De Novo Pain in Pregnancy: The Mediating Roles of Depression and Maternal‐Fetal Attachment in De Novo Chronic Pain

BACKGROUND: Chronic pain affects up to 30% of pregnant individuals globally and substantially impairs maternal well-being. The prevalence and contributing factors of de novo chronic pain in pregnancy (DNPAP) remain poorly studied, with previous chronic pain rarely distinguished from newly arising pain. We examined the prevalence and characteristics of DNPAP and its association with foetal and maternal factors, including dysmenorrhea, depressive symptoms and maternal-foetal attachment. METHODS: This cross-sectional study included 207 pregnant women between 30 and 34 weeks of gestation. Assessments comprised pain measures (Douleur Neuropathique-4, McGill Pain Questionnaire, Brief Pain Inventory and Pain Catastrophizing Scale) and maternal well-being measures (Edinburgh Postnatal Depression Scale, Maternal-Foetal Attachment Scale and Prenatal Psychosocial Profile). Women with DNPAP were compared with those without chronic pain to identify associated factors. RESULTS: De novo pain was reported by 20.7% of participants, with 59.6% describing it as moderate to severe. DNPAP was significantly associated with higher depressive symptoms, lower maternal-foetal attachment and a history of dysmenorrhea. Mediation analyses identified depressive symptoms as a key factor linking foetal malformations and gestational diseases to de novo pain. CONCLUSION: Depression, reduced maternal-foetal attachment and a history of dysmenorrhea were significantly associated with de novo pain during pregnancy. Depressive symptom severity mediated the relationship between foetal malformations or gestational diseases and DNPAP. Clear characterization of pregnancy-related pain can inform preventive and therapeutic strategies to improve maternal health outcomes. SIGNIFICANCE STATEMENT: This study is the first to report the prevalence of de novo chronic pain during pregnancy, which was found to be high affecting 20.7% of the pregnant women. De novo chronic pain in pregnancy is directly associated with depressive symptoms and is mediated by depressive symptoms in cases involving foetal malformation diagnosis and the presence of gestational diseases. A history of dysmenorrhea is significantly associated with the development of de novo chronic pain in pregnancy, suggesting potential shared underlying mechanisms that open possibilities for testing new early-detection, therapeutic, and prognostication approaches to pain across women's life-cycle.