Mental health in early pregnancy: Interplay of objectively measured lifestyles, gut microbiota, and metabolomics.

Prenatal anxiety symptoms (AS) and depression symptoms (DS) in early pregnancy substantially impact maternal-infant health, but their pathophysiological mechanisms remain unclear. We conducted a multimodal assessment of 161 early-pregnant women. DS exhibited significantly longer standing/sitting durations and shorter nocturnal sleep and nap times (p < 0.05). AS was associated with lower fiber intake (p = 0.018). AS and DS had more complex microbial co-occurrence networks with more extensive metabolomic changes. DS was characterized by dysregulated cysteine/methionine metabolism and Bifidobacterium-mediated modulation of standing/sleep effects. Machine learning achieved best DS discrimination by combining physical activity, diet, and microbiome data (AUC = 0.877), while metabolomics alone best discriminated AS (AUC = 0.844). In conclusion, AS is associated with metabolomic dysregulation and fiber deficiency, while DS is associated with sedentary behavior and microbiota-metabolite disruption. This study establishes a precision framework prioritizing fiber interventions for AS and activity/sleep modulation targeting microbiota-metabolite pathways for DS.