Perinatal mental health across different trimesters of pregnancy and during the postpartum period: trends and risk factors for anxiety and depression

Perinatal mental health across different trimesters of pregnancy and during the postpartum period: trends and risk factors for anxiety and depression | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Perinatal mental health across different trimesters of pregnancy and during the postpartum period: trends and risk factors for anxiety and depression Rina Kim, Soon Sup Shim, Hye Sim Kang, Jin-Yi Hyun, Hyun-Jun Yun This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6525083/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Perinatal mental health is a serious concern, as anxiety and depression affect both mothers and newborns. Nonetheless, only few studies have investigated the changes in symptom patterns across all pregnancy stages and during the postpartum period. This study aimed to assess anxiety and depression at each stage of pregnancy and during postpartum and to identify trimester-specific risk factors. Methods: Pregnant and postpartum women who visited the Department of Obstetrics and Gynecology at Jeju National University Hospital from December 2021 to January 2023 were evaluated. Anxiety and depression were assessed using the Korean versions of the Beck Anxiety Inventory and Edinburgh Postnatal Depression Scale. Participants were categorized into first, second, and third trimesters and postpartum. Results: A total of 445 women were included in the study. During pregnancy, 33.2% and 17.9% of the participants screened positive for anxiety and depression, respectively, at least once. During the postpartum period, 23.6% and 22.9% screened positive for anxiety and depression, respectively. The highest positivity rates for both conditions were observed during the first trimester of pregnancy. Significant risk factors for anxiety and depression in the perinatal period were unemployment, antiemetic drug use, history of thyroid disease, history of miscarriage, preterm premature rupture of membranes, neonatal intensive care unit admission, and adverse neonatal outcomes, including low birth weight. Conclusions: This study highlights the importance of early recognition of mental health risks during pregnancy to enable early intervention and support for affected individuals. Anxiety Beck Anxiety Inventory Depression Edinburgh Postnatal Depression Scale Mental health Postpartum Period Pregnancy Figures Figure 1 BACKGROUND Pregnancy is a transformative period characterized by physical and emotional changes, including substantial hormonal, physiological, and psychological changes[ 1 , 2 ]. These changes render women particularly vulnerable to mental health challenges, with anxiety and depression being the most prevalent conditions[ 3 – 5 ]. Maternal mental health not only affect the well-being of mothers but also has long-term consequences on their children, including adverse birth outcomes, delayed developmental milestones, and behavioral problems[ 4 – 9 ]. Postpartum depression is a well-known mental-health disorder. In 1987, the Edinburgh Postnatal Depression Scale (EPDS) was developed as a screening tool for postpartum depression; consequently, most early research had primarily focused on postpartum depression[ 10 ]. Since then, anxiety has emerged as an equally important mental health concern; as a result, increased attention has been paid to postpartum anxiety[ 4 , 9 ]. While most early studies had investigated anxiety and depression separately, more recent investigations have highlighted a close correlation between these two conditions, encouraging a more integrated approach to understanding maternal mental health[ 1 , 8 , 11 , 12 ]. Nonetheless, current screening and assessment methods for maternal mental health have several limitations. First, despite the availability of various screening tools for evaluating anxiety and depression, few have been specifically designed for pregnant women[ 9 , 11 , 13 , 14 ]. Furthermore, no tool has been specifically developed or internationally standardized to assess maternal anxiety and depression during pregnancy or the postpartum period[ 13 , 15 ]. To date, the EPDS remains the primary screening tool for assessing postpartum depression. Second, numerous screening tools in non-English-speaking countries have not been fully translated or culturally validated, making it difficult for clinicians to select the most appropriate tools for pregnant and postpartum individuals in these countries[ 5 ]. In South Korea, five anxiety screening tools and five depression screening tools have been officially translated and validated for use[ 16 – 24 ]. Third, although studies investigating the prevalence and associated risk factors of maternal mental health issues across different trimesters of pregnancy and during the postpartum period have gradually increased, they remain limited, particularly with respect to comprehensive, trimester-specific, and longitudinal research[ 11 , 25 ]. To address these research gaps, the current study aimed to analyze patterns and changes in anxiety and depression across trimesters of pregnancy and during the postpartum period among Korean women using validated screening tools. Given that maternal mental disorders represent a unique situation in which pharmacological treatment is often limited because of pregnancy, the goal is to prevent mental health issues via the identification of unique risk factors and trends influencing anxiety and depression. The findings of this study have important implications for establishing a foundation for the lifelong health and well-being of mothers and their children. METHODS Study participants This retrospective study analyzed pregnant and postpartum women who visited the Department of Obstetrics and Gynecology at Jeju National University Hospital from December 29, 2021, to January 31, 2023 (over approximately 13 months) and underwent screening for anxiety and depression using the Korean versions of the Beck Anxiety Inventory (BAI) and EPDS. All participants delivered in our hospital at 23 weeks and 0 day of gestation or later when the fetuses were viable. The analysis included participants who completed screening during the postpartum period and underwent at least one screening test during pregnancy, irrespective of gestational age (GA). However, non-Korean patients, individuals previously diagnosed with a mental illness, those with multiple pregnancies, and pregnant women who refused or discontinued the evaluation were excluded. Tests were not conducted during hospitalization for any reason. The participants were categorized as follows according to GA: the first trimester (from confirmation of pregnancy to 13 + 6 weeks of GA), second trimester (from 14 + 0 to 27 + 6 weeks of GA), third trimester (from 28 + 0 weeks to immediately before delivery), and postpartum period (from delivery until clinical recovery was determined during postpartum outpatient follow-up). Ethical considerations This study was approved by the Institutional Review Board of Jeju National University Hospital (approval number: 2022-11-011). The requirement for informed consent was waived owing to the retrospective nature of participant recruitment. Screening for anxiety and depression Two types of screening tests were employed to assess mental health. First, anxiety was assessed using the BAI, which is a self-report questionnaire that was developed to reliably assess the severity of anxiety symptoms and was specifically designed to distinguish anxiety from depressive symptoms. The inventory consists of 21 items, many of which evaluate physical symptoms associated with anxiety. Participants rated the severity of their symptoms over the past week. The total score was calculated by summing the item scores (possible score range: 0–63). A score of 0 to 7 was considered to be within the normal range, whereas scores of 8–15, 16–25, and 26–63 indicated mild, moderate, and severe anxiety, respectively[ 26 ]. Second, depression was evaluated using the EPDS, which is a well-validated 10-item self-report screening test. Each item asked participants to report how they felt during the past 7 days. The total score ranged from 0 to 30, with higher scores indicating more severe depressive symptoms. Most studies and guidelines demonstrated that a score of 10 or higher had high sensitivity, specificity, and positive predictive value in detecting perinatal depression[ 13 , 27 , 28 ]. Thus, in this study, a score of 10 or higher was set to denote positivity for depression. Measurements In this study, miscarriage was defined as the termination of pregnancy prior to 20 + 0 weeks of GA. Fetal growth restriction was defined as an estimated fetal weight below the 10th percentile for the GA. Preterm premature rupture of membranes (PPROM) and preterm birth (PTB) were defined as occurring between 23 + 0 and 36 + 6 weeks of GA. Hypertensive disorders included pregnancy-induced hypertension and preeclampsia. Statistical analyses Descriptive statistics were applied to summarize the demographic and clinical characteristics of the study population. Continuous variables were compared using two-sample t -test or Wilcoxon rank-sum test, depending on the data distribution. Categorical variables were analyzed using the chi-square test or Fisher’s exact test, as appropriate. Logistic regression models with stepwise variable selection methods were used to identify significant risk factors associated with anxiety and depression. A linear mixed model was used to analyze longitudinal data across different gestational stages. Statistical analyses were performed using SAS software version 9.4 (SAS Institute Inc., Cary, NC, USA), with statistical significance set at a p- value of < 0.05. RESULTS This study analyzed the patterns of anxiety and depression during pregnancy and the postpartum period in 445 women who delivered at our hospital and underwent testing. No participant refused or discontinued the evaluation. The mean age at delivery was 35.2 years (range: 21.0–49.0). Among these women, 23, 190, 90, and 445 completed the screening tests during the first, second, and third trimesters and the postpartum period, respectively. Of note, 12 women completed all four assessments from early pregnancy to the postpartum period. The mean GA at testing was 12 + 0 weeks for the first trimester, 22 + 2 weeks for the second trimester, 34 + 1 weeks for the third trimester, and 5 + 5 weeks postpartum. Table 1 presents the mean BAI and EPDS scores, as well as the number and percentage of patients exceeding the cutoff scores. Anxiety and depression had the highest positivity rates in the first trimester. Anxiety showed a secondary peak in the third trimester, whereas depression peaked again during the postpartum period. Among the participants who underwent at least one screening test during the entire pregnancy period, the number of patients with positive scores at least once was as follows: 78/235 (33.2%) patients had anxiety on the BAI, and 42/235 (17.9%) patients screened positive for depression on the EPDS. Table 1 BAI and EPDS scores across different trimesters and during the postpartum period First trimester Second trimester Third trimester Postpartum N 23 190 90 445 Mean GA at test 12 + 0 [8 + 3 –13 + 5 ] 22 + 2 [16 + 3 –27 + 6 ] 34 + 1 [28 + 3 –39 + 0 ] 5 + 5 [1 + 4 –12 + 6 ] Mean BAI score 9.4 [1.0–30.0] 5.9 [0–30.0] 6.9 [0–32.0] 5.1 [0–40.0] BAI score ≥ 8 13 (56.5) 51 (26.8) 28 (31.1) 105 (23.6) BAI score ≥ 16 4 (17.4) 13 (6.8) 9 (10.0) 24 (5.4) BAI score ≥ 26 2 (8.7) 2 (1.1) 3 (3.3) 7 (1.6) Mean EPDS score 8.2 [1.0–22.0] 5.6 [0–23.0] 5.7 [0–21.0] 6.6 [0–25.0] EPDS score ≥ 10 8 (34.8) 29 (15.3) 16 (17.8) 102 (22.9) Data are expressed as mean [range] or numbers (percentages). Bold font was used to indicate the key findings. BAI, Beck Anxiety Inventory; EPDS, Edinburgh Postnatal Depression Scale; GA, gestational age. Results of 12 women who completed all screening tests indicated that mean scores decreased from the first trimester to the postpartum period when divided by trimester and analyzed using least-squares means (Table 2 and Fig. 1 ). Table 2 Least squares mean scores for anxiety and depression across gestational stages and during the postpartum period Anxiety Depression Overall time effect p = 0.0062 p < 0.0001 Estimate Standard error Estimate Standard error First trimester 8.6157 2.4749 7.6319 1.7586 Second trimester 7.3849 2.4749 5.7088 1.7586 Third trimester 7.5388 2.4749 5.0934 1.7586 Postpartum period 3.2311 2.4749 4.2473 1.7586 Comparisons between anxiety-positive and anxiety-negative groups and between depression-positive and depression-negative groups were conducted to identify statistically significant factors across different trimesters. In the second trimester, significant factors were unemployment and antiemetic drug use in the anxiety-positive group and thyroid disease and antiemetic drug use in the depression-positive group (Table 3 ). During the postpartum period, unemployment, history of miscarriage, PPROM in the current pregnancy, and neonatal intensive care unit (NICU) admission were identified as significant factors in the anxiety-positive group. In the depression-positive group, significant factors included history of miscarriage, prior PTB, PPROM in the current pregnancy, neonatal birth weight < 1.5 kg, and NICU admission (Table 4 ). However, there were not enough patients for analysis during the first trimester. No significant factors were identified in either group during the third trimester of pregnancy (Table 5 ). Table 3 Basic characteristics and risk factors in the second trimester by anxiety and depression scores Anxiety Depression Score < 8 Score ≥ 8 p- value Score < 10 Score ≥ 10 p- value N 154 36 161 29 Age at delivery* 35.2 36.3 0.2032 35.4 35.2 0.8479 ≥ 35-year-old 91 (59.1) 24 (66.7) 0.4025 96 (59.6) 19 (65.5) 0.5503 Marriage 152 (98.7) 36 (100) 1.0000 159 (98.8) 29 (100) 1.0000 Unemployment 50 (32.5) 20 (55.6) 0.0097 55 (34.2) 15 (51.7) 0.0711 Prepregnancy BMI* 23.6 23.7 0.8374 23.6 23.6 0.9647 History of disease Hypertension 5 (3.3) 1 (2.8) 1.0000 6 (3.7) 0 0.5930 Diabetes mellitus 3 (2.0) 1 (2.8) 0.5716 4 (2.5) 0 1.0000 Thyroid disease 8 (5.2) 2 (5.6) 1.0000 10 (6.2) 0 0.3647 Gynecologic disease 39 (25.3) 7 (19.4) 0.4584 44 (27.3) 2 (6.9) 0.0178 Obstetric history ART 43 (27.9) 14 (38.9) 0.1961 47 (29.2) 10 (34.5) 0.5671 Miscarriages 56 (36.4) 16 (44.4) 0.3682 58 (36.0) 14 (48.3) 0.2106 Stillbirth or neonatal death 5 (3.3) 2 (5.6) 0.6189 7 (4.4) 0 0.5975 PTB 13 (8.4) 2 (5.6) 0.7405 10 (6.2) 5 (17.2) 0.0578 Having children 68 (44.2) 18 (50.0) 0.5259 71 (44.1) 15 (51.7) 0.4476 Complication during pregnancy History of admission 36 (23.4) 7 (19.4) 0.6117 38 (23.6) 5 (17.2) 0.4511 Hypertension disorder 7 (4.6) 2 (5.6) 0.6800 9 (5.6) 0 0.3593 Gestational diabetes 19 (12.3) 5 (13.9) 0.7834 20 (12.4) 4 (13.8) 0.7673 Thyroid disease 7 (4.6) 2 (5.6) 0.6800 5 (3.1) 4 (13.8) 0.0322 Abnormal screening test results 12 (7.8) 1 (2.9) 0.4681 11 (6.7) 2 (6.9) 1.0000 Antiemetic drug use 11 (7.1) 8 (22.2) 0.0122 13 (8.1) 6 (20.7) 0.0481 Data are expressed as numbers (percentages), whereas *data are presented as mean. Bold font was used to indicate the key findings. ART, assisted reproductive technology; BMI, body mass index; PTB, preterm birth. Table 4 Basic characteristics and risk factors during the postpartum period by anxiety and depression scores Anxiety Depression Score < 8 Score ≥ 8 p- value Score < 10 Score ≥ 10 p- value N 375 70 343 102 Age at delivery* 35.1 35.6 0.4131 35.1 35.5 0.5007 ≥ 35-year-old 209 (55.7) 42 (60.0) 0.5087 192 (56.0) 59 (57.8) 0.7386 Marriage 372 (99.2) 68 (97.1) 0.1776 341 (99.4) 99 (97.1) 0.0817 Unemployment 128 (34.1) 35 (50.0) 0.0114 121 (35.3) 42 (41.2) 0.2776 Prepregnancy BMI* 28.7 28.7 0.9925 28.6 29.1 0.3135 History of disease Hypertension 11 (2.9) 1 (1.4) 0.7008 10 (2.9) 2 (2.0) 1.0000 Diabetes mellitus 5 (1.3) 1 (1.4) 1.0000 4 (1.2) 2 (2.0) 0.6241 Thyroid disease 20 (5.3) 5 (7.1) 0.5702 19 (5.5) 6 (5.9) 0.8949 Gynecologic disease 88 (23.5) 13 (18.6) 0.3694 86 (25.1) 15 (14.7) 0.0282 Obstetric history ART 76 (20.3) 17 (24.3) 0.4477 70 (20.4) 23 (20.6) 0.6406 Miscarriages 114 (30.4) 37 (52.9) 0.0003 106 (30.9) 45 (44.1) 0.0133 Stillbirth or neonatal death 11 (2.9) 0 0.2265 9 (2.6) 2 (2.0) 1.0000 PTB 22 (5.9) 7 (10) 0.1929 18 (5.3) 11 (10.8) 0.0467 Having children 141 (37.6) 34 (48.6) 0.0845 129 (37.6) 46 (45.1) 0.1740 Complication during pregnancy History of admission 76 (20.3) 17 (24.3) 0.4477 68 (19.8) 25 (24.5) 0.3070 Hypertension disorder 32 (8.5) 5 (7.1) 0.6989 26 (7.6) 11 (10.8) 0.3035 Gestational diabetes 47 (12.5) 6 (8.6) 0.3475 43 (12.5) 10 (9.8) 0.4545 Thyroid disease 19 (5.1) 4 (5.7) 0.7708 20 (5.8) 3 (2.9) 0.2471 Abnormal screening test results 13 (13.5) 2 (2.9) 1.0000 11 (3.2) 4 (3.9) 0.7559 Antiemetic drug use 20 (5.4) 6 (8.6) 0.2740 16 (4.7) 10 (9.8) 0.0530 FGR 8 (2.1) 2 (2.9) 0.6612 5 (1.5) 5 (4.9) 0.0541 PPROM 32 (8.5) 12 (17.1) 0.0267 28 (8.2) 16 (15.7) 0.0254 Pregnancy outcome PTB 89 (23.7) 20 (28.6) 0.3876 75 (21.9) 34 (33.3) 0.0181 Cesarean section 270 (72.0) 58 (82.9) 0.0582 249 (72.6) 79 (77.5) 0.3710 Neonatal death 2 (0.5) 0 1.0000 0 2 (2.0) 0.0521 Neonate birth weight >2,500 g 294 (78.6) 51 (72.9) 0.2541 275 (80.4) 70 (68.6) 0.0007 1,500–2,500 g 68 (18.2) 14 (20.0) 60 (17.5) 22 (21.6) <1,500 g 12 (3.2) 5 (7.1) 7 (2.1) 10 (9.8) NICU admission 52 (13.9) 17 (24.3) 0.0285 45 (13.2) 24 (23.5) 0.0116 Data are expressed as numbers (percentages), whereas *data are presented as mean. Bold font was used to indicate the key findings. ART, assisted reproductive technology; BMI, body mass index; FGR, fetal growth restriction; PPROM, preterm premature rupture of membranes; PTB, preterm birth; NICU, neonatal intensive care unit. Table 5 Basic characteristics and risk factors in the third trimester by anxiety and depression scores Anxiety Depression Score < 8 Score ≥ 8 p- value Score < 10 Score ≥ 10 p- value N 70 20 74 16 Age at delivery* 34.8 34.5 0.8429 34.9 33.9 0.3575 ≥ 35-year-old 38 (54.3) 7 (35.0) 0.1282 40 (54.1) 5 (31.3) 0.0981 Marriage 70 (100) 20 (100) 1.0000 74 (100) 16 (100) 1.0000 Unemployment 31 (44.3) 13 (65.0) 0.1022 34 (46.0) 10 (62.5) 0.2297 Prepregnancy BMI* 23.4 24.8 0.3439 23.4 25.1 0.2832 History of disease Hypertension 1 (1.4) 0 1.0000 1 (1.4) 0 1.0000 Diabetes mellitus 0 1 (5.0) 0.2222 0 1 (6.3) 0.1778 Thyroid disease 2 (2.9) 2 (10.0) 0.2127 3 (4.1) 1 (6.3) 0.5497 Gynecologic disease 16 (22.9) 3 (15.0) 0.5480 17 (23.0) 2 (12.5) 0.5066 Obstetric history ART 11 (15.7) 2 (10.0) 0.7248 9 (12.2) 4 (25.0) 0.2363 Miscarriages 24 (34.3) 6 (30.0) 0.7937 26 (35.1) 4 (25.0) 0.5640 Stillbirth or neonatal death 2 (2.9) 0 1.0000 2 (2.7) 0 1.0000 PTB 6 (8.6) 0 0.3314 6 (8.1) 0 0.5860 Having children 29 (41.4) 5 (25.0) 0.3314 29 (39.2) 5 (31.3) 0.7769 Complication during pregnancy History of admission 21 (30.0) 6 (30.0) 1.0000 23 (31.1) 4 (25.0) 0.7684 Hypertension disorder 4 (5.7) 4 (20.0) 0.0695 6 (8.1) 2 (12.5) 0.6285 Gestational diabetes 9 (12.9) 3 (15.0) 0.7248 12 (16.2) 0 0.1150 Thyroid disease 6 (8.6) 2 (10.0) 1.0000 6 (8.1) 2 (12.5) 0.6285 Abnormal screening test results 5 (7.1) 0 0.5803 4 (5.5) 1 (6.3) 1.0000 Antiemetic drug use 5 (7.3) 4 (20.0) 0.1102 5 (6.9) 4 (25.0) 0.0513 Data are expressed as numbers (percentages), whereas *data are presented as mean. ART, assisted reproductive technology; BMI, body mass index; PTB, preterm birth. Univariate logistic regression analysis revealed that both anxiety and depression were significantly associated with neonatal birth weight < 1.5 kg. Anxiety was significantly associated with NICU admission and positive depression screening results (Table 6 ). Table 6 Univariate logistic regression analysis of risk factors for anxiety and depression Anxiety Depression OR 95% CI p- value OR 95% CI p- value PTB 1.017 0.482–2.144 0.9655 1.468 0.795–2.711 0.2195 Cesarean section 1.767 0.891–3.505 0.1030 1.595 0.898–2.830 0.1109 Neonate birth weight > 2,500 g 1.000 1,500–2,500 g 1.184 0.466–3.006 0.2923 1.735 0.812–3.707 0.4915 < 1,500 g 4.369 1.326–14.390 0.0278 3.309 0.860–12.722 0.0170 NICU admission 2.194 1.078–4.466 0.0302 1.784 0.928–3.432 0.0827 Positive on the EPDS 7.181 2.741–18.815 < 0.0001 Bold font was used to indicate the key findings. CI, confidence interval; EPDS, Edinburgh Postnatal Depression Scale; NICU, neonatal intensive care unit; OR, odds ratio; PTB, preterm birth We recommended psychiatric clinic visits to 66 patients who had moderate-to-severe positive screening results or were clinically indicated for psychiatric care. Only 7 (10.6%) patients visited the clinic and received counselling. DISCUSSION The current study revealed high screening positivity rates for anxiety and depression, particularly during early pregnancy, and identified trimester-specific risk factors. In this study, 28.4% and 20.4% of perinatal women screened positive for anxiety (BAI score ≥ 8) and depression (EPDS score ≥ 10), respectively. During antenatal pregnancy, 33.2% and 17.9% of pregnant women screened positive for anxiety and depression, respectively, at least once throughout the entire pregnancy period. These rates were comparable to those reported by previous studies, which estimated antenatal anxiety and depression screening positivity rates of approximately 20–32% and 7–28%[ 6 , 12 , 29 – 34 ]. Otherwise, we found that 23.6% and 22.9% of postpartum women screened positive for anxiety and depression, respectively. These rates were comparable to or higher than those reported in previous studies[ 5 , 6 , 32 , 33 , 35 ]. While it would have been more accurate to compare our screening positivity rates with those of similar studies, differences in the types of assessment tools and study populations limited the validity of such comparisons. Therefore, we compared our findings to officially reported prevalence rates and found that our screening positivity rates were comparable or slightly higher than those rates. The first trimester was observed to be the most vulnerable period, with the highest proportion of positive screenings for both conditions, as reported in several studies[ 36 , 37 ]. Anxiety and depression in early pregnancy should be recognized as critical concerns, because they are not merely transient symptoms and are instead associated with persistent mental health issues in late pregnancy, as well as adverse outcomes such as preterm birth, low birth weight, and difficult infant temperament[ 38 – 40 ]. Additionally, the longitudinal analysis of the 12 study participants revealed that the symptoms of anxiety and depression gradually declined from early pregnancy through the third trimester to the postpartum period. This finding likely reflects a pattern wherein elevated symptoms in early pregnancy gradually stabilized over time. Although our sample size was limited and there are few papers to support this finding[ 25 , 38 , 41 ], these longitudinal observations may offer insight into clinical implications than prevalence rates reported in cross-sectional studies. These results underscore the need for early identification and continuous intervention during early pregnancy. We explored several significant risk factors that are generally consistent with the results reported by many previous studies. In antenatal period, a noteworthy finding of this study was the association between antiemetic drug use, a proxy for physical distress such as hyperemesis, and mental health symptoms, suggesting a close link between somatic discomfort and emotional well-being[ 42 ]. Furthermore, we revealed that a history of thyroid disorders diagnosed before pregnancy is associated with antenatal depression during pregnancy, which has been supported by previous reports[ 43 , 44 ]. Hormonal changes, inflammation, and alterations in neurotransmitter systems may mediate this association. Furthermore, employment instability has been repeatedly reported as a predictor of perinatal mental health difficulties[ 1 , 29 , 45 ]. We found that unemployment was a critical factor affecting anxiety in the perinatal period. In the postpartum period, the history of miscarriage emerges as an important risk factor contributing to both conditions, in the postpartum period and in antenatal period, as reported previously [ 1 , 45 , 46 ]. Similarly, adverse obstetric effects such as PPROM and NICU admission have been shown to increase the risk of postpartum anxiety and depression[ 47 – 49 ]. As many studies have shown, a potent effect of anxiety is depression[ 6 , 9 , 15 ]. These results emphasize the importance of comprehensive risk assessment throughout the perinatal period and support the need for multidimensional screening approaches in early pregnancy. In our study, only 10.6% of pregnant individuals with elevated anxiety or depression scores attended psychiatric services despite clinical recommendations. This proportion is notably lower than those reported in other high-income countries (approximately 25% in the United States and 54% in Canada)[ 5 , 13 , 50 ]. Similarly, guidelines from the European region and the United Kingdom have acknowledged low mental-health service utilization rates[ 51 , 52 ]. This treatment gap has been attributed to common barriers across guidelines, such as stigma, lack of mental-health literacy, insufficient provider training, unclear referral pathways, long wait times, and structural challenges, including cost, childcare, and transportation. These factors may be more pronounced in the Korean context, potentially contributing to the exceptionally low engagement rate observed in our cohort. In this study, the BAI and EPDS were used to assess the mental health status during pregnancy and the postpartum period. Both tools have been validated in Korea and are widely used in clinical settings because of their ease of administration as self-report questionnaires[ 17 , 22 ]. In non-English-speaking countries, such as Korea, the range of available tools is limited owing to a lack of validated translations and psychometric testing. We chose the BAI, which has been found to be more appropriate in length (21 items) than other commonly used tools such as the State-Trait Anxiety Inventory[ 53 ] (40 items) or Generalized Anxiety Disorder-7[ 21 ] (7 items). Additionally, compared with instruments such as the Hospital Anxiety and Depression Scale or Depression Anxiety Stress Scales-21—which are used in hospital-based populations or to assess multiple emotional states, the BAI focuses on the somatic symptoms of anxiety and minimizes overlap with depression, making it more suitable for isolating anxiety in perinatal populations[ 22 , 26 ]. Although several tools such as the Patient Health Questionnaire-9[ 19 ], Beck Depression Inventory-II[ 18 ], and the Center for Epidemiologic Studies Depression Scale[ 24 ] are sometimes used to assess antenatal depression, the EPDS was selected to ensure consistency from the antenatal to postnatal period[ 10 ]. This study evaluated maternal mental health throughout the entire perinatal period—that is, from early pregnancy to the postpartum stage—and was strengthened by its relatively large sample size and the combined use of cross-sectional and longitudinal analyses. The use of clinical data collected in real-world healthcare settings also enhances practical applicability. Furthermore, screening was simultaneously conducted for anxiety and depression to accurately elucidate the influence of both conditions. However, this study had some limitations. In particular, this was a retrospective study conducted at a single institution, and the number of participants in the longitudinal component was limited (n = 12), warranting caution in its interpretation. Furthermore, the screening tools used in this study were self-reported measures rather than diagnostic instruments, raising the possibility of over- or under-reporting. Future studies should adopt a large-scale, multicenter, prospective, and longitudinal design to better understand the temporal course and outcomes of perinatal mental health symptoms. Screening efforts should be expanded to include not only perinatal women but also women of reproductive age, allowing for earlier identification and preventive intervention before pregnancy begins. Furthermore, we should establish standardized guidelines for antenatal and postpartum mental-health screening, like those in the United States, the United Kingdom, and Europe [ 13 , 27 , 51 , 52 ]. CONCLUSIONS This study highlights the temporal patterns of and risk factors for anxiety and depression during pregnancy and the postpartum period, with peaking in the first trimester. Significant risk factors included unemployment, history of miscarriage, thyroid disease, gestational complications, and adverse neonatal outcomes such as low birth weight and NICU admission. These findings underscore the importance of early recognition of mental health risks during pregnancy, enabling early interventions and support for affected individuals. ABBREVIATIONS BAI, Beck Anxiety Inventory EPDS, Edinburgh Postnatal Depression Scale GA, gestational age NICU, neonatal intensive care unit PPROM, preterm premature rupture of membranes PTB, preterm birth Declarations Ethical approval and consent to participate: This study was approved by our Institutional Review Board (approval number: 2022-11-011). The retrospective nature of this study was waived off. Consent for publication: Not applicable. Availability of data and materials: Data and materials used in this study are available from the corresponding author upon request. Competing interests: No potential conflict of interest was reported by the authors Funding: This work was supported by a research grant from the Jeju National University Hospital in 2021. Author’s contributions: RK: Conceptualization, Methodology, Resources, Software, Writing and Original Draft Preparation, Reviewing and Editing. SSS: Conceptualization, Resources, Methodology, Reviewing. HSK: Resources, Methodology, Reviewing. JYH: Investigation, Resources, Writing- original draft preparation. HJY: Investigation, Resources, Writing- original draft preparation Acknowledgments: Not applicable References Biaggi A, Conroy S, Pawlby S, Pariante CM. Identifying the women at risk of antenatal anxiety and depression: A systematic review. J Affect Disord. 2016;191:62-77.doi:10.1016/j.jad.2015.11.014 Smith MV, Shao L, Howell H, Lin H, Yonkers KA. Perinatal depression and birth outcomes in a healthy start project. Matern Child Health J. 2011;15:401-9.doi:10.1007/s10995-010-0595-6. Lancaster CA, Gold KJ, Flynn HA, Yoo H, Marcus SM, Davis MM. Risk factors for depressive symptoms during pregnancy: A systematic review. Am J Obstet Gynecol. 2010;202:5-14.doi:10.1016/j.ajog.2009.09.007 Dunkel Schetter C, Tanner L. Anxiety, depression and stress in pregnancy: Implications for mothers, children, research, and practice. Curr Opin Psychiatry. 2012;25:141-8.doi:10.1097/YCO.0b013e3283503680 Shea A, Jumah NA, Forte M, Cantin C, Bayrampour H, Butler K, et al. Guideline No. 454: Identification and treatment of perinatal mood and anxiety disorders. J Obstet Gynaecol Can. 2024;46:1-21.doi:10.1016/j.jogc.2024.102696 Dennis CL, Falah-Hassani K, Shiri R. Prevalence of antenatal and postnatal anxiety: Systematic review and meta-analysis. Br J Psychiatry. 2017;210:315-23.doi:10.1192/bjp.bp.116.187179 Field T. Prenatal anxiety effects: A review. Infant Behav Dev. 2017;49:120-8.doi:10.1016/j.infbeh.2017.08.008 Rogers A, Obst S, Teague SJ, Rossen L, Spry EA, Macdonald JA, et al. Association between maternal perinatal depression and anxiety and child and adolescent development: A meta-analysis. JAMA Pediatr. 2020;174:1082-92.doi:10.1001/jamapediatrics.2020.2910 Araji S, Griffin A, Dixon L, Spencer S-K, Peavie C, Wallace K. An overview of maternal anxiety during pregnancy and the post-partum period. J Ment Health Clin Psychol. 2020;4:47-56 Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782-6.doi:10.1192/bjp.150.6.782 Jimènez-Barragan M, Falguera-Puig G, Curto-Garcia JJ, Monistrol O, Coll-Navarro E, Tarrago-Grima M, et al. Prevalence of anxiety and depression and their associated risk factors throughout pregnancy and postpartum: A prospective cross-sectional descriptive multicentred study. BMC Pregnancy Childbirth. 2024;24:500.doi:10.1186/s12884-024-06695-6 Li H, Bowen A, Bowen R, Muhajarine N, Balbuena L. Mood instability, depression, and anxiety in pregnancy and adverse neonatal outcomes. BMC Pregnancy Childbirth. 2021;21:583.doi:10.1186/s12884-021-04021-y American College of Obstetricians and Gynecologists. ACOG clinical practice guideline no. 4: Screening and diagnosis of mental health conditions during pregnancy and postpartum. Obstet Gynecol. 2023;141:1232-61.doi:10.1097/AOG.0000000000005200 Rondung E, Massoudi P, Nieminen K, Wickberg B, Peira N, Silverstein R, et al. Identification of depression and anxiety during pregnancy: A systematic review and meta-analysis of test accuracy. Acta Obstet Gynecol Scand. 2024;103:423-36.doi:10.1111/aogs.14734 Meades R, Ayers S. Anxiety measures validated in perinatal populations: A systematic review. J Affect Disord. 2011;133:1-15.doi:10.1016/j.jad.2010.10.009 Kim J-T, Shin D-K. A study based on the standardization of the STAI for Korea. New Med J. 1978;21:69-75 Kim YK, Won SD, Lim HJ, Choi S-H, Lee SM, Shin YC, et al. Validation study of the Korean version of Edinburgh Postnatal Depression Scale (K-EPDS) J Kor Soc Dep Bip Disord. 2005;3:42-9 Sung H-M, Kim J-B, Park Y-N, Bai D-S, Lee S-H, Ahn H-N. A study on the reliability and the valiadity of Korean version of the Beck Depression Inventory-II. J Korean Soc Biol Ther Psychiatry. 2008;14:201-12 Park S-J, Choi H-R, Choi J-H, Kim K, Hong JP. Reliability and validity of the Korean version of the Patient Health Questionnaire-9 (PHQ-9). Anxiety Mood. 2010;6:119-24 Kim SH, Jung S, Park K, Eunju J, Lee S-H, Choi Y, et al. Development of the Korean screening tool for anxiety disorders: Review of current anxiety scales and development of preliminary item pools. Korean J Clin Psychol. 2016;35:630-44.doi:10.15842/kjcp.2016.35.3.004 Ahn JK, Kim Y, Choi KH. The psychometric properties and clinical utility of the Korean version of GAD-7 and GAD-2. Front Psychiatry. 2019;10:127.doi:10.3389/fpsyt.2019.00127 Lee H-K, Lee E-H, Hwang S-T, Hong S-H, Kim J-H. Psychometric properties of the Beck Anxiety Inventory in the community-dwelling sample of Korean adults. Korean J Clin Psychol. 2016;35:822-30.doi:10.15842/kjcp.2016.35.4.010 Oh S, Min K, Park D. A comparison of normal, depressed and anxious groups: A study on the standardization of the hospital anxiety and depressed scale for Koreans. J Korean Neuropsychiatr Assoc. 1999;38:289-96 Lee S, Oh S-T, Ryu SY, Jun JY, Lee K, Lee E, et al. Validation of the Korean version of Center for Epidemiologic Studies Depression Scale-Revised (K-CESD-R). Korean J Psychosom Med. 2016;24:83-93 Figueiredo B, Conde A. Anxiety and depression symptoms in women and men from early pregnancy to 3-months postpartum: Parity differences and effects. J Affect Disord. 2011;132:146-57.doi:10.1016/j.jad.2011.02.007 Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: Psychometric properties. J Consult Clin Psychol. 1988;56:893-7 ACOG Committee Opinion No. 757 Summary: Screening for Perinatal Depression. Obstet Gynecol. 2018;132:1314-6.doi:10.1097/AOG.0000000000002928 Kim Y-K, Hur J-W, Kim K-H, Oh K-S, Shin Y-C. Clinical application of Korean version of Edinburgh Postnatal Depression Scale. J Korean Neuropsychiatr Assoc. 2008;47:36-44 Schatz DB, Hsiao M-C, Liu C-Y. Antenatal depression in East Asia: A review of the literature. Psychiatry Investig. 2012;9.doi:10.4306/pi.2012.9.2.111 Gelaye B, Rondon MB, Araya R, Williams MA. Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries. Lancet Psychiatry. 2016;3:973-82.doi:10.1016/s2215-0366(16)30284-x Woody CA, Ferrari AJ, Siskind DJ, Whiteford HA, Harris MG. A systematic review and meta-regression of the prevalence and incidence of perinatal depression. J Affect Disord. 2017;219:86-92.doi:10.1016/j.jad.2017.05.003 Nakić Radoš S, Tadinac M, Herman R. Anxiety during pregnancy and postpartum: Course, predictors and comorbidity with postpartum depression. Acta Clinica Croatica. 2018;57:39-51.doi:10.20471/acc.2018.57.01.05 Choi H, Kwak DW, Kim MH, Lee SY, Chung JH, Han YJ, et al. The Korean Pregnancy Outcome Study (KPOS): Study design and participants. J Epidemiol. 2021;31:392-400.doi:10.2188/jea.JE20200055 Al-Abri K, Edge D, Armitage CJ. Prevalence and correlates of perinatal depression. Soc Psychiatry Psychiatr Epidemiol. 2023;58:1581-90.doi:10.1007/s00127-022-02386-9 Fiala A, Švancara J, Klánová J, Kašpárek T. Sociodemographic and delivery risk factors for developing postpartum depression in a sample of 3233 mothers from the Czech ELSPAC study. BMC Psychiatry. 2017;17:104.doi:10.1186/s12888-017-1261-y Lee AM, Lam SK, Sze Mun Lau SM, Chong CSY, Chui HW, Fong DYT. Prevalence, course, and risk factors for antenatal anxiety and depression. Obstet Gynecol. 2007;110:1102-12 Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression: A systematic review of prevalence and incidence. Obstet Gynecol. 2005;106:1071-83 Figueiredo B, Conde A. Anxiety and depression in women and men from early pregnancy to 3-months postpartum. Arch Womens Ment Health. 2011;14:247-55.doi:10.1007/s00737-011-0217-3 Glover V. Maternal depression, anxiety and stress during pregnancy and child outcome; what needs to be done. Best Pract Res Clin Obstet Gynaecol. 2014;28:25-35.doi:10.1016/j.bpobgyn.2013.08.017 Field T. Prenatal depression effects on early development: A review. Infant Behav Dev. 2011;34:1-14.doi:10.1016/j.infbeh.2010.09.008 Asselmann E, Kunas SL, Wittchen HU, Martini J. Maternal personality, social support, and changes in depressive, anxiety, and stress symptoms during pregnancy and after delivery: A prospective-longitudinal study. PLOS One. 2020;15:e0237609.doi:10.1371/journal.pone.0237609 Tan PC, Zaidi SN, Azmi N, Omar SZ, Khong SY. Depression, anxiety, stress and hyperemesis gravidarum: Temporal and case controlled correlates. PLOS One. 2014;9:e92036.doi:10.1371/journal.pone.0092036 Alsaeed JK, Zayed AM, Buhassan ZH, Alhadrami SH, Naguib Y, Husni M. Hyperthyroidism masking depression and panic disorder symptoms during pregnancy: A case report. Cureus. 2023;15:e50582.doi:10.7759/cureus.50582 Basraon S, Costantine MM. Mood disorders in pregnant women with thyroid dysfunction. Clin Obstet Gynecol. 2011;54:506-14 Rubertsson C, Waldenström U, Wickberg B. Depressive mood in early pregnancy: Prevalence and women at risk in a national Swedish sample. J Reprod Infant Psychol. 2003;21:113-23.doi:10.1080/0264683031000124073 Bergner A, Beyer R, Klapp BF, Rauchfuss M. Pregnancy after early pregnancy loss: A prospective study of anxiety, depressive symptomatology and coping. J Psychosom Obstet Gynaecol. 2008;29:105-13.doi: 10.1080/01674820701687521 Lee DTS, Chung TKH. Postnatal depression: An update. Best Pract Res Clin Obstet Gynaecol. 2007;21:183-91.doi:10.1016/j.bpobgyn.2006.10.003 Youn JH, Jeong IS. Predictors of postpartum depression: Prospective cohort study. J Korean Acad Nurs. 2013;43:225-35.doi:10.4040/jkan.2013.43.2.225 Zhao X-H, Zhang Z-H. Risk factors for postpartum depression: An evidence-based systematic review of systematic reviews and meta-analyses. Asian J Psychiatry. 2020;53.doi:10.1016/j.ajp.2020.102353 American College of Obstetricians and Gynecologists. ACOG clinical practice guideline no. 4: Treatment and management of mental health conditions during pregnancy and postpartum. Obstet Gynecol. 2023;141:1262-88.doi:10.1097/AOG.0000000000005202 National Institute for Health and Care Excellence. Antenatal and postnatal mental health: Clinical management and service guidance. 2014; Horakova A, Nemcova H, Hrdlickova K, Kalli S, Davletova A, Duarte M, et al. State of perinatal mental health care in the WHO region of Europe: A scoping review. Front Psychiatry. 2024;15:1350036.doi:10.3389/fpsyt.2024.1350036 Hahn D-W, Lee C-H, Chon K-K. Korean adaptation of Spielberger's STAI (K-STAI). Korean J Health Psychol. 1996;1:1-14 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6525083","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":463134290,"identity":"5a5e72e7-8c70-49d4-81b9-dfa5671d9bd7","order_by":0,"name":"Rina Kim","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5klEQVRIie3PPQrCMBTA8UihXV7qmpIe4kmhRSz2MIVO9WsTHLxALuBFMiuCXXIAwUHBVaEgiKCDUVeJujnkP4Q35MdLCLHZ/jZkkFXiOYL/HRmmIVHqRdzHOf9I6iIl6/I1fySJJ+LdBZfQmB0Xp1HZDV1CF/vaQNpCJS2hicP7OZ/JXD/Mz9G0Bdc9yUATl5fIqXQ0gZgZyfYog5smEKjoSuX0QZKLeQuVHLAAxiDWW5bPLcbvoxqceYgpIJRxh8oKXAcipkykWhXB4cYy9FS0oXKSNT3RqscG8ibnt+s2m81me9MdtRBCq+io2DIAAAAASUVORK5CYII=","orcid":"","institution":"Jeju National University College of Medicine, Jeju National University Hospital","correspondingAuthor":true,"prefix":"","firstName":"Rina","middleName":"","lastName":"Kim","suffix":""},{"id":463134291,"identity":"4d39073b-11a6-477b-99b7-23c53c4b03bc","order_by":1,"name":"Soon Sup Shim","email":"","orcid":"","institution":"Jeju National University College of Medicine, Jeju National University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Soon","middleName":"Sup","lastName":"Shim","suffix":""},{"id":463134292,"identity":"59b5e9b9-2078-4474-9406-d331d365b90b","order_by":2,"name":"Hye Sim Kang","email":"","orcid":"","institution":"Jeju National University College of Medicine, Jeju National University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hye","middleName":"Sim","lastName":"Kang","suffix":""},{"id":463134293,"identity":"9c8f9e3d-eb6a-48cc-9311-27d48233f33b","order_by":3,"name":"Jin-Yi Hyun","email":"","orcid":"","institution":"Jeju National University","correspondingAuthor":false,"prefix":"","firstName":"Jin-Yi","middleName":"","lastName":"Hyun","suffix":""},{"id":463134294,"identity":"aacaaae0-c6a2-4da3-8386-d7e5a1a5b36c","order_by":4,"name":"Hyun-Jun Yun","email":"","orcid":"","institution":"Jeju National University","correspondingAuthor":false,"prefix":"","firstName":"Hyun-Jun","middleName":"","lastName":"Yun","suffix":""}],"badges":[],"createdAt":"2025-04-25 04:23:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6525083/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6525083/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83770999,"identity":"7273efc7-8a0f-4293-b335-69a590e962ad","added_by":"auto","created_at":"2025-06-02 12:31:08","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":17859,"visible":true,"origin":"","legend":"\u003cp\u003eLongitudinal changes in anxiety and depression scores across the gestational stages and during the postpartum period. BAI, Beck Anxiety Inventory; EPDS, Edinburgh Postnatal Depression Scale\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6525083/v1/8b1e4e709f784ac72ca7f019.png"},{"id":105367794,"identity":"b171954c-cbca-4289-92f6-32cd53c8c099","added_by":"auto","created_at":"2026-03-25 08:56:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1079146,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6525083/v1/68e13995-7803-45d0-897c-11775a0dc341.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Perinatal mental health across different trimesters of pregnancy and during the postpartum period: trends and risk factors for anxiety and depression","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003ePregnancy is a transformative period characterized by physical and emotional changes, including substantial hormonal, physiological, and psychological changes[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. These changes render women particularly vulnerable to mental health challenges, with anxiety and depression being the most prevalent conditions[\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Maternal mental health not only affect the well-being of mothers but also has long-term consequences on their children, including adverse birth outcomes, delayed developmental milestones, and behavioral problems[\u003cspan additionalcitationids=\"CR5 CR6 CR7 CR8\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePostpartum depression is a well-known mental-health disorder. In 1987, the Edinburgh Postnatal Depression Scale (EPDS) was developed as a screening tool for postpartum depression; consequently, most early research had primarily focused on postpartum depression[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Since then, anxiety has emerged as an equally important mental health concern; as a result, increased attention has been paid to postpartum anxiety[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. While most early studies had investigated anxiety and depression separately, more recent investigations have highlighted a close correlation between these two conditions, encouraging a more integrated approach to understanding maternal mental health[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Nonetheless, current screening and assessment methods for maternal mental health have several limitations. First, despite the availability of various screening tools for evaluating anxiety and depression, few have been specifically designed for pregnant women[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Furthermore, no tool has been specifically developed or internationally standardized to assess maternal anxiety and depression during pregnancy or the postpartum period[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. To date, the EPDS remains the primary screening tool for assessing postpartum depression.\u003c/p\u003e \u003cp\u003eSecond, numerous screening tools in non-English-speaking countries have not been fully translated or culturally validated, making it difficult for clinicians to select the most appropriate tools for pregnant and postpartum individuals in these countries[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In South Korea, five anxiety screening tools and five depression screening tools have been officially translated and validated for use[\u003cspan additionalcitationids=\"CR17 CR18 CR19 CR20 CR21 CR22 CR23\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThird, although studies investigating the prevalence and associated risk factors of maternal mental health issues across different trimesters of pregnancy and during the postpartum period have gradually increased, they remain limited, particularly with respect to comprehensive, trimester-specific, and longitudinal research[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo address these research gaps, the current study aimed to analyze patterns and changes in anxiety and depression across trimesters of pregnancy and during the postpartum period among Korean women using validated screening tools. Given that maternal mental disorders represent a unique situation in which pharmacological treatment is often limited because of pregnancy, the goal is to prevent mental health issues via the identification of unique risk factors and trends influencing anxiety and depression. The findings of this study have important implications for establishing a foundation for the lifelong health and well-being of mothers and their children.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy participants\u003c/h2\u003e \u003cp\u003eThis retrospective study analyzed pregnant and postpartum women who visited the Department of Obstetrics and Gynecology at Jeju National University Hospital from December 29, 2021, to January 31, 2023 (over approximately 13 months) and underwent screening for anxiety and depression using the Korean versions of the Beck Anxiety Inventory (BAI) and EPDS. All participants delivered in our hospital at 23 weeks and 0 day of gestation or later when the fetuses were viable. The analysis included participants who completed screening during the postpartum period and underwent at least one screening test during pregnancy, irrespective of gestational age (GA). However, non-Korean patients, individuals previously diagnosed with a mental illness, those with multiple pregnancies, and pregnant women who refused or discontinued the evaluation were excluded. Tests were not conducted during hospitalization for any reason.\u003c/p\u003e \u003cp\u003eThe participants were categorized as follows according to GA: the first trimester (from confirmation of pregnancy to 13\u003csup\u003e+\u0026thinsp;6\u003c/sup\u003e weeks of GA), second trimester (from 14\u003csup\u003e+\u0026thinsp;0\u003c/sup\u003e to 27\u003csup\u003e+\u0026thinsp;6\u003c/sup\u003e weeks of GA), third trimester (from 28\u003csup\u003e+\u0026thinsp;0\u003c/sup\u003e weeks to immediately before delivery), and postpartum period (from delivery until clinical recovery was determined during postpartum outpatient follow-up).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\u003cp\u003e This study was approved by the Institutional Review Board of Jeju National University Hospital (approval number: 2022-11-011). The requirement for informed consent was waived owing to the retrospective nature of participant recruitment.\u003c/p\u003e\n\u003ch3\u003eScreening for anxiety and depression\u003c/h3\u003e\n\u003cp\u003eTwo types of screening tests were employed to assess mental health.\u003c/p\u003e \u003cp\u003eFirst, anxiety was assessed using the BAI, which is a self-report questionnaire that was developed to reliably assess the severity of anxiety symptoms and was specifically designed to distinguish anxiety from depressive symptoms. The inventory consists of 21 items, many of which evaluate physical symptoms associated with anxiety. Participants rated the severity of their symptoms over the past week. The total score was calculated by summing the item scores (possible score range: 0\u0026ndash;63). A score of 0 to 7 was considered to be within the normal range, whereas scores of 8\u0026ndash;15, 16\u0026ndash;25, and 26\u0026ndash;63 indicated mild, moderate, and severe anxiety, respectively[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSecond, depression was evaluated using the EPDS, which is a well-validated 10-item self-report screening test. Each item asked participants to report how they felt during the past 7 days. The total score ranged from 0 to 30, with higher scores indicating more severe depressive symptoms. Most studies and guidelines demonstrated that a score of 10 or higher had high sensitivity, specificity, and positive predictive value in detecting perinatal depression[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Thus, in this study, a score of 10 or higher was set to denote positivity for depression.\u003c/p\u003e\n\u003ch3\u003eMeasurements\u003c/h3\u003e\n\u003cp\u003eIn this study, miscarriage was defined as the termination of pregnancy prior to 20\u003csup\u003e+\u0026thinsp;0\u003c/sup\u003e weeks of GA. Fetal growth restriction was defined as an estimated fetal weight below the 10th percentile for the GA. Preterm premature rupture of membranes (PPROM) and preterm birth (PTB) were defined as occurring between 23\u003csup\u003e+\u0026thinsp;0\u003c/sup\u003e and 36\u003csup\u003e+\u0026thinsp;6\u003c/sup\u003e weeks of GA. Hypertensive disorders included pregnancy-induced hypertension and preeclampsia.\u003c/p\u003e\n\u003ch3\u003eStatistical analyses\u003c/h3\u003e\n\u003cp\u003eDescriptive statistics were applied to summarize the demographic and clinical characteristics of the study population. Continuous variables were compared using two-sample \u003cem\u003et\u003c/em\u003e-test or Wilcoxon rank-sum test, depending on the data distribution. Categorical variables were analyzed using the chi-square test or Fisher\u0026rsquo;s exact test, as appropriate. Logistic regression models with stepwise variable selection methods were used to identify significant risk factors associated with anxiety and depression. A linear mixed model was used to analyze longitudinal data across different gestational stages. Statistical analyses were performed using SAS software version 9.4 (SAS Institute Inc., Cary, NC, USA), with statistical significance set at a \u003cem\u003ep-\u003c/em\u003evalue of \u0026lt;\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThis study analyzed the patterns of anxiety and depression during pregnancy and the postpartum period in 445 women who delivered at our hospital and underwent testing. No participant refused or discontinued the evaluation. The mean age at delivery was 35.2 years (range: 21.0\u0026ndash;49.0). Among these women, 23, 190, 90, and 445 completed the screening tests during the first, second, and third trimesters and the postpartum period, respectively. Of note, 12 women completed all four assessments from early pregnancy to the postpartum period. The mean GA at testing was 12\u003csup\u003e+\u0026thinsp;0\u003c/sup\u003e weeks for the first trimester, 22\u003csup\u003e+\u0026thinsp;2\u003c/sup\u003e weeks for the second trimester, 34\u003csup\u003e+\u0026thinsp;1\u003c/sup\u003e weeks for the third trimester, and 5\u003csup\u003e+\u0026thinsp;5\u003c/sup\u003e weeks postpartum.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the mean BAI and EPDS scores, as well as the number and percentage of patients exceeding the cutoff scores. Anxiety and depression had the highest positivity rates in the first trimester. Anxiety showed a secondary peak in the third trimester, whereas depression peaked again during the postpartum period. Among the participants who underwent at least one screening test during the entire pregnancy period, the number of patients with positive scores at least once was as follows: 78/235 (33.2%) patients had anxiety on the BAI, and 42/235 (17.9%) patients screened positive for depression on the EPDS.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBAI and EPDS scores across different trimesters and during the postpartum period\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFirst trimester\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eSecond trimester\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eThird trimester\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003ePostpartum\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e190\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e445\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean GA at test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003csup\u003e+\u0026thinsp;0\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e[8\u003csup\u003e+\u0026thinsp;3\u003c/sup\u003e\u0026ndash;13\u003csup\u003e+\u0026thinsp;5\u003c/sup\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22\u003csup\u003e+\u0026thinsp;2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[16\u003csup\u003e+\u0026thinsp;3\u003c/sup\u003e\u0026ndash;27\u003csup\u003e+\u0026thinsp;6\u003c/sup\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34\u003csup\u003e+\u0026thinsp;1\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e[28\u003csup\u003e+\u0026thinsp;3\u003c/sup\u003e\u0026ndash;39\u003csup\u003e+\u0026thinsp;0\u003c/sup\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5\u003csup\u003e+\u0026thinsp;5\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e[1\u003csup\u003e+\u0026thinsp;4\u003c/sup\u003e\u0026ndash;12\u003csup\u003e+\u0026thinsp;6\u003c/sup\u003e]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean BAI score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e[1.0\u0026ndash;30.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[0\u0026ndash;30.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e[0\u0026ndash;32.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e[0\u0026ndash;40.0]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBAI score\u0026thinsp;\u0026ge;\u0026thinsp;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e13\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e(56.5)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(26.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e28\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e(31.1)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(23.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBAI score\u0026thinsp;\u0026ge;\u0026thinsp;16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(17.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(6.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(5.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBAI score\u0026thinsp;\u0026ge;\u0026thinsp;26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(8.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(1.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean EPDS score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e[1.0\u0026ndash;22.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e[0\u0026ndash;23.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e[0\u0026ndash;21.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e[0\u0026ndash;25.0]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEPDS score\u0026thinsp;\u0026ge;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e(34.8)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(15.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(17.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e102\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e(22.9)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e \u003cp\u003eData are expressed as mean [range] or numbers (percentages).\u003c/p\u003e \u003cp\u003eBold font was used to indicate the key findings.\u003c/p\u003e \u003cp\u003eBAI, Beck Anxiety Inventory; EPDS, Edinburgh Postnatal Depression Scale; GA, gestational age.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eResults of 12 women who completed all screening tests indicated that mean scores decreased from the first trimester to the postpartum period when divided by trimester and analyzed using least-squares means (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLeast squares mean scores for anxiety and depression across gestational stages and during the postpartum period\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall time effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEstimate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStandard error\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEstimate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStandard error\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst trimester\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.6157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.4749\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.6319\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.7586\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecond trimester\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.3849\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.4749\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.7088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.7586\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThird trimester\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.5388\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.4749\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.0934\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.7586\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostpartum period\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.2311\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.4749\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.2473\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.7586\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eComparisons between anxiety-positive and anxiety-negative groups and between depression-positive and depression-negative groups were conducted to identify statistically significant factors across different trimesters. In the second trimester, significant factors were unemployment and antiemetic drug use in the anxiety-positive group and thyroid disease and antiemetic drug use in the depression-positive group (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). During the postpartum period, unemployment, history of miscarriage, PPROM in the current pregnancy, and neonatal intensive care unit (NICU) admission were identified as significant factors in the anxiety-positive group. In the depression-positive group, significant factors included history of miscarriage, prior PTB, PPROM in the current pregnancy, neonatal birth weight\u0026thinsp;\u0026lt;\u0026thinsp;1.5 kg, and NICU admission (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). However, there were not enough patients for analysis during the first trimester. No significant factors were identified in either group during the third trimester of pregnancy (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBasic characteristics and risk factors in the second trimester by anxiety and depression scores\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eScore\u0026thinsp;\u0026lt;\u0026thinsp;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eScore\u0026thinsp;\u0026ge;\u0026thinsp;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep-\u003c/em\u003evalue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eScore\u0026thinsp;\u0026lt;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eScore\u0026thinsp;\u0026ge;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003ep-\u003c/em\u003evalue\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eN\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge at delivery*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e35.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.8479\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;35-year-old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91 (59.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e96 (59.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19 (65.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.5503\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarriage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e152 (98.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e159 (98.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50 (32.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.0097\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e55 (34.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15 (51.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0711\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrepregnancy BMI*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8374\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.9647\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eHistory of disease\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.5930\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5716\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThyroid disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (5.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.3647\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGynecologic disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39 (25.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (19.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4584\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e44 (27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (6.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0178\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eObstetric history\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eART\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43 (27.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (38.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.1961\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e47 (29.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10 (34.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.5671\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiscarriages\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56 (36.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.3682\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e58 (36.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14 (48.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.2106\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStillbirth or neonatal death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6189\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.5975\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePTB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (8.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7405\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0578\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHaving children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68 (44.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5259\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e71 (44.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15 (51.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.4476\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eComplication during pregnancy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (23.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (19.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e38 (23.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.4511\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6800\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.3593\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational diabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (12.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (13.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7834\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20 (12.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (13.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.7673\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThyroid disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6800\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (13.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.0322\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbnormal screening test results\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (7.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4681\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (6.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntiemetic drug use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.0122\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13 (8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 (20.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.0481\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eData are expressed as numbers (percentages), whereas *data are presented as mean.\u003c/p\u003e \u003cp\u003eBold font was used to indicate the key findings.\u003c/p\u003e \u003cp\u003eART, assisted reproductive technology; BMI, body mass index; PTB, preterm birth.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBasic characteristics and risk factors during the postpartum period by anxiety and depression scores\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eScore\u0026thinsp;\u0026lt;\u0026thinsp;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eScore\u0026thinsp;\u0026ge;\u0026thinsp;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep-\u003c/em\u003evalue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eScore\u0026thinsp;\u0026lt;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eScore\u0026thinsp;\u0026ge;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003ep-\u003c/em\u003evalue\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eN\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e375\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e343\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge at delivery*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e35.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.5007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;35-year-old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e209 (55.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (60.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5087\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e192 (56.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e59 (57.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.7386\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarriage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e372 (99.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (97.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.1776\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e341 (99.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e99 (97.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0817\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e128 (34.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.0114\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e121 (35.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e42 (41.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.2776\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrepregnancy BMI*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.9925\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.3135\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eHistory of disease\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.6241\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThyroid disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5702\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19 (5.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 (5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.8949\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGynecologic disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88 (23.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (18.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.3694\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e86 (25.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15 (14.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0282\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eObstetric history\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eART\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76 (20.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (24.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4477\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e70 (20.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23 (20.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.6406\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiscarriages\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e114 (30.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (52.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.0003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e106 (30.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e45 (44.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.0133\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStillbirth or neonatal death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2265\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePTB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.1929\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18 (5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11 (10.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.0467\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHaving children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e141 (37.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (48.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0845\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e129 (37.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e46 (45.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.1740\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eComplication during pregnancy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76 (20.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (24.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4477\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e68 (19.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25 (24.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.3070\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6989\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26 (7.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11 (10.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.3035\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational diabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (8.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.3475\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10 (9.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.4545\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThyroid disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7708\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20 (5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.2471\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbnormal screening test results\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (13.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.7559\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntiemetic drug use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (8.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2740\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16 (4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10 (9.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0530\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFGR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6612\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0541\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePPROM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (17.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.0267\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28 (8.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16 (15.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.0254\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003ePregnancy outcome\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePTB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e89 (23.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.3876\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e75 (21.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0181\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCesarean section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e270 (72.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (82.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0582\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e249 (72.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e79 (77.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.3710\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeonatal death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0521\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeonate birth weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;2,500 g\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e294 (78.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51 (72.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2541\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e275 (80.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e70 (68.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.0007\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1,500\u0026ndash;2,500 g\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68 (18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e60 (17.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22 (21.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;1,500 g\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10 (9.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNICU admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52 (13.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (24.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.0285\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45 (13.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24 (23.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.0116\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eData are expressed as numbers (percentages), whereas *data are presented as mean.\u003c/p\u003e \u003cp\u003eBold font was used to indicate the key findings.\u003c/p\u003e \u003cp\u003eART, assisted reproductive technology; BMI, body mass index; FGR, fetal growth restriction; PPROM, preterm premature rupture of membranes; PTB, preterm birth; NICU, neonatal intensive care unit.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBasic characteristics and risk factors in the third trimester by anxiety and depression scores\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eScore\u0026thinsp;\u0026lt;\u0026thinsp;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eScore\u0026thinsp;\u0026ge;\u0026thinsp;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep-\u003c/em\u003evalue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eScore\u0026thinsp;\u0026lt;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eScore\u0026thinsp;\u0026ge;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003ep-\u003c/em\u003evalue\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eN\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge at delivery*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8429\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.3575\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;35-year-old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38 (54.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (35.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.1282\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40 (54.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (31.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0981\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarriage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e74 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (44.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (65.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.1022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34 (46.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10 (62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.2297\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrepregnancy BMI*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.3439\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.2832\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eHistory of disease\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2222\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.1778\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThyroid disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.5497\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGynecologic disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (22.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5480\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17 (23.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.5066\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eObstetric history\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eART\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (15.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (12.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.2363\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiscarriages\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (34.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7937\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26 (35.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.5640\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStillbirth or neonatal death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePTB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (8.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.3314\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.5860\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHaving children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (41.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.3314\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29 (39.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (31.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.7769\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eComplication during pregnancy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23 (31.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.7684\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0695\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.6285\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational diabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (12.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 (16.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.1150\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThyroid disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (8.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.6285\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbnormal screening test results\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5803\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (5.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntiemetic drug use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (7.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.1102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (6.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.0513\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eData are expressed as numbers (percentages), whereas *data are presented as mean.\u003c/p\u003e \u003cp\u003eART, assisted reproductive technology; BMI, body mass index; PTB, preterm birth.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eUnivariate logistic regression analysis revealed that both anxiety and depression were significantly associated with neonatal birth weight\u0026thinsp;\u0026lt;\u0026thinsp;1.5 kg. Anxiety was significantly associated with NICU admission and positive depression screening results (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate logistic regression analysis of risk factors for anxiety and depression\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep-\u003c/em\u003evalue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003ep-\u003c/em\u003evalue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePTB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.482\u0026ndash;2.144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.9655\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.468\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.795\u0026ndash;2.711\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.2195\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCesarean section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.767\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.891\u0026ndash;3.505\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.1030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.595\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.898\u0026ndash;2.830\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.1109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeonate birth weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;2,500 g\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1,500\u0026ndash;2,500 g\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.466\u0026ndash;3.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2923\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.735\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.812\u0026ndash;3.707\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.4915\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1,500 g\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.369\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.326\u0026ndash;14.390\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.0278\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e3.309\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.860\u0026ndash;12.722\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.0170\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNICU admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.194\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.078\u0026ndash;4.466\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.0302\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.784\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.928\u0026ndash;3.432\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.0827\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive on the EPDS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.181\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.741\u0026ndash;18.815\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e \u003cp\u003eBold font was used to indicate the key findings.\u003c/p\u003e \u003cp\u003eCI, confidence interval; EPDS, Edinburgh Postnatal Depression Scale; NICU, neonatal intensive care unit; OR, odds ratio; PTB, preterm birth\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWe recommended psychiatric clinic visits to 66 patients who had moderate-to-severe positive screening results or were clinically indicated for psychiatric care. Only 7 (10.6%) patients visited the clinic and received counselling.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe current study revealed high screening positivity rates for anxiety and depression, particularly during early pregnancy, and identified trimester-specific risk factors. In this study, 28.4% and 20.4% of perinatal women screened positive for anxiety (BAI score\u0026thinsp;\u0026ge;\u0026thinsp;8) and depression (EPDS score\u0026thinsp;\u0026ge;\u0026thinsp;10), respectively.\u003c/p\u003e \u003cp\u003eDuring antenatal pregnancy, 33.2% and 17.9% of pregnant women screened positive for anxiety and depression, respectively, at least once throughout the entire pregnancy period. These rates were comparable to those reported by previous studies, which estimated antenatal anxiety and depression screening positivity rates of approximately 20\u0026ndash;32% and 7\u0026ndash;28%[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan additionalcitationids=\"CR30 CR31 CR32 CR33\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Otherwise, we found that 23.6% and 22.9% of postpartum women screened positive for anxiety and depression, respectively. These rates were comparable to or higher than those reported in previous studies[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. While it would have been more accurate to compare our screening positivity rates with those of similar studies, differences in the types of assessment tools and study populations limited the validity of such comparisons. Therefore, we compared our findings to officially reported prevalence rates and found that our screening positivity rates were comparable or slightly higher than those rates.\u003c/p\u003e \u003cp\u003eThe first trimester was observed to be the most vulnerable period, with the highest proportion of positive screenings for both conditions, as reported in several studies[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Anxiety and depression in early pregnancy should be recognized as critical concerns, because they are not merely transient symptoms and are instead associated with persistent mental health issues in late pregnancy, as well as adverse outcomes such as preterm birth, low birth weight, and difficult infant temperament[\u003cspan additionalcitationids=\"CR39\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Additionally, the longitudinal analysis of the 12 study participants revealed that the symptoms of anxiety and depression gradually declined from early pregnancy through the third trimester to the postpartum period. This finding likely reflects a pattern wherein elevated symptoms in early pregnancy gradually stabilized over time. Although our sample size was limited and there are few papers to support this finding[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e], these longitudinal observations may offer insight into clinical implications than prevalence rates reported in cross-sectional studies. These results underscore the need for early identification and continuous intervention during early pregnancy.\u003c/p\u003e \u003cp\u003eWe explored several significant risk factors that are generally consistent with the results reported by many previous studies. In antenatal period, a noteworthy finding of this study was the association between antiemetic drug use, a proxy for physical distress such as hyperemesis, and mental health symptoms, suggesting a close link between somatic discomfort and emotional well-being[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Furthermore, we revealed that a history of thyroid disorders diagnosed before pregnancy is associated with antenatal depression during pregnancy, which has been supported by previous reports[\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Hormonal changes, inflammation, and alterations in neurotransmitter systems may mediate this association. Furthermore, employment instability has been repeatedly reported as a predictor of perinatal mental health difficulties[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. We found that unemployment was a critical factor affecting anxiety in the perinatal period.\u003c/p\u003e \u003cp\u003eIn the postpartum period, the history of miscarriage emerges as an important risk factor contributing to both conditions, in the postpartum period and in antenatal period, as reported previously [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Similarly, adverse obstetric effects such as PPROM and NICU admission have been shown to increase the risk of postpartum anxiety and depression[\u003cspan additionalcitationids=\"CR48\" citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. As many studies have shown, a potent effect of anxiety is depression[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. These results emphasize the importance of comprehensive risk assessment throughout the perinatal period and support the need for multidimensional screening approaches in early pregnancy.\u003c/p\u003e \u003cp\u003eIn our study, only 10.6% of pregnant individuals with elevated anxiety or depression scores attended psychiatric services despite clinical recommendations. This proportion is notably lower than those reported in other high-income countries (approximately 25% in the United States and 54% in Canada)[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. Similarly, guidelines from the European region and the United Kingdom have acknowledged low mental-health service utilization rates[\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. This treatment gap has been attributed to common barriers across guidelines, such as stigma, lack of mental-health literacy, insufficient provider training, unclear referral pathways, long wait times, and structural challenges, including cost, childcare, and transportation. These factors may be more pronounced in the Korean context, potentially contributing to the exceptionally low engagement rate observed in our cohort.\u003c/p\u003e \u003cp\u003eIn this study, the BAI and EPDS were used to assess the mental health status during pregnancy and the postpartum period. Both tools have been validated in Korea and are widely used in clinical settings because of their ease of administration as self-report questionnaires[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In non-English-speaking countries, such as Korea, the range of available tools is limited owing to a lack of validated translations and psychometric testing. We chose the BAI, which has been found to be more appropriate in length (21 items) than other commonly used tools such as the State-Trait Anxiety Inventory[\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e] (40 items) or Generalized Anxiety Disorder-7[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] (7 items). Additionally, compared with instruments such as the Hospital Anxiety and Depression Scale or Depression Anxiety Stress Scales-21\u0026mdash;which are used in hospital-based populations or to assess multiple emotional states, the BAI focuses on the somatic symptoms of anxiety and minimizes overlap with depression, making it more suitable for isolating anxiety in perinatal populations[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Although several tools such as the Patient Health Questionnaire-9[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], Beck Depression Inventory-II[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], and the Center for Epidemiologic Studies Depression Scale[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] are sometimes used to assess antenatal depression, the EPDS was selected to ensure consistency from the antenatal to postnatal period[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e This study evaluated maternal mental health throughout the entire perinatal period\u0026mdash;that is, from early pregnancy to the postpartum stage\u0026mdash;and was strengthened by its relatively large sample size and the combined use of cross-sectional and longitudinal analyses. The use of clinical data collected in real-world healthcare settings also enhances practical applicability. Furthermore, screening was simultaneously conducted for anxiety and depression to accurately elucidate the influence of both conditions. However, this study had some limitations. In particular, this was a retrospective study conducted at a single institution, and the number of participants in the longitudinal component was limited (n\u0026thinsp;=\u0026thinsp;12), warranting caution in its interpretation. Furthermore, the screening tools used in this study were self-reported measures rather than diagnostic instruments, raising the possibility of over- or under-reporting.\u003c/p\u003e \u003cp\u003eFuture studies should adopt a large-scale, multicenter, prospective, and longitudinal design to better understand the temporal course and outcomes of perinatal mental health symptoms. Screening efforts should be expanded to include not only perinatal women but also women of reproductive age, allowing for earlier identification and preventive intervention before pregnancy begins. Furthermore, we should establish standardized guidelines for antenatal and postpartum mental-health screening, like those in the United States, the United Kingdom, and Europe [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e].\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eThis study highlights the temporal patterns of and risk factors for anxiety and depression during pregnancy and the postpartum period, with peaking in the first trimester. Significant risk factors included unemployment, history of miscarriage, thyroid disease, gestational complications, and adverse neonatal outcomes such as low birth weight and NICU admission. These findings underscore the importance of early recognition of mental health risks during pregnancy, enabling early interventions and support for affected individuals.\u003c/p\u003e"},{"header":"ABBREVIATIONS","content":"\u003cp\u003eBAI, Beck Anxiety Inventory\u003c/p\u003e\n\u003cp\u003eEPDS, Edinburgh Postnatal Depression Scale\u003c/p\u003e\n\u003cp\u003eGA, gestational age\u003c/p\u003e\n\u003cp\u003eNICU, neonatal intensive care unit\u003c/p\u003e\n\u003cp\u003ePPROM, preterm premature rupture of membranes\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePTB, preterm birth\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthical approval and consent to participate: This study was approved by our Institutional Review Board (approval number: 2022-11-011). The retrospective nature of this study was waived off.\u003c/p\u003e\n\u003cp\u003eConsent for publication:\u0026nbsp;Not applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials:\u0026nbsp;Data and materials used in this study are available from the corresponding author upon request.\u003c/p\u003e\n\u003cp\u003eCompeting interests:\u0026nbsp;No potential conflict of interest was reported by the authors\u003c/p\u003e\n\u003cp\u003eFunding:\u0026nbsp;This work was supported by a research grant from the Jeju National University Hospital in 2021.\u003c/p\u003e\n\u003cp\u003eAuthor\u0026rsquo;s contributions:\u0026nbsp;RK: Conceptualization, Methodology, Resources, Software, Writing and Original Draft Preparation, Reviewing and Editing. SSS: Conceptualization, Resources, Methodology, Reviewing. HSK: Resources, Methodology, Reviewing. JYH: Investigation, Resources, Writing- original draft preparation. HJY: Investigation, Resources, Writing- original draft preparation\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgments:\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eBiaggi A, Conroy S, Pawlby S, Pariante CM. Identifying the women at risk of antenatal anxiety and depression: A systematic review. J Affect Disord. 2016;191:62-77.doi:10.1016/j.jad.2015.11.014\u003c/li\u003e\n \u003cli\u003eSmith MV, Shao L, Howell H, Lin H, Yonkers KA. Perinatal depression and birth outcomes in a healthy start project. Matern Child Health J. 2011;15:401-9.doi:10.1007/s10995-010-0595-6.\u003c/li\u003e\n \u003cli\u003eLancaster CA, Gold KJ, Flynn HA, Yoo H, Marcus SM, Davis MM. Risk factors for depressive symptoms during pregnancy: A systematic review. Am J Obstet Gynecol. 2010;202:5-14.doi:10.1016/j.ajog.2009.09.007\u003c/li\u003e\n \u003cli\u003eDunkel Schetter C, Tanner L. Anxiety, depression and stress in pregnancy: Implications for mothers, children, research, and practice. Curr Opin Psychiatry. 2012;25:141-8.doi:10.1097/YCO.0b013e3283503680\u003c/li\u003e\n \u003cli\u003eShea A, Jumah NA, Forte M, Cantin C, Bayrampour H, Butler K, et al. Guideline No. 454: Identification and treatment of perinatal mood and anxiety disorders. J Obstet Gynaecol Can. 2024;46:1-21.doi:10.1016/j.jogc.2024.102696\u003c/li\u003e\n \u003cli\u003eDennis CL, Falah-Hassani K, Shiri R. Prevalence of antenatal and postnatal anxiety: Systematic review and meta-analysis. Br J Psychiatry. 2017;210:315-23.doi:10.1192/bjp.bp.116.187179\u003c/li\u003e\n \u003cli\u003eField T. Prenatal anxiety effects: A review. Infant Behav Dev. 2017;49:120-8.doi:10.1016/j.infbeh.2017.08.008\u003c/li\u003e\n \u003cli\u003eRogers A, Obst S, Teague SJ, Rossen L, Spry EA, Macdonald JA, et al. Association between maternal perinatal depression and anxiety and child and adolescent development: A meta-analysis. JAMA Pediatr. 2020;174:1082-92.doi:10.1001/jamapediatrics.2020.2910\u003c/li\u003e\n \u003cli\u003eAraji S, Griffin A, Dixon L, Spencer S-K, Peavie C, Wallace K. An overview of maternal anxiety during pregnancy and the post-partum period. J Ment Health Clin Psychol. 2020;4:47-56\u003c/li\u003e\n \u003cli\u003eCox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782-6.doi:10.1192/bjp.150.6.782\u003c/li\u003e\n \u003cli\u003eJim\u0026egrave;nez-Barragan M, Falguera-Puig G, Curto-Garcia JJ, Monistrol O, Coll-Navarro E, Tarrago-Grima M, et al. Prevalence of anxiety and depression and their associated risk factors throughout pregnancy and postpartum: A prospective cross-sectional descriptive multicentred study. BMC Pregnancy Childbirth. 2024;24:500.doi:10.1186/s12884-024-06695-6\u003c/li\u003e\n \u003cli\u003eLi H, Bowen A, Bowen R, Muhajarine N, Balbuena L. Mood instability, depression, and anxiety in pregnancy and adverse neonatal outcomes. BMC Pregnancy Childbirth. 2021;21:583.doi:10.1186/s12884-021-04021-y\u003c/li\u003e\n \u003cli\u003eAmerican College of Obstetricians and Gynecologists. ACOG clinical practice guideline no. 4: Screening and diagnosis of mental health conditions during pregnancy and postpartum. Obstet Gynecol. 2023;141:1232-61.doi:10.1097/AOG.0000000000005200\u003c/li\u003e\n \u003cli\u003eRondung E, Massoudi P, Nieminen K, Wickberg B, Peira N, Silverstein R, et al. Identification of depression and anxiety during pregnancy: A systematic review and meta-analysis of test accuracy. Acta Obstet Gynecol Scand. 2024;103:423-36.doi:10.1111/aogs.14734\u003c/li\u003e\n \u003cli\u003eMeades R, Ayers S. Anxiety measures validated in perinatal populations: A systematic review. J Affect Disord. 2011;133:1-15.doi:10.1016/j.jad.2010.10.009\u003c/li\u003e\n \u003cli\u003eKim J-T, Shin D-K. A study based on the standardization of the STAI for Korea. New Med J. 1978;21:69-75\u003c/li\u003e\n \u003cli\u003eKim YK, Won SD, Lim HJ, Choi S-H, Lee SM, Shin YC, et al. Validation study of the Korean version of Edinburgh Postnatal Depression Scale (K-EPDS) J Kor Soc Dep Bip Disord. 2005;3:42-9\u003c/li\u003e\n \u003cli\u003eSung H-M, Kim J-B, Park Y-N, Bai D-S, Lee S-H, Ahn H-N. A study on the reliability and the valiadity of Korean version of the Beck Depression Inventory-II. J Korean Soc Biol Ther Psychiatry. 2008;14:201-12\u003c/li\u003e\n \u003cli\u003ePark S-J, Choi H-R, Choi J-H, Kim K, Hong JP. Reliability and validity of the Korean version of the Patient Health Questionnaire-9 (PHQ-9). Anxiety Mood. 2010;6:119-24\u003c/li\u003e\n \u003cli\u003eKim SH, Jung S, Park K, Eunju J, Lee S-H, Choi Y, et al. Development of the Korean screening tool for anxiety disorders: Review of current anxiety scales and development of preliminary item pools. Korean J Clin Psychol. 2016;35:630-44.doi:10.15842/kjcp.2016.35.3.004\u003c/li\u003e\n \u003cli\u003eAhn JK, Kim Y, Choi KH. The psychometric properties and clinical utility of the Korean version of GAD-7 and GAD-2. Front Psychiatry. 2019;10:127.doi:10.3389/fpsyt.2019.00127\u003c/li\u003e\n \u003cli\u003eLee H-K, Lee E-H, Hwang S-T, Hong S-H, Kim J-H. Psychometric properties of the Beck Anxiety Inventory in the community-dwelling sample of Korean adults. Korean J Clin Psychol. 2016;35:822-30.doi:10.15842/kjcp.2016.35.4.010\u003c/li\u003e\n \u003cli\u003eOh S, Min K, Park D. A comparison of normal, depressed and anxious groups: A study on the standardization of the hospital anxiety and depressed scale for Koreans. J Korean Neuropsychiatr Assoc. 1999;38:289-96\u003c/li\u003e\n \u003cli\u003eLee S, Oh S-T, Ryu SY, Jun JY, Lee K, Lee E, et al. Validation of the Korean version of Center for Epidemiologic Studies Depression Scale-Revised (K-CESD-R). Korean J Psychosom Med. 2016;24:83-93\u003c/li\u003e\n \u003cli\u003eFigueiredo B, Conde A. Anxiety and depression symptoms in women and men from early pregnancy to 3-months postpartum: Parity differences and effects. J Affect Disord. 2011;132:146-57.doi:10.1016/j.jad.2011.02.007\u003c/li\u003e\n \u003cli\u003eBeck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: Psychometric properties. J Consult Clin Psychol. 1988;56:893-7\u003c/li\u003e\n \u003cli\u003eACOG Committee Opinion No. 757 Summary: Screening for Perinatal Depression. Obstet Gynecol. 2018;132:1314-6.doi:10.1097/AOG.0000000000002928\u003c/li\u003e\n \u003cli\u003eKim Y-K, Hur J-W, Kim K-H, Oh K-S, Shin Y-C. Clinical application of Korean version of Edinburgh Postnatal Depression Scale. J Korean Neuropsychiatr Assoc. 2008;47:36-44\u003c/li\u003e\n \u003cli\u003eSchatz DB, Hsiao M-C, Liu C-Y. Antenatal depression in East Asia: A review of the literature. Psychiatry Investig. 2012;9.doi:10.4306/pi.2012.9.2.111\u003c/li\u003e\n \u003cli\u003eGelaye B, Rondon MB, Araya R, Williams MA. Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries. Lancet Psychiatry. 2016;3:973-82.doi:10.1016/s2215-0366(16)30284-x\u003c/li\u003e\n \u003cli\u003eWoody CA, Ferrari AJ, Siskind DJ, Whiteford HA, Harris MG. A systematic review and meta-regression of the prevalence and incidence of perinatal depression. J Affect Disord. 2017;219:86-92.doi:10.1016/j.jad.2017.05.003\u003c/li\u003e\n \u003cli\u003eNakić Rado\u0026scaron; S, Tadinac M, Herman R. Anxiety during pregnancy and postpartum: Course, predictors and comorbidity with postpartum depression. Acta Clinica Croatica. 2018;57:39-51.doi:10.20471/acc.2018.57.01.05\u003c/li\u003e\n \u003cli\u003eChoi H, Kwak DW, Kim MH, Lee SY, Chung JH, Han YJ, et al. The Korean Pregnancy Outcome Study (KPOS): Study design and participants. J Epidemiol. 2021;31:392-400.doi:10.2188/jea.JE20200055\u003c/li\u003e\n \u003cli\u003eAl-Abri K, Edge D, Armitage CJ. Prevalence and correlates of perinatal depression. Soc Psychiatry Psychiatr Epidemiol. 2023;58:1581-90.doi:10.1007/s00127-022-02386-9\u003c/li\u003e\n \u003cli\u003eFiala A, \u0026Scaron;vancara J, Kl\u0026aacute;nov\u0026aacute; J, Ka\u0026scaron;p\u0026aacute;rek T. Sociodemographic and delivery risk factors for developing postpartum depression in a sample of 3233 mothers from the Czech ELSPAC study. BMC Psychiatry. 2017;17:104.doi:10.1186/s12888-017-1261-y\u003c/li\u003e\n \u003cli\u003eLee AM, Lam SK, Sze Mun Lau SM, Chong CSY, Chui HW, Fong DYT. Prevalence, course, and risk factors for antenatal anxiety and depression. Obstet Gynecol. 2007;110:1102-12\u003c/li\u003e\n \u003cli\u003eGavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression: A systematic review of prevalence and incidence. Obstet Gynecol. 2005;106:1071-83\u003c/li\u003e\n \u003cli\u003eFigueiredo B, Conde A. Anxiety and depression in women and men from early pregnancy to 3-months postpartum. Arch Womens Ment Health. 2011;14:247-55.doi:10.1007/s00737-011-0217-3\u003c/li\u003e\n \u003cli\u003eGlover V. Maternal depression, anxiety and stress during pregnancy and child outcome; what needs to be done. Best Pract Res Clin Obstet Gynaecol. 2014;28:25-35.doi:10.1016/j.bpobgyn.2013.08.017\u003c/li\u003e\n \u003cli\u003eField T. Prenatal depression effects on early development: A review. Infant Behav Dev. 2011;34:1-14.doi:10.1016/j.infbeh.2010.09.008\u003c/li\u003e\n \u003cli\u003eAsselmann E, Kunas SL, Wittchen HU, Martini J. Maternal personality, social support, and changes in depressive, anxiety, and stress symptoms during pregnancy and after delivery: A prospective-longitudinal study. PLOS One. 2020;15:e0237609.doi:10.1371/journal.pone.0237609\u003c/li\u003e\n \u003cli\u003eTan PC, Zaidi SN, Azmi N, Omar SZ, Khong SY. Depression, anxiety, stress and hyperemesis gravidarum: Temporal and case controlled correlates. PLOS One. 2014;9:e92036.doi:10.1371/journal.pone.0092036\u003c/li\u003e\n \u003cli\u003eAlsaeed JK, Zayed AM, Buhassan ZH, Alhadrami SH, Naguib Y, Husni M. Hyperthyroidism masking depression and panic disorder symptoms during pregnancy: A case report. Cureus. 2023;15:e50582.doi:10.7759/cureus.50582\u003c/li\u003e\n \u003cli\u003eBasraon S, Costantine MM. Mood disorders in pregnant women with thyroid dysfunction. Clin Obstet Gynecol. 2011;54:506-14\u003c/li\u003e\n \u003cli\u003eRubertsson C, Waldenstr\u0026ouml;m U, Wickberg B. Depressive mood in early pregnancy: Prevalence and women at risk in a national Swedish sample. J Reprod Infant Psychol. 2003;21:113-23.doi:10.1080/0264683031000124073\u003c/li\u003e\n \u003cli\u003eBergner A, Beyer R, Klapp BF, Rauchfuss M. Pregnancy after early pregnancy loss: A prospective study of anxiety, depressive symptomatology and coping. J Psychosom Obstet Gynaecol. 2008;29:105-13.doi: 10.1080/01674820701687521\u003c/li\u003e\n \u003cli\u003eLee DTS, Chung TKH. Postnatal depression: An update. Best Pract Res Clin Obstet Gynaecol. 2007;21:183-91.doi:10.1016/j.bpobgyn.2006.10.003\u003c/li\u003e\n \u003cli\u003eYoun JH, Jeong IS. Predictors of postpartum depression: Prospective cohort study. J Korean Acad Nurs. 2013;43:225-35.doi:10.4040/jkan.2013.43.2.225\u003c/li\u003e\n \u003cli\u003eZhao X-H, Zhang Z-H. Risk factors for postpartum depression: An evidence-based systematic review of systematic reviews and meta-analyses. Asian J Psychiatry. 2020;53.doi:10.1016/j.ajp.2020.102353\u003c/li\u003e\n \u003cli\u003eAmerican College of Obstetricians and Gynecologists. ACOG clinical practice guideline no. 4: Treatment and management of mental health conditions during pregnancy and postpartum. Obstet Gynecol. 2023;141:1262-88.doi:10.1097/AOG.0000000000005202\u003c/li\u003e\n \u003cli\u003eNational Institute for Health and Care Excellence. Antenatal and postnatal mental health: Clinical management and service guidance. 2014;\u003c/li\u003e\n \u003cli\u003eHorakova A, Nemcova H, Hrdlickova K, Kalli S, Davletova A, Duarte M, et al. State of perinatal mental health care in the WHO region of Europe: A scoping review. Front Psychiatry. 2024;15:1350036.doi:10.3389/fpsyt.2024.1350036\u003c/li\u003e\n \u003cli\u003eHahn D-W, Lee C-H, Chon K-K. Korean adaptation of Spielberger\u0026apos;s STAI (K-STAI). Korean J Health Psychol. 1996;1:1-14\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Anxiety, Beck Anxiety Inventory, Depression, Edinburgh Postnatal Depression Scale, Mental health, Postpartum Period, Pregnancy","lastPublishedDoi":"10.21203/rs.3.rs-6525083/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6525083/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003ePerinatal mental health is a serious concern, as anxiety and depression affect both mothers and newborns. Nonetheless, only few studies have investigated the changes in symptom patterns across all pregnancy stages and during the postpartum period. This study aimed to assess anxiety and depression at each stage of pregnancy and during postpartum and to identify trimester-specific risk factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003ePregnant and postpartum women who visited the Department of Obstetrics and Gynecology at Jeju National University Hospital from December 2021 to January 2023 were evaluated. Anxiety and depression were assessed using the Korean versions of the Beck Anxiety Inventory and Edinburgh Postnatal Depression Scale. Participants were categorized into first, second, and third trimesters and postpartum.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eA total of 445 women were included in the study. During pregnancy, 33.2% and 17.9% of the participants screened positive for anxiety and depression, respectively, at least once. During the postpartum period, 23.6% and 22.9% screened positive for anxiety and depression, respectively. The highest positivity rates for both conditions were observed during the first trimester of pregnancy. Significant risk factors for anxiety and depression in the perinatal period were unemployment, antiemetic drug use, history of thyroid disease, history of miscarriage, preterm premature rupture of membranes, neonatal intensive care unit admission, and adverse neonatal outcomes, including low birth weight.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThis study highlights the importance of early recognition of mental health risks during pregnancy to enable early intervention and support for affected individuals.\u003c/p\u003e","manuscriptTitle":"Perinatal mental health across different trimesters of pregnancy and during the postpartum period: trends and risk factors for anxiety and depression","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-02 12:31:03","doi":"10.21203/rs.3.rs-6525083/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3b07e656-3fe0-460c-bda9-0118022bce36","owner":[],"postedDate":"June 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-25T08:53:44+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-02 12:31:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6525083","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6525083","identity":"rs-6525083","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}