Trajectories of perinatal depression, anxiety, perceived stress, sleep quality, and psychological flexibility from pregnancy to six months postpartum and their relationship with the number of abortions and deliveries

Abstract

Perinatal psychological distress is common and longitudinally heterogeneous, yet little is known about how obstetric history shapes symptom trajectories. We identified trajectories of depressive symptoms, perceived stress, sleep quality, psychological flexibility, and anxiety from early pregnancy to 24 weeks postpartum and examined their associations with the number of previous abortions and deliveries. In this prospective longitudinal cohort study, 254 pregnant women were recruited at 13 weeks of gestation from a tertiary hospital in China and assessed eight times through 24 weeks postpartum using the EPDS, CPSS, PSQI, CompACT, and GAD-7. Group-based trajectory modeling identified latent trajectory classes. Logistic regression examined associations with obstetric history, adjusting for sociodemographic covariates. Three trajectories emerged for depressive symptoms (low-stable, 38.98%; mild-stable, 47.24%; moderate-increasing, 13.78%), perceived stress (low-stable, 31.89%; moderate-increasing, 16.54%; high-stable, 51.57%), and sleep quality (good-stable, 50.00%; mild-worsening, 38.58%; persistent poor, 11.42%); two emerged for psychological flexibility (continuously declining vs high-stable) and anxiety (low-stable, 93.70%; moderate, 6.30%). Compared with women without abortion history, those with two or more abortions had higher odds of mild-stable (OR = 5.14) and moderate-increasing depression (OR = 19.12), mild-worsening (OR = 3.06) and persistent poor sleep (OR = 5.51), and declining psychological flexibility (OR = 2.61); one abortion was associated with increased stress (OR = 2.54 and 2.16) and moderate anxiety (OR = 4.18). Number of deliveries was not associated with any trajectory. Previous abortions predict adverse perinatal psychological trajectories in a dose-dependent manner. Routine assessment of abortion history at the first prenatal visit could help target early screening and tailored interventions.