Depression, anxiety, and stress across the perinatal period: longitudinal trends and associations with adverse outcomes

BACKGROUND: Depression, anxiety, and stress are common during the perinatal period and may adversely affect maternal and neonatal outcomes. However, longitudinal data on their trajectories across pregnancy and the postpartum period, as well as their associations with adverse outcomes, remain limited. AIM: To assess the prevalence and longitudinal trends of depression, anxiety, and stress from the first trimester through three months postpartum and to examine their associations with adverse perinatal outcomes, along with sociodemographic and obstetric factors. METHODS: This prospective cohort study included 253 pregnant women followed from early pregnancy to three months postpartum at five time points. Psychological symptoms were assessed using the Depression, Anxiety and Stress Scale–21 (DASS-21). Longitudinal changes were analyzed using linear mixed-effects models. Associations with perinatal outcomes (cesarean delivery, postpartum hemorrhage, gestational diabetes mellitus, gestational hypertension, and selected neonatal outcomes) were examined using univariable and multivariable Firth penalized logistic regression. RESULTS: The prevalence of clinically relevant depressive symptoms ranged from 4.5% to 9.9%, anxiety symptoms from 18.2% to 28.3%, and stress symptoms from 12.3% to 20.3% across the study period. Depressive symptoms remained relatively stable across the perinatal period. After correction for multiple testing, only anxiety showed a significant decline after childbirth, while no consistent significant changes were observed for stress. In multivariable analyses, cesarean delivery was associated with BMI ≥ 25 kg/m² and a history of obstetric complications, whereas no significant associations were found for postpartum hemorrhage, small for gestational age, or gestational diabetes. CONCLUSIONS: Perinatal psychological symptoms show distinct longitudinal patterns, with a decline in anxiety after childbirth. Most associations with adverse outcomes were not statistically significant or were imprecise. Larger multicenter studies are needed to clarify these relationships.