Trait mindfulness in early pregnancy and adverse perinatal outcomes: a prospective cohort study

Mindfulness centered therapy has been shown to improve perinatal mental health outcomes. There is emerging evidence that mindfulness training (MT) can also be harnessed to improve somatic outcomes. Yet, little is known about which perinatal populations might benefit the most from mindfulness training interventions. We aimed to evaluate the association between trait mindfulness and adverse pregnancy outcomes.

This is a planned secondary analysis of a prospective cohort study of nulliparous participants recruited between May 2019 and February 2022 from a single, high volume tertiary care center. Participants completed the validated Mindfulness and Attentive Awareness Scale prior to 20 weeks gestation. Trained research staff abstracted pregnancy and delivery data. The primary outcome was unplanned cesarean delivery (CD). Secondary outcomes included gestational diabetes, hypertensive disorders of pregnancy and a neonatal morbidity composite. We examined outcomes by mindfulness quartile (Q), adjusting for covariates determined a priori.

Of the 281 participants with full outcome data, 47.9% experienced one or more of the adverse perinatal outcomes and the median trait mindfulness score was 4.6 (IQR 3.9-5.3). After adjusting for potential confounders, there were significantly lower rates of CD rates in those in Q2 and Q3 compared to Q4 (adjusted odds ratio [aOR] Q2 0.42, 95% confidence interval [CI] 0.20 - 0.87, Q3 aOR 0.23, 95% CI 0.10-0.51). There were no differences in rates of gestational diabetes, hypertension or composite neonatal outcomes by trait mindfulness quartile.

In this prospective cohort of nulliparous people, those with trait mindfulness in the 2nd and 3rd quartiles had lower rates of CD. Given prior literature suggesting active MT decreases adverse outcomes, there may be a component of the active practice of mindfulness, rather than trait mindfulness levels, associated with improved outcomes.