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Objective: To assess the effect of a consumer-based mobile meditation application (app) on wellness in outpatient obstetric and gynecology patients during the coronavirus disease 2019 (COVID-19) pandemic., Methods: We conducted a randomized controlled trial at a university outpatient clinic of obstetric and gynecology patients during the COVID-19 pandemic. Women were randomly assigned to the intervention group, who was prescribed a mobile meditation app for 30 days, or the control group, which received standard care. The primary outcome was self-reported perceived stress. Secondary outcomes included self-reported depression, anxiety, sleep disturbance, and satisfaction with the meditation app. A sample size of 80 participants (40 per group) was calculated to achieve 84% power to detect a 3-point difference in the primary outcome., Results: From April to May 2020, 101 women were randomized in the study-50 in the meditation app group and 51 in the control group. Analysis was by intention-to-treat. Most characteristics were similar between groups. Perceived stress was significantly less in the intervention group at days 14 and 30 (mean difference 4.27, 95% CI 1.30-7.24, P=.005, d=0.69 and mean difference 4.28, 95% CI 1.68-6.88, P=.002, d=0.69, respectively). Self-reported depression and anxiety were significantly less in the intervention group at days 14 and 30 (depression: P=.002 and P=.04; anxiety: P=.01, and P=.04, respectively). Sleep disturbance was significantly less in the intervention group at days 14 and 30 (P=.001 and P=.02, respectively). More than 80% of those in the intervention group reported high satisfaction with the meditation app, and 93% reported that mindfulness meditation improved their stress., Conclusion: Outpatient obstetric and gynecology patients who used the prescribed consumer-based mobile meditation app during the COVID-19 pandemic had significant reductions in perceived stress, depression, anxiety, and sleep disturbance compared with standard care., Clinical Trial Registration: ClinicalTrials.gov, NCT04329533., Competing Interests: Financial Disclosure: Dr. Mourad reports conflict unrelated to this work with Applied Medical and Intuitive Surgical as a consultant. Dr. Huberty reports conflict related to this work as a consultant for Calm, Inc in the role of Director of Science and Director of Scientific Advisory Board. Dr. Huberty conducts investigator-initiated research that utilizes the Calm application, however, Calm, Inc does not financially support her research. Dr. Huberty is paid for her consultation on an as-needed basis, however, her role is to ensure the quality of Calm's science and she has no specific obligations to the company. Dr. Huberty receives no financial incentives (eg, stocks) related to the growth or success of the company. The other authors did not report any potential conflicts of interest., (Copyright © 2021 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: To describe the use of complementary approaches in pregnant women with a history of miscarriage and to investigate whether a miscarriage is associated with the use of complementary approaches during their pregnancy., Design: A cross-sectional survey was distributed to pregnant women residing in the United States (N=890)., Results: Women who had a history of miscarriage, were Caucasian, were college educated, reported a high income, had low depression scores, and had low anxiety scores (all P<0.001) were more likely to use complementary approaches. In pregnant women with a history of miscarriage (N=193), the most frequently reported complementary approaches used were prayer (22.3%), yoga (15%), massage (14.5%), chiropractic (13%), and meditation (11.4%). Finally, after adjustment for age, race, education, and income, the odds of using a complementary approach in women with a history of miscarriage was 1.8 (95% CI: 1.3, 2.5, P<0.001) as compared with women without a history of miscarriage (model 1). Associations persisted after additional adjustment for depression, anxiety, and stress; the odds of using a complementary approach in women with a history of miscarriage was 1.7 (95% CI: 1.2, 2.4, P<0.001) (model 2), compared with women without a history of miscarriage., Conclusions: Findings from this study may help inform future studies for pregnant women with a history of miscarriage and may also provide information about appropriate strategies in which health care providers can refer their patients., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Purpose: Promoting women's health during the interconception period is critical for the health of future pregnancies. Methods: This was a cross-sectional study to better understand interconception mental health and wellbeing using a convenience sample of women recruited on social media who completed an online survey. Results: Women who participated in the survey (N = 146) were 1 to 4 years since last pregnancy, primarily non-Hispanic White (81.2%), with an average age of 30 years (SD = 5.0; range = 19-47 years); 20% were insured by Medicaid. Depression, anxiety, stress, social support, mindfulness, and resilience were assessed. Approximately 22.9% reported depressive symptomatology, 18.8% symptoms of anxiety, 6.5% high stress, and 52.9% moderate stress. These patterns differed across years after giving birth, with percentages peaking for depressive symptoms during the first to second year (χ2 = 9.81, p = 0.007), and anxiety symptoms peaking after the third year (χ2 = 7.28, p = 0.026). Women reported moderate scores on wellbeing measures, with resilience scores decreasing as years since last pregnancy increased (F = 3.24, p = 0.042). Less than 25% reported that a provider discussed depressed mood during the interconception period. Clinical Implications: Our findings revealed high prevalence and temporal patterns of depressive and anxiety symptoms during the interconception period, identifying a need for nurses to continue to follow-up with their patients about mental health concerns well after the traditionally defined 1 year postpartum. Further investigation of women's mental health and wellbeing and their unique needs during the interconception period is warranted. Many new mothers experience anxiety and depression during postpartum. The Centers for Disease Control and Prevention estimates 1 in 8 women report symptoms of depression after giving birth and over 50% are not treated. In this study, women during postpartum and up to 4 years after giving birth were recruited using social media to particpate in a survey about their physical and mental health. Findings are similar to national prevalence data on postpartum depression and anxiety. Nursing care during postpartum must include screening for depression and appropriate referral and treatment when identifed. [ABSTRACT FROM AUTHOR]

Nearly 20% of women in the United States experience clinically significant depressive symptoms during pregnancy or the postpartum period. These women may benefit from easily accessible, nonpharmacologic, and inexpensive self‐management approaches, such as via internet and mobile‐based interventions, to prevent development of symptoms and/or intervene with current symptoms. This paper summarizes the research protocol of a nationally‐funded large‐scale randomized controlled study to evaluate "Mamma Mia," a self‐guided program with 44 modules that women use throughout pregnancy to 6 months postpartum. The program contains a novel combination of components designed to enable women to enhance self‐efficacy, emotional self‐regulation, and perceived social support. The overall goal of this three‐arm longitudinal randomized controlled trial is to evaluate the effects and mechanisms of this self‐management approach in diverse women in the U.S. (n = 1950). Enrolled pregnant women will be randomly assigned to one of three groups: (1) "Mamma Mia" alone, which is self‐guided; (2) "Mamma Mia Plus" in which participants engage in the "Mamma Mia" modules plus receive brief guided support from a registered nurse; or (3) usual prenatal/postpartum care. The first specific aim is to evaluate effects by group on the primary outcome of interest, depressive symptoms, over time. The second aim is to evaluate effects by group on subjective well‐being, anxiety, and stress. Using a conceptual framework based upon Individual and Family Self‐Management Theory, the third aim is to evaluate possible mediators (self‐efficacy, emotion self‐regulation, perceived support) and possible moderators (e.g., race/ethnicity, type of healthcare clinician) of this self‐management approach. [ABSTRACT FROM AUTHOR]

Introduction: Maternal depression is associated with numerous deleterious maternal and child health outcomes. Although there are several treatment options for prenatal depression, many depressed women remain untreated. This study tested the effects of a low-intensity online training module on providers' attitudes, beliefs, and management practices of prenatal depression across a diverse group of providers. Methods: Health care providers who were providing care to pregnant women completed a 64-item survey consisting of items from the Management of Maternal Depression Inventory. Upon completion of the survey, providers were randomized into the intervention or the active control arm (wait-listed). The intervention consisted of an online training, which targeted knowledge and skills related to providing guidance on prenatal mood disorders. Approximately 6 to 8 weeks after randomization, all providers completed the survey again, and a general linear model framework was used to test change from baseline. Results: The final sample was comprised 74 compliant providers (intervention arm: n = 41; control arm: n = 33). Providers in the intervention arm reported significant increases in the sense of responsibility and self-efficacy when compared with their counterparts in the active control arm (all P <.001). Providers in the intervention arm also reported an increase in satisfaction related to communication with mental health specialists when compared with their counterparts in the active control arm (P =.05). Discussion: Our findings suggest that a brief, online training improved the attitudes, confidence, and communication of diverse providers related to the management of prenatal depression. Provider online training may help encourage patient-provider dialogue and in turn, enhance the management of prenatal depression. [ABSTRACT FROM AUTHOR]

Objective To identify the psychosocial factors (i.e., stress, anxiety, depression, social support) that are associated with gestational weight gain (GWG) and the relationship of mindfulness with GWG during each trimester of pregnancy. Design In this cross-sectional study, an online survey that assessed physical and mental health and wellness practices was administered to pregnant women. Participants Pregnant women ≥8 weeks gestation, ≥18 years old, and could read and write in English. Measurement and findings Women who responded to the survey (N=1,073) were on average 28.7±4.6 years old. Findings from a regression analysis suggest that increased levels of depression may be predictive of increased GWG in the second trimester and decreased levels of mindfulness may be predictive of increased GWG in the first trimester. Anxiety, stress, and overall social support were not associated with GWG in any trimester. Key conclusions Mindfulness-based strategies (e.g., yoga) may have the potential to manage both depression and excessive GWG and may beneficial for and preferred by pregnant women. More research is warranted to determine clear relationships between psychosocial health, mindfulness, and GWG. Implications for practice Health care providers are encouraged to screen for depression in early pregnancy (i.e., first or second trimester) and provide resources to manage symptoms of depression and GWG to promote optimal birth outcomes. Health care providers may want to counsel patients on how to manage depression and/or GWG by suggesting mindfulness-based approaches. [ABSTRACT FROM AUTHOR]

Background: Little is known about how to best care for mothers after stillbirth. As such, this paper will report the satisfaction and perceptions of an online yoga intervention (12-week beta test) in women after stillbirth. Methods: Participants (n=74) had a stillbirth within the last 24-months (M time since loss 9.65 ± 6.9 months). Post-intervention satisfaction surveys and interviews and dropout surveys were conducted. Descriptive statistics were used to analyze survey responses and demographic information. A phenomenological approach was used to explore and understand unique experiences of participant interviews. Data were analyzed using NVivo10. Results: Twenty-six women (M age 33.73 ± 4.38) were completers (> 3 wks of yoga), 26 (M age 31.82 ± 4.13) were non-completers (< 3 wks of yoga), and 22 (M age 32.94 ± 2.93) dropped out. Twenty completers participated in a post-intervention satisfaction survey with 75% (n=15) reporting being very satisfied or satisfied with the online yoga intervention, found it to be very enjoyable or enjoyable, and very helpful or helpful to cope with grief. Satisfaction and perceptions of the intervention in those who completed an interview (n=12) were clustered around the following themes: benefits, barriers, dislikes, satisfaction, and preferences. Of the 22 dropouts, 14 completed a dropout survey. Women withdrew from the study due to pregnancy (n=3, 21%), burden (n=3, 21%), stress (n=2, 14%), lack of time (n=2, 14%), did not enjoy (n=1, 7%), and other (n=3, 21%). Conclusion: Findings here may be used to help design future research. [ABSTRACT FROM AUTHOR]

Depression affects up to 23% of pregnant women and is associated with adverse physical/mental health outcomes for both the mother and baby. Depressed pregnant women may be more likely to engage in unhealthy lifestyle behaviors that contribute to an increased risk for chronic disease. Little is known regarding depressed pregnant women’s perceptions, uses of, and interests in complementary health approaches. Study participants (mean age 28.7 ± 6.8; n = 1032) included pregnant women ≥8 weeks gestation who responded to a survey assessing physical and mental health and wellness practices. Of those completing the survey, depressed pregnant women (n = 272) had significantly higher levels of anxiety (P < .001) and stress (P < .001) and had poorer sleep quality (P < .001), mindfulness (P < .001), and social support (P < .001) compared to nondepressed pregnant women (n = 760). A majority (84%) of depressed pregnant women would consider using a complementary health approach for weight and/or stress management during pregnancy, and more than 50% were interested in yoga. [ABSTRACT FROM AUTHOR]

Objectives: women who have experienced miscarriage may be at increased risk for elevated depressive and anxiety symptoms in subsequent pregnancies. Exercise may be a useful strategy for coping with these symptoms. Little is known about how miscarriage influences prenatal exercise behavior. The study purpose was to examine the influences of miscarriage history and prepregnancy weight status on pregnant women's psychological health, exercise motivation, and behavior using the Theory of Planned Behavior. Participants/Setting: Pregnant women (N=203; 41 with prior miscarriage; 72 overweight/obese; BMI > 25.0) in the northeast United States. Design: Women prospectively reported their depressive/anxiety symptoms and exercise motivation/behavior in the 1st, 2nd, and 3rd trimesters via mailed surveys. Group differences in depressive/anxiety symptoms, exercise behavior, and its motivational determinants were examined using Chi Square analyses and Univariate and Multivariate Analyses of Covariance. Measurements and findings: Women with a history of miscarriage had higher 1st and 2nd trimester depressive/anxiety symptoms and lower 1st trimester attitudes about exercise and 1st and 2nd trimester perceived behavior control than women without a history of miscarriage. Overweight/obese women had higher 1st and 2nd trimester pregnancy depressive/anxiety symptoms, engaged in less prepregnancy exercise, and had lower levels of exercise intention, attitude, and perceived behavior control throughout pregnancy than normal weight women. Key Conclusions: Women with a history of miscarriage and overweight/obese women have poorer psychological health and lower motivation to exercise during pregnancy than women without a history of miscarriage and normal weight women. Implications for practitioners: Interventions and healthcare provider communications aimed at promoting perinatal exercise behavior and psychological health should take into account pre-pregnancy weight status and pregnancy history to identify strategies to help women, particularly overweight/obese women with a history of miscarriage, to overcome exercise barriers. [ABSTRACT FROM AUTHOR]

To review the evidence of the potential mechanisms (behavioral, psychological/emotional, and physical factors) of prenatal yoga for preventing excessive gestational weight gain (GWG) in pregnant women to guide future research. Prenatal yoga is a common form of physical activity during pregnancy and includes a combination of physical postures, breath control and meditation. This review theorizes how combining physical activity (i.e., prenatal yoga postures) with the add-ons brought by prenatal yoga (e.g., breath control, meditation), might provide a more comprehensive and effective strategy to prevent excessive GWG than physical activity alone. This article a) summarizes the literature on potential mechanisms of prenatal yoga to prevent excessive GWG specifically focusing on behavioral (diet, physical activity, and sleep), psychological/emotional (self-awareness, emotion regulation, stress, mood, mindfulness) and physical factors (pregnancy discomforts), b) highlights limitations of current studies, and c) provides suggestions for future research. The findings demonstrate there is insufficient evidence that prenatal yoga improves behavioral, psychological/emotional and physical factors in pregnant women and more research is needed. Though these factors have been more strongly linked to improved weight outcomes in non-pregnant populations, further testing in pregnant women is necessary to draw definitive conclusions for the efficacy of prenatal yoga to prevent excessive GWG. Effective strategies are needed to prevent excessive GWG to encourage optimal maternal and child health outcomes. More research is warranted to evaluate the impact of prenatal yoga on weight outcomes during pregnancy and design studies to test the proposed mechanisms discussed in this review. • Effective strategies to prevent EGWG are needed to promote maternal health outcomes. • There is insufficient evidence for prenatal yoga to prevent EGWG. • More research is needed to examine effects of prenatal yoga and EGWG. [ABSTRACT FROM AUTHOR]

To describe pregnant women's experiences and perceived facilitators/barriers of a prenatal yoga intervention to prevent excessive gestational weight gain (EGWG). Pregnant women (N = 13) were interviewed after participation in a 12-week prenatal yoga intervention to prevent EGWG. Interviews were summarized using thematic analysis. Twelve themes were identified and organized into four categories: 1) experiences of prenatal yoga (positive experience/enjoyment, pain relief, connecting to body), 2) prenatal yoga and weight (increased mindfulness/self-awareness, increased physical activity, weight management), 3) barriers to prenatal yoga (physical body, commute/traffic, schedule), and 4) facilitators of prenatal yoga (healthy pregnancy, support from other pregnant women, the feeling from prenatal yoga). Prenatal yoga may relieve pain and help women be more connected to their bodies. Prenatal yoga may also help women become more aware of their health behaviors and increases their physical activity which may have important implications for reducing EGWG. • Prenatal yoga may help women be more connected to their bodies. • Prenatal yoga may help women become more self-aware/mindful of health behaviors. • Women report prenatal yoga provides an opportunity to increase physical activity. [ABSTRACT FROM AUTHOR]