The trajectory of depressive and anxiety symptom networks across pregnancy: A large-scale longitudinal study of 41,140 women.

BACKGROUND

Depression and anxiety are highly comorbid during pregnancy, yet their symptom patterns may vary across gestational stages. Most existing studies rely on cross-sectional designs and overlook the dynamic interplay of symptoms over time. This study employs both cross-sectional and longitudinal network analyses to identify core and bridge symptoms and explore their temporal evolution throughout pregnancy.

METHODS

A total of 41,140 pregnant women in Shenzhen, China, were assessed between 2020 and 2022 during early, mid, and late pregnancy. Depressive and anxiety symptoms were measured using the nine-item Patient Health Questionnaire (PHQ-9) and the seven-item Generalized Anxiety Disorder Scale (GAD-7), respectively. Cross-sectional networks were constructed using graphical Gaussian models with regularization, while longitudinal relationships were analyzed via cross-lagged panel network models. Symptom centrality and bridge roles were examined, and network accuracy and stability were assessed through bootstrapping.

RESULTS

Across trimesters, core symptoms included excessive worry (GAD-A3), low energy (PHQ-D4), and anhedonia (PHQ-D1), with their prominence shifting over time. From early to mid-pregnancy, worthlessness (PHQ-D6) predicted anhedonia, while from mid to late pregnancy, anhedonia, worthlessness, and excessive worry had the strongest predictive effects. Cognitive rumination may underlie persistent worry and emotional distress, particularly in the context of unmet family support.

CONCLUSIONS

Antenatal depression and anxiety are marked by dynamic shifts in worry, fatigue, and loss of pleasure. Findings underscore the need for trimester-specific screening and culturally adaptive intervention frameworks that account for dynamic symptom evolution.