Objective: To evaluate whether perceived stress and baseline depression predict the intensity and frequency of pregnancy-specific experiences, and to assess whether physical activity moderate these relationships. The study also explores the role of demographic factors—particularly age and education—in shaping maternal mental health outcomes. Study Design: This study is a secondary analysis using data from Hoosier Mom Cohort (HMC), a pregnancy cohort of individuals with singleton gestation enrolled at < 20 weeks. A total of 411 participants were recruited, and data from 391 participants were included in this analysis. Baseline depression was assessed by Edinburgh Postnatal Depression Scale (EPDS) at Visit 1 (<20 weeks gestation), and perceived stress was measured at Visit 1 and Visit 2 using Perceived Stress Scale (PSS), prior to delivery. Pregnancy experiences, the main outcome was collected at Visit 2 using Pregnancy Experiences Scale (PES), which provided hassles-to-uplift ratios for both intensity and frequency. Physical activity was measured at Visit 1 and Visit 2 and converted into metabolic equivalents (METs). MET values were dichotomized at recommendation levels (≥150 min/week = active). Linear regression models analyzed the associations between EPDS, PSS and PES outcomes. An interaction term was included to explore the moderation effect of physical activity. Results: Participants with high perceived stress scores (PSS ≥14) at Visit 1 were significantly younger (28.7 vs 30.2 years, p = 0.006), more likely to have lower educational attainment (high school or less, p < 0.0001) and reported more intense negative pregnancy experiences (PES intensity ratio: 0.81 vs 0.62, p < 0.0001). Although the frequency ratio of negative pregnancy experiences seemed higher in high-stress group (0.86 vs 0.67), the differences were not statistically significant (p=0.35). Participants with high stress levels at Visit 1 were also more likely to meet physical activity guidelines (p = 0.03). Similarly, participants with high depression scores (EPDS ≥10) at Visit 1 were significantly younger (28.2 vs 29.8 years, p = 0.03), less likely to have a college degree (p = 0.0001) and reported more intense (p < 0.0001) and frequent (p = 0.009) negative pregnancy experiences. No significant differences in activity level were found between EPDS groups. In adjusted regression models, perceived stress at Visit 2 remained associated with negative pregnancy experiences (intensity ratio: β= 0.010, p = 0.003; frequency ratio: β= -0.017, p = 0.0001). A significant interaction effect was observed between perceived stress and physical activity at Visit 2. Individuals reporting higher physical activity who also reported high stress experienced significantly more intense (β= 0.029, p = 0.0007) and frequent (β= 0.040, p = 0.006) negative experiences during pregnancy, compared to those with lower physical activity (intensity: β= 0.013, p < 0.0001; frequency: β= 0.017, p < 0.0001). This relationship was visualized in an interaction plot, where the slope of perceived stress predicting PES outcomes was steeper in the physically activity group (0.029 vs 0.013, p=0.04)—highlighting that under high stress, physical activity may amplify rather than buffer the intensity and frequency of negative pregnancy-related experiences. Conclusion: Perceived stress is a robust and consistent predictor of pregnancy-specific hassles and uplifts. While physical activity is typically considered as a benefit to overall health, our findings suggest that under high stress conditions, it may amplify perceived hassles during pregnancy. These results underline the need to integrate targeted stress management strategies to enhance maternal mental health outcomes during pregnancy.
Ambily et al. (Sun,) studied this question.
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