during pregnancy with the mother's depressive symptoms later in pregnancy and the neonatal outcomes. We hypothesized that mindfulness may be associated not only with a lower level of depressive symptoms later in pregnancy, but also with a more favorable gestational age and birth weight of the child, adjusted for important confounders.