There have been inconsistent findings for an association between assisted reproductive technology (ART) and poorer perinatal emotional wellbeing. This study is to explore whether ART is associated with increased depression and depressive symptoms, anxiety symptoms and parenting stress, and poorer antenatal attachment, over the perinatal period from pregnancy to 12 months postpartum.

This study drew on data collected within an ongoing cohort from 806 women including 42 who had conceived using ART, and all recruited in early pregnancy and followed to 12 months postpartum. Measures included the Structured Clinical Interview for the DSM, Edinburgh Postnatal Depression Scale, State and Trait Anxiety Inventory, Maternal Antenatal Attachment Scale and Parenting Stress Index.

Women who conceived with ART were no more likely to be depressed. They had lower depressive and anxiety symptoms in early pregnancy, higher antenatal attachment and lower parenting stress. However, women who conceived with ART had a significant increase in depressive and anxiety symptoms in late pregnancy which reduced in the postpartum and showed a distinct pattern compared to those who conceived naturally.

This study found that women who conceived with ART did not have poorer emotional wellbeing across the perinatal period. However, in late pregnancy depressive and anxiety symptoms did rise and consideration of this clinically and in future research is warranted.

The course of depression is heterogeneous. The employed treatment is a key element in the impact of the course of depression over the time. However, there is currently a gap of knowledge about the trajectories per treatment and related baseline factors. We aimed to identify trajectories of depressive symptoms and associated baseline characteristics for two treatment arms in a randomized clinical trial: treatment as usual (TAU) or TAU plus transdiagnostic group cognitive behavioral therapy (TAU + TDG-CBT).

Growth mixture modeling (GMM) was used to identify trajectories of depressive symptoms over 12 months post-treatment. Logistic regression models were used to examine associations between baseline characteristics and trajectory class membership in 483 patients (TAU: 231; TAU + TDG-CBT: 251).

We identified different patterns of symptom change in the randomized groups: two trajectories in TAU (‘improvement’ (71.4%) and ‘no improvement’ (28.6%)), and four trajectories in TAU + TDG-CBT (‘recovery’ (69.8%), ‘late recovery’ (5.95%), ‘chronicity’ (4.77%), and ‘relapse’ (19.44%)). Higher baseline symptom severity and comorbidity were associated with poorer treatment outcomes in both treatment groups and worse emotional regulation strategies were linked to the ‘no improvement trajectory’ in TAU. The TAU + TDG-CBT group demonstrated greater symptom reduction compared to TAU alone.

There is heterogeneity in treatment outcomes. Integration of TDG-CBT with TAU significantly improves symptom reduction compared to TAU alone. Patients with higher baseline severity and comorbidities show poorer outcomes. Identification of trajectories and related factors could assist clinicians in tailoring treatment strategies to optimize outcomes, particularly for patients with a worse prognosis.