A Mobile-Based Perinatal Mindfulness Intervention (Thriving in Pregnancy) on Psychological Well-Being for Perinatal Women during COVID-19: A Randomized Controlled Trial

Introduction: Being pregnant, giving birth, and becoming a parent are three closely intertwined major life transitions experienced by a woman within a short period. The presence of ppsychological symptoms is very common for perinatal women, particularly during the COVID-19 pandemic.

Objective: The aim is to assess the effectiveness of a mobile-based mindfulness intervention as a scalable approach for improving maternal psychological well-being during the perinatal period in the community setting.

Methods: This is a 2-armed, parallel-group, randomized controlled trial with a randomization ratio of 1:1. A total of 75 adult pregnant Chinese women in the 2^nd trimester (12^th to 28^th week gestation) were recruited across China via social media platforms. The intervention group (IG) received both a guided mobile-based Four-Immeasurable mindfulness intervention – “Thriving in Pregnancy” and an Internet-based perinatal psychoeducation; while the control group (CG) received the Internet-based perinatal psychoeducation only. The outcomes were Edinburgh Postnatal Depression Scale, Hospital Anxiety and Depression Scale – Anxiety subscale, Five Facet Mindfulness Questionnaire, Self-Compassion Scale, Non-Attachment Scale, and Body-Mind-Spirit Well-Being Inventory – Spirituality subscale. All outcome measurements were assessed at 4-timepoint: baseline (T0), post-intervention (T1), 37-week gestation follow-up (T2), and 1-month postpartum follow-up (T3). Obstetric and neonatal outcomes were also collected at T3.

Results: Of 75 randomized participants, 67 completed the trial and the assessment at 1-month postpartum. Linear mixed-effect models with intention-to-treat analysis revealed significant time-by-group interaction effects on depression (t=-5.4, p<.001), anxiety (t=-4.2, p<.001), mindfulness (t=4.6, p<.001), self-compassion (t=3.2, p<.01), non-attachment (t=3.1, p<.01), and spirituality (t=4.0, p<.001), favoring the effects of IG across four assessment time points (using times as continuous variables). Further mixed model analysis indicated that at 1-month postpartum follow-up, the IG group showed statistically significantly greater improvements in depression (t= -5.81, p<.001, Cohen’s d=-1.2), anxiety (t=-3.62, p<.001, Cohen’s d=-1.2), mindfulness (t=4.32, p<.001, Cohen’s d =1.0), self-compassion (t= 2.87, p-.004, Cohen’s d= 0.58), non-attachment (t=3.57, p=.010, Cohen’s d= 0.57), and spirituality (t= 3.35, p<.001, Cohen’s d=0.64), in comparison to CG (using times as categorical variables). Participants from CG also showed significant greater risk of having an emergent cesarean rather than nature birth (X²=4.22(1), p=.04, Ex(β)=7.71), and a significantly smaller Apgar score (β=0.59, t=2.18, p =0.034).

Conclusion: The findings show that “Thriving in Pregnancy” has the potential as an effective intervention on preventing postpartum depression and improving psychological well-being during. By practicing Four-Immeasurable meditations, perinatal women could develop the capacity to endure maintain the tranquility of mood, retain a sense of direction, construct and reconstruct life meaning in the face of challenges entailed by these major life transitions. The positive maternal outcomes can also translate to less risk of having an emergent cesarean delivery and a higher Apgar score.

Keywords: Perinatal, Mindfulness meditation, Four-Immeasurable; Postnatal depression; Anxiety; Spirituality