A Guided Mobile-Based Perinatal Mindfulness Intervention

Psychological Distress Clinical Trial

Official title:

A Guided Mobile-Based Perinatal Mindfulness Intervention - A Randomized Control Trial

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT04876014
• Other study ID #: 17603520
• Status: Active, not recruiting
• Phase: N/A
• Start date: January 1, 2021
• Est. completion date: June 30, 2023

Study information

• Verified date: May 2021
• Source: The University of Hong Kong
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Psychological distress commonly occurs among women during perinatal period. maternal psychological distress can also bring negative influence on neonatal outcomes, such as infant health, child development or mother-child interaction. Hence, developing interventions to improve mental wellbeing during this period is vital. Mindfulness based intervention (MBI) was found effective in reducing psychological distress. Most currently, delivering MBIs via internet, which is more accessible and inexpensive, shows promising positive effect in reducing psychological distress. However, randomized control trial with sufficient power is await to further confirm the positive effect among pregnant women. Moreover, the positive effects of MBIs was found associated with the heart rate variability biofeedback. However, the efficacy of MBI on HRV is rarely studied among pregnant women. Also, the potential association of HRV between MBI and psychological wellbeing needs further examination. This research aims to test the effectiveness of the Guided-Mobile Based Perinatal Mindfulness Intervention (GMBPMI) among pregnant women experiencing psychological distress during the pre and post-natal period, as well as examining the efficacy of GMBPMI on HRV.

Description:

BACKGROUND Being pregnant, giving birth and turning into a mother are three closely intertwined major life transitions that a woman would experience within a short period of time. This period is often clouded by intense distress due to dramatic physical and psychosocial changes. In Hong Kong, a highly competitive and work-intense society, women face pressures on all fronts. Hong Kong ranks among the fifth with the oldest first-time mother in the world. Pregnancy at an older age is a known risk factor for antenatal depression. Women's labor force participation rate in Hong Kong is high - 84.1% in the 20-39 age group. The difficulty of balancing work and life is amplified when a woman is pregnant. The adverse consequences of stress are broad and far-reaching, shaping obstetric and neonatal outcomes, including increased analgesic use and unplanned cesarean delivery, preterm delivery, low birth weight and Apgar scores, smaller head circumference and major congenital anomalies. Research started to reveal that the disrupting maternal cardiovascular system in pregnant women with elevated psychological distress, indexed by low heart rate variability (HRV), might be a mechanism for the worsening of birth outcomes. However, the finding is not conclusive. In the recent decade, empirical research supporting the efficacy of prenatal mindfulness-based interventions (MBI) has emerged. MBI cultivates abilities that are important to pregnant women and new mothers, such as savoring, self-acceptance and psychological flexibility. In Hong Kong, the investigators developed and evaluated a cultural-sensitive MBI - Eastern-Based Meditation Intervention (EBMI) for pregnant women. The intervention not only showed significantly positive effects on prenatal distress coping and salivary cortisol reduction, but also associated with positive infant outcomes, including a higher cord blood cortisol level at birth and a less difficult temperament. Higher cord blood cortisol levels are believed to protect against the development of neonatal health abnormalities. While the efficacy of prenatal MBI has been revealed in the past decade, the availability and usage of the programme remain low for various practical reasons. Moreover, providing only a limited number of lessons, mostly in the second trimester, seems insufficient. It is highly desirable to provide extended support so as to ensure continued mindfulness practice in both pre and postnatal period. Considering the predicaments of pregnant woman/new mother, a guided mobile-based MBI appears to be more feasible than the traditional face-to-face mode. Grounded on EBMI, the investigators developed and satisfactorily piloted a guided mobile-based perinatal mindfulness intervention (GMBPMI). OBJECTIVE and DESIGN The project aims to rigorously evaluate GMBPMI. The research adopts a parallel-armed, randomized controlled trial design. To control for confounding effects, such as attention and placebo effect, the trial will utilize an active control group. Participants in the control group will receive psychoeducation on perinatal care mimic the schedule and level of support of the experimental group.The target sample size is 198. Pregnant women in the second trimester will be recruited to the program. With the support of a trained research assistant (RA), participants can take the 6 weekly EBMI lessons online flexibly at home. The RA will provide continued prompt and support for mindfulness practice to each participant till 5 weeks postpartum. The RA is backed up by the PI and co-I's who are experienced mental health practitioners and mindfulness teachers. One of them is an experienced obstetrics and gynaecology specialist. EXPECTED OUTCOME In Hong Kong, around 50,000 newborn babies are delivered each year. To meet the service needs of this scale, it is imperative for us to develop a cost-effective, accessible and acceptable intervention, tailored to the predicaments of women during the perinatal period. To address the barrier and cost issues, a guided mobile-based perinatal mindfulness intervention appears to be a good choice. If the model is shown to be effective, it can be a practical solution to a large scale mental health issue - benefiting women significantly during pregnancy, as well as enhancing the subsequent mental health outcomes of these women and the well-being of their babies.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 198
• Est. completion date: June 30, 2023
• Est. primary completion date: June 30, 2022
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: Female
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Adult age 18 or above
• Pregnant Chinese women in their 2nd trimester

Exclusion Criteria:

• Not able to understand Chinese (the intervention will be delivered in Chinese)
• High-risk pregnancy status (e.g., preterm labor, placental abnormality, multiple gestations, required bed rest, or morbid obesity)
• Current psychiatric disorders that necessitated priority attention (e.g., schizoaffective disorder, bipolar disorder, or current psychosis; organic mental disorder or pervasive developmental delay; current substance abuse or dependence; imminent suicide or homicide risk)

Related Conditions & MeSH terms

• Mental Health Wellness 1
• Psychological Distress

Intervention

Other:
• Guided Mobile-Based Perinatal Mindfulness Intervention
GMBPMI includes 6 EBMI lessons in 6 weeks, and it will require the participants to do mindfulness practice for about 30-60 minutes daily. The project RA will send prompt and guidance for daily mindfulness practice to each participant through social media platform. The RA will be available online to support, and will initiate chat every week throughout the whole intervention period. The chats will focus on participants' experiences or difficulties of mindfulness practice.

Locations

Country	Name	City	State
Hong Kong	The University of Hong Kong	Hong Kong

Sponsors (1)

Lead Sponsor	Collaborator
The University of Hong Kong

Country where clinical trial is conducted

Hong Kong, 

References & Publications (60)

Alder J, Fink N, Bitzer J, Hösli I, Holzgreve W. Depression and anxiety during pregnancy: a risk factor for obstetric, fetal and neonatal outcome? A critical review of the literature. J Matern Fetal Neonatal Med. 2007 Mar;20(3):189-209. Review. — View Citation

Alderdice F, Lynn F. Factor structure of the Prenatal Distress Questionnaire. Midwifery. 2011 Aug;27(4):553-9. doi: 10.1016/j.midw.2010.05.003. Epub 2010 Sep 15. — View Citation

Andrews G, Cuijpers P, Craske MG, McEvoy P, Titov N. Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis. PLoS One. 2010 Oct 13;5(10):e13196. doi: 10.1371/journal.pone.0013196. — View Citation

Bonacquisti A, Cohen MJ, Schiller CE. Acceptance and commitment therapy for perinatal mood and anxiety disorders: development of an inpatient group intervention. Arch Womens Ment Health. 2017 Oct;20(5):645-654. doi: 10.1007/s00737-017-0735-8. Epub 2017 Jun 10. Review. — View Citation

Boyd, N. G., Lewin, J. E., & Sager, J. K. (2009). A model of stress and coping and their influence on individual and organizational outcomes. Journal of Vocational Behavior, 75(2), 197-211.

Braeken MA, Jones A, Otte RA, Nyklícek I, Van den Bergh BR. Potential benefits of mindfulness during pregnancy on maternal autonomic nervous system function and infant development. Psychophysiology. 2017 Feb;54(2):279-288. doi: 10.1111/psyp.12782. Epub 2016 Nov 7. — View Citation

Byatt N, Biebel K, Friedman L, Debordes-Jackson G, Ziedonis D, Pbert L. Patient's views on depression care in obstetric settings: how do they compare to the views of perinatal health care professionals? Gen Hosp Psychiatry. 2013 Nov-Dec;35(6):598-604. doi: 10.1016/j.genhosppsych.2013.07.011. Epub 2013 Aug 19. — View Citation

Carlson LE, Speca M, Faris P, Patel KD. One year pre-post intervention follow-up of psychological, immune, endocrine and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer outpatients. Brain Behav Immun. 2007 Nov;21(8):1038-49. Epub 2007 May 22. — View Citation

Carver CS, Connor-Smith J. Personality and coping. Annu Rev Psychol. 2010;61:679-704. doi: 10.1146/annurev.psych.093008.100352. Review. — View Citation

Chan KP. Prenatal meditation influences infant behaviors. Infant Behav Dev. 2014 Nov;37(4):556-61. doi: 10.1016/j.infbeh.2014.06.011. Epub 2014 Jul 24. — View Citation

Chan, K. P. (2015). Effects of perinatal meditation on pregnant Chinese women in Hong Kong: a randomized controlled trial. Journal of Nursing Education and Practice, 5(1), 1.

Chan, K. P. (2016). Perceptions and experiences of pregnant Chinese women in Hong Kong on prenatal meditation: A qualitative study. Journal of Nursing Education and Practice, 6(3), 135.

Collins NL, Dunkel-Schetter C, Lobel M, Scrimshaw SC. Social support in pregnancy: psychosocial correlates of birth outcomes and postpartum depression. J Pers Soc Psychol. 1993 Dec;65(6):1243-58. — View Citation

Dewe, P., & Cooper, C. L. (2007). Coping research and measurement in the context of work related stress. International review of industrial and organizational psychology, 22, 141.

Dunkel Schetter C. Psychological science on pregnancy: stress processes, biopsychosocial models, and emerging research issues. Annu Rev Psychol. 2011;62:531-58. doi: 10.1146/annurev.psych.031809.130727. Review. — View Citation

Ecklund-Flores L, Myers MM, Monk C, Perez A, Odendaal HJ, Fifer WP. Maternal depression during pregnancy is associated with increased birth weight in term infants. Dev Psychobiol. 2017 Apr;59(3):314-323. doi: 10.1002/dev.21496. — View Citation

Female age-related fertility decline. Committee Opinion No. 589. Obstet Gynecol. 2014 Mar;123(3):719-721. doi: 10.1097/01.AOG.0000444440.96486.61. Review. — View Citation

Field T, Diego M, Hernandez-Reif M. Prenatal depression effects on the fetus and newborn: a review. Infant Behav Dev. 2006 Jul;29(3):445-55. Epub 2006 May 30. Review. — View Citation

Folkman S. The case for positive emotions in the stress process. Anxiety Stress Coping. 2008 Jan;21(1):3-14. Review. — View Citation

Goodman JH, Tyer-Viola L. Detection, treatment, and referral of perinatal depression and anxiety by obstetrical providers. J Womens Health (Larchmt). 2010 Mar;19(3):477-90. doi: 10.1089/jwh.2008.1352. — View Citation

Goodman WB, Crouter AC; The Family Life Project Key Investigators. Longitudinal Associations between Maternal Work Stress, Negative Work-Family Spillover, and Depressive Symptoms. Fam Relat. 2009 Jul 1;58(3):245-258. — View Citation

Guardino CM, Schetter CD. Coping during pregnancy: a systematic review and recommendations. Health Psychol Rev. 2014;8(1):70-94. Epub 2014 Jan 8. Review. — View Citation

Halbreich U. The association between pregnancy processes, preterm delivery, low birth weight, and postpartum depressions--the need for interdisciplinary integration. Am J Obstet Gynecol. 2005 Oct;193(4):1312-22. Review. — View Citation

Hong Kong Census and Statistics Department. (2019, Aug 15). Hong Kong Monthly Digest of Statistics. Retrieved from: https://www.statistics.gov.hk/pub/B10100022018MM09B0100.pdf

Hou J, Wong SY, Lo HH, Mak WW, Ma HS. Validation of a Chinese version of the Five Facet Mindfulness Questionnaire in Hong Kong and development of a short form. Assessment. 2014 Jun;21(3):363-71. doi: 10.1177/1073191113485121. Epub 2013 Apr 16. — View Citation

Howard LM, Piot P, Stein A. No health without perinatal mental health. Lancet. 2014 Nov 15;384(9956):1723-4. doi: 10.1016/S0140-6736(14)62040-7. Epub 2014 Nov 14. — View Citation

Hughes A, Williams M, Bardacke N, Duncan LG, Dimidjian S, Goodman SH. Mindfulness approaches to childbirth and parenting. Br J Midwifery. 2009 Oct 1;17(10):630-635. — View Citation

Isgut M, Smith AK, Reimann ES, Kucuk O, Ryan J. The impact of psychological distress during pregnancy on the developing fetus: biological mechanisms and the potential benefits of mindfulness interventions. J Perinat Med. 2017 Dec 20;45(9):999-1011. doi: 10.1515/jpm-2016-0189. Review. — View Citation

Kingston D, Austin MP, Heaman M, McDonald S, Lasiuk G, Sword W, Giallo R, Hegadoren K, Vermeyden L, van Zanten SV, Kingston J, Jarema K, Biringer A. Barriers and facilitators of mental health screening in pregnancy. J Affect Disord. 2015 Nov 1;186:350-7. doi: 10.1016/j.jad.2015.06.029. Epub 2015 Jul 29. — View Citation

Lacaille, J., Sadikaj, G., Nishioka, M., Flanders, J., & Knäuper, B. (2015). Measuring mindful responding in daily life: Validation of the Daily Mindful Responding Scale (DMRS). Mindfulness, 6(6), 1422-1436.

Lau Y, Keung DW. Correlates of depressive symptomatology during the second trimester of pregnancy among Hong Kong Chinese. Soc Sci Med. 2007 May;64(9):1802-11. Epub 2007 Feb 21. — View Citation

Lau Y. The effect of maternal stress and health-related quality of life on birth outcomes among Macao Chinese pregnant women. J Perinat Neonatal Nurs. 2013 Jan-Mar;27(1):14-24. doi: 10.1097/JPN.0b013e31824473b9. — View Citation

Lee DT, Ngai IS, Ng MM, Lok IH, Yip AS, Chung TK. Antenatal taboos among Chinese women in Hong Kong. Midwifery. 2009 Apr;25(2):104-13. Epub 2007 Apr 3. — View Citation

Lee DT, Yip SK, Chiu HF, Leung TY, Chan KP, Chau IO, Leung HC, Chung TK. Detecting postnatal depression in Chinese women. Validation of the Chinese version of the Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1998 May;172:433-7. — View Citation

Leung SS, Lee AM, Chiang VC, Lam SK, Kuen YW, Wong DF. Culturally sensitive, preventive antenatal group cognitive-behavioural therapy for Chinese women with depression. Int J Nurs Pract. 2013 Feb;19 Suppl 1:28-37. doi: 10.1111/ijn.12021. — View Citation

Lever Taylor B, Cavanagh K, Strauss C. The Effectiveness of Mindfulness-Based Interventions in the Perinatal Period: A Systematic Review and Meta-Analysis. PLoS One. 2016 May 16;11(5):e0155720. doi: 10.1371/journal.pone.0155720. eCollection 2016. Review. — View Citation

Lo HH, Ng SM, Chan CL, Lam KF, Lau BH. The Chinese medicine construct "stagnation" in mind-body connection mediates the effects of mindfulness training on depression and anxiety. Complement Ther Med. 2013 Aug;21(4):348-57. doi: 10.1016/j.ctim.2013.05.008. Epub 2013 Jun 25. — View Citation

Lobel, M., Yali, A. M., Zhu, W., DeVincent, C., & Meyer, B. (2002). Beneficial associations between optimistic disposition and emotional distress in high-risk pregnancy. Psychology and health, 17(1), 77-95.

Marcus SM. Depression during pregnancy: rates, risks and consequences--Motherisk Update 2008. Can J Clin Pharmacol. 2009 Winter;16(1):e15-22. Epub 2009 Jan 22. Review. — View Citation

Marteau TM, Bekker H. The development of a six-item short-form of the state scale of the Spielberger State-Trait Anxiety Inventory (STAI). Br J Clin Psychol. 1992 Sep;31(3):301-6. Erratum in: Br J Clin Psychol. 2020 Jun;59(2):276. — View Citation

Martini J, Knappe S, Beesdo-Baum K, Lieb R, Wittchen HU. Anxiety disorders before birth and self-perceived distress during pregnancy: associations with maternal depression and obstetric, neonatal and early childhood outcomes. Early Hum Dev. 2010 May;86(5):305-10. doi: 10.1016/j.earlhumdev.2010.04.004. Epub 2010 May 23. — View Citation

Ng SM, Fong TC, Tsui EY, Au-Yeung FS, Law SK. Validation of the Chinese version of Underwood's Daily Spiritual Experience Scale--transcending cultural boundaries? Int J Behav Med. 2009;16(2):91-7. doi: 10.1007/s12529-009-9045-5. Epub 2009 Mar 17. — View Citation

Ng SM, Fong TC, Wang XL, Wang YJ. Confirmatory factor analysis of the stagnation scale--a traditional Chinese medicine construct operationalized for mental health practice. Int J Behav Med. 2012 Jun;19(2):228-33. doi: 10.1007/s12529-011-9146-9. — View Citation

Ng SM, Yau JK, Chan CL, Chan CH, Ho DY. The measurement of body-mind-spirit well-being toward multidimensionality and transcultural applicability. Soc Work Health Care. 2005;41(1):33-52. — View Citation

Ng SM. Validation of the 10-item Chinese perceived stress scale in elderly service workers: one-factor versus two-factor structure. BMC Psychol. 2013 Jun 19;1(1):9. doi: 10.1186/2050-7283-1-9. eCollection 2013. — View Citation

Ng, S. M., Chan, C. L., Ho, D. Y., Wong, Y. Y., & Ho, R. T. (2006). Stagnation as a distinct clinical syndrome: comparing 'Yu'(stagnation) in traditional Chinese medicine with depression. British Journal of Social Work, 36(3), 467-484.

Nyklícek I, Truijens SEM, Spek V, Pop VJM. Mindfulness skills during pregnancy: Prospective associations with mother's mood and neonatal birth weight. J Psychosom Res. 2018 Apr;107:14-19. doi: 10.1016/j.jpsychores.2018.01.012. Epub 2018 Feb 4. — View Citation

Porges SW. The polyvagal perspective. Biol Psychol. 2007 Feb;74(2):116-43. Epub 2006 Oct 16. Review. — View Citation

Räisänen S, Lehto SM, Nielsen HS, Gissler M, Kramer MR, Heinonen S. Risk factors for and perinatal outcomes of major depression during pregnancy: a population-based analysis during 2002-2010 in Finland. BMJ Open. 2014 Nov 14;4(11):e004883. doi: 10.1136/bmjopen-2014-004883. — View Citation

Shea AK, Kamath MV, Fleming A, Streiner DL, Redmond K, Steiner M. The effect of depression on heart rate variability during pregnancy. A naturalistic study. Clin Auton Res. 2008 Aug;18(4):203-12. doi: 10.1007/s10286-008-0480-1. Epub 2008 Jun 30. — View Citation

Shearer, A., Hunt, M., Chowdhury, M., & Nicol, L. (2016). Effects of a brief mindfulness meditation intervention on student stress and heart rate variability. International Journal of Stress Management, 23(2), 232.

Siu BW, Leung SS, Ip P, Hung SF, O'Hara MW. Antenatal risk factors for postnatal depression: a prospective study of Chinese women at maternal and child health centres. BMC Psychiatry. 2012 Mar 22;12:22. doi: 10.1186/1471-244X-12-22. — View Citation

Spijkerman MP, Pots WT, Bohlmeijer ET. Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials. Clin Psychol Rev. 2016 Apr;45:102-14. doi: 10.1016/j.cpr.2016.03.009. Epub 2016 Apr 1. Review. — View Citation

Tsuda H, Kotani T, Sumigama S, Mano Y, Nakano T, Hua L, Kikkawa F. Relationship between the cortisol levels in umbilical cord blood and neonatal RDS/TTN in twin pregnancies. J Matern Fetal Neonatal Med. 2016;29(13):2151-6. doi: 10.3109/14767058.2015.1077510. Epub 2015 Sep 15. — View Citation

Underwood LG, Teresi JA. The daily spiritual experience scale: development, theoretical description, reliability, exploratory factor analysis, and preliminary construct validity using health-related data. Ann Behav Med. 2002 Winter;24(1):22-33. — View Citation

van den Heuvel MI, Donkers FC, Winkler I, Otte RA, Van den Bergh BR. Maternal mindfulness and anxiety during pregnancy affect infants' neural responses to sounds. Soc Cogn Affect Neurosci. 2015 Mar;10(3):453-60. doi: 10.1093/scan/nsu075. Epub 2014 Jun 12. — View Citation

van den Heuvel MI, Johannes MA, Henrichs J, Van den Bergh BR. Maternal mindfulness during pregnancy and infant socio-emotional development and temperament: the mediating role of maternal anxiety. Early Hum Dev. 2015 Feb;91(2):103-8. doi: 10.1016/j.earlhumdev.2014.12.003. Epub 2015 Jan 8. — View Citation

Woolhouse H, Brown S, Krastev A, Perlen S, Gunn J. Seeking help for anxiety and depression after childbirth: results of the Maternal Health Study. Arch Womens Ment Health. 2009 Apr;12(2):75-83. doi: 10.1007/s00737-009-0049-6. Epub 2009 Feb 13. — View Citation

Zeng Y, Cui Y, Li J. Prevalence and predictors of antenatal depressive symptoms among Chinese women in their third trimester: a cross-sectional survey. BMC Psychiatry. 2015 Apr 2;15:66. doi: 10.1186/s12888-015-0452-7. — View Citation

Zhang JY, Cui YX, Zhou YQ, Li YL. Effects of mindfulness-based stress reduction on prenatal stress, anxiety and depression. Psychol Health Med. 2019 Jan;24(1):51-58. doi: 10.1080/13548506.2018.1468028. Epub 2018 Apr 26. — View Citation

* Note: There are 60 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Clinical outcomes-Obstetric outcomes	Obstetric outcomes includes a list of 6 questions collecting information about participant's gestational age at birth, pregnancy complications, mode of birth. They are fact data without scoring.	5 weeks postpartum
Other	Clinical outcomes-Neonatal outcomes	Neonatal outcomes includes a list of 4 questions collecting information about infant's birth weight, head circumference, months of maturity, and APGAR score.They are fact information without scoring.	5 weeks postpartum
Other	Individual factors-Socio-demographic	Socio-demographic includes age, gender, marital status, family income, employment, education, gestational age, parity, obstetric history, medical history, and pre-pregnancy BMI. No scoring system.	Baseline (Day 0)
Other	Individual factors-Social Support('change' is being assessed)	Social support is measured by Prenatal Social Support - 4 items. The minimum and maximum values range from 1 to 4, with higher score represents higher level of social support the participant has experienced.	Change from baseline Social Support at post intervention (8 weeks) and 36-week gestation.
Primary	Maternal psychological stress-General Stress ('change' is being assessed)	General stress will be measured by Perceived Stress Scale -10. The minimum and maximum values for each item is 1 to 4 with lower score represents lower stress.	Change from baseline General Stress at post intervention (8 weeks), 36-week gestation and 5-week postpartum.
Primary	Maternal psychological stress-Pregnancy specific stress('change' is being assessed)	Pregnancy specific stress will be measured by Prenatal Distress Questionnaire-12. The minimum and maximum values for each item is 0 to 4, with lower score represents lower stress.	Change from baseline Pregnancy specific stress at post intervention (8 weeks) and 36-week gestation.
Primary	Maternal psychological stress-Depression('change' is being assessed)	Depression is measured by Edinburgh Postnatal Depression Scale-Chinese-10. The minimum and maximum values are 1 to 4, with higher score represents higher depressive symptoms.	Change from baseline Depression at post intervention (8 weeks), 36-week gestation and 5-week postpartum.
Primary	Mindfulness-State mindfulness('change' is being assessed)	State mindfulness is measured bu Short-form Five Facet Mindfulness Questionnaire-Chinese-20 items. The minimum and maximum values are 0 to 4, with higher score represents higher state of mindfulness.	Change from baseline State MIndfulness at post intervention (8 weeks), 36-week gestation and 5-week postpartum.
Primary	Mindfulness-Daily mindfulness('change' is being assessed)	Daily mindfulness is measured by Daily Mindful Responding Scale - 4 items. The minimum and maximum values are 0 to 10, with higher score represents higher state of mindfulness.	Weekly changes from baseline Daily Mindfulness at 5-week postpartum.
Primary	Positive appraisal-Coping('change' is being assessed)	Coping is measured by Prenatal Coping Inventory - 22 items. The minimum and maximum values are 0 to 4, with higher score represents higher coping frequency.	Change from baseline Coping at post intervention (8 weeks) and 36-week gestation.
Primary	Heart rate variability('change' is being assessed)	HRV score, with higher score represents higher physical and mental condition for the day.	Change from baseline HRV at post intervention (8 weeks), 36-week gestation and 5-week postpartum.
Secondary	Psychological Well-being- Anxiety('change' is being assessed)	Anxiety is measured by Short-form State subscale of the State-Trait Anxiety Inventory - 6 items. The minimum and maximum values range from 0 to 4, with higher score represents higher anxiety level.	Change from baseline Anxiety at post intervention (8 weeks), 36-week gestation and 5-week postpartum.
Secondary	Psychological Well-being- Affect('change' is being assessed)	Affect is measured by Positive & Negative Affect Subscales of Body-Mind-Spirit Well-being Inventory 9 and 10 items. The minimum and maximum values range from 0 to 10, with higher score represents higher higher frequency of experiencing particular affect.	Change from baseline Affect at post intervention (8 weeks), 36-week gestation and 5-week postpartum.
Secondary	Psychological Well-being- Spirituality('change' is being assessed)	Spirituality is measured by Chinese Daily Spiritual Experience Sacle - 16 items. The minimum and maximum values range from 0 to 5, with higher score represents higher frequency of experiencing spirituality.	Change from baseline Spirituality at post intervention (8 weeks), 36-week gestation and 5-week postpartum.
Secondary	Physical well-being-Stagnation('change' is being assessed)	Stagnation is measured by Stagnation Scale - 16 items. The minimum and maximum values range from 0 to 10, with higher score represents higher stagnation level.	Change from baseline Stagnation at post intervention (8 weeks), 36-week gestation and 5-week postpartum.