Evidence mapPaperPMID 42021189Full record

ArticleBMC pregnancy and childbirth2026

Depression, anxiety, and stress across the perinatal period: longitudinal trends and associations with adverse outcomes : Article Type: Original Paper.

Marija Žonjić, Vesna Mandić-Marković, Zorana Pavlović, Jelena Rakočević, Milica Mandić, Olivera Džatić Smiljković, Dragana Maglić, Jelena Mitrović, Nataša Maksimović, Aleksandra Nikolić

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Article in BMC pregnancy and childbirth, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

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10 authors.

Marija ŽonjićObstetrics and Gynecology Clinic "Narodni front", Belgrade, Republic of Serbia.ORCID http://orcid.org/0009-0003-8248-9451
Vesna Mandić-MarkovićObstetrics and Gynecology Clinic "Narodni front", Belgrade, Republic of Serbia.ORCID http://orcid.org/0000-0002-0005-8443
Zorana PavlovićFaculty of Medicine, University of Belgrade, Belgrade, Republic of Serbia.ORCID http://orcid.org/0009-0003-7636-306X
Jelena RakočevićInstitute of Histology and Embryology "Aleksandar Ð. Kostić", Faculty of Medicine, University of Belgrade, Belgrade, Republic of Serbia.ORCID http://orcid.org/0000-0001-8365-4840
Milica MandićObstetrics and Gynecology Clinic "Narodni front", Belgrade, Republic of Serbia.ORCID http://orcid.org/0009-0009-3560-0720
Olivera Džatić SmiljkovićObstetrics and Gynecology Clinic "Narodni front", Belgrade, Republic of Serbia.ORCID http://orcid.org/0009-0003-4271-9785
Dragana MaglićObstetrics and Gynecology Clinic "Narodni front", Belgrade, Republic of Serbia.ORCID http://orcid.org/0000-0003-4788-4707
Jelena MitrovićObstetrics and Gynecology Clinic "Narodni front", Belgrade, Republic of Serbia.
Nataša MaksimovićInstitute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Republic of Serbia.ORCID http://orcid.org/0000-0002-4397-2446
Aleksandra NikolićInstitute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Republic of Serbia. aleksandra.m.nikolic@med.bg.ac.rs.ORCID http://orcid.org/0000-0002-6714-4274

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDepression, anxiety, and stress are common during the perinatal period and may adversely affect maternal and neonatal outcomes. However, longitudinal data on their trajectories across pregnancy and the postpartum period, as well as their associations with adverse outcomes, remain limited.

aimTo assess the prevalence and longitudinal trends of depression, anxiety, and stress from the first trimester through three months postpartum and to examine their associations with adverse perinatal outcomes, along with sociodemographic and obstetric factors.

methodsThis prospective cohort study included 253 pregnant women followed from early pregnancy to three months postpartum at five time points. Psychological symptoms were assessed using the Depression, Anxiety and Stress Scale–21 (DASS-21). Longitudinal changes were analyzed using linear mixed-effects models. Associations with perinatal outcomes (cesarean delivery, postpartum hemorrhage, gestational diabetes mellitus, gestational hypertension, and selected neonatal outcomes) were examined using univariable and multivariable Firth penalized logistic regression.

resultsThe prevalence of clinically relevant depressive symptoms ranged from 4.5% to 9.9%, anxiety symptoms from 18.2% to 28.3%, and stress symptoms from 12.3% to 20.3% across the study period. Depressive symptoms remained relatively stable across the perinatal period. After correction for multiple testing, only anxiety showed a significant decline after childbirth, while no consistent significant changes were observed for stress. In multivariable analyses, cesarean delivery was associated with BMI ≥ 25 kg/m² and a history of obstetric complications, whereas no significant associations were found for postpartum hemorrhage, small for gestational age, or gestational diabetes.

conclusionsPerinatal psychological symptoms show distinct longitudinal patterns, with a decline in anxiety after childbirth. Most associations with adverse outcomes were not statistically significant or were imprecise. Larger multicenter studies are needed to clarify these relationships.

Indexed as

AnxietyDepressionPregnancy ComplicationsStress, PsychologicalAdultCesarean SectionDiabetes, GestationalFemaleHumansHypertension, Pregnancy-InducedLongitudinal StudiesPostpartum HemorrhagePostpartum PeriodPregnancyPregnancy OutcomePrevalenceAnxietyDepressionLongitudinal cohort studyPerinatal mental healthPregnancy outcomesStress

Identifiers

PMID42021189
PMCPMC13235039

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.