Evaluating Antenatal Bre-Lax Education for Perinatal Anxiety Reduction and Self-efficacy Among Pregnant Women in Karachi's Urban Slums: A Prospective, Randomized, Open-label, Blind Endpoint (PROBE) Trial

Introduction:

Pakistan is ranked fifth among the most populous countries with a total population of around 260 million in spite of a 77 years long history of family planning programs in the country. The year 2015 was the culminating year of the Millennium Development Goals (MDGs) for Pakistan as well as in other countries, yet the indicators for achieving MDGs 4 (reduce child mortality) and 5 (improve maternal health) have remained unfavorable. Moreover, the current sustainable development's goal (SDGs) has added additional responsibility on the country to improve indicators on population control in addition to the FP2030 vision and commitments.

Pregnancy is a significant milestone in a woman's life, bringing joy and expectation. However, it also comes with some challenges, as the body undergoes physical changes while emotional and psychological changes arise within the women. Despite all these changes, pregnancy is a transformative journey that prepares women for motherhood, making it both a beautiful and demanding experience . However, with the passage of time, there is rising recognition that pregnancy can also bring psychological challenges within the women. Women are increasingly seen as vulnerable towards the mental health issues like anxiety and depression. Acknowledging these challenges is crucial to providing the necessary support and care for pregnant women during this transformative period. It is seen that Depression and Anxiety are considering as common mental health issues during pregnancy, but recent research suggests that anxiety may be even more prevalent than depression. Emerging evidence indicates that expectant mothers are more likely to experience anxiety, highlighting the need for support for maternal mental health.

Pregnancy related anxiety is not only associated with the expected mother but also has a great influence on the prenatal environment. According to the Fetal Programming Hypothesis, a developing fetus is highly sensitive to its environment, especially during rapid growth stages. Factors like maternal anxiety can lead to physiological changes that affect the fetus critically. If these influences occur during crucial developmental stages, they may cause long-lasting effects in the baby's physical health and as well as in metabolism. Essentially, the conditions in the womb shape long-term health outcomes. This means that stress and other environmental factors during pregnancy don't just impact the mother but they can have lifelong effects on the child's body and as well as on its functions.

Pregnancy-related anxiety is strongly linked to various negative health outcomes for both the mother and baby. Studies consistently shows that high levels of anxiety during pregnancy can increase the risk of preterm birth, leading to possible complications for the newborn baby. It is seen that women are more vulnerable toward mental health disorders like Anxiety and Depression during the time period of prenatal period, which is closely associated with the health of the pregnant women and as well as the children. Children born to mothers who experience significant anxiety may face developmental delays as they grow. Anxiety can also negatively impact the childbirth process, contributing to prolonged labor and increasing the need for pain relief or sedation during delivery. These highlight the crucial role of maternal mental health in pregnancy. When a mother experiences high stress or anxiety, it can affect both the course of labor and the baby's early development. Understanding and addressing pregnancy-related anxiety is essential to improving birth outcomes and promoting healthier development in children.