JMIR Publications

ABSTRACT

Background:

Prenatal depression and anxiety have emerged as pressing global public health challenges. In the digital era, excessive smartphone use may exert complex effects on maternal mental health. Prior research has predominantly focused on adolescent populations; studies on pregnant women, particularly those differentiating total weekly screen time from exposure during critical circadian windows such as smartphone use after waking and duration of bedtime smartphone use, remain limited. Furthermore, the mediating role of sleep quality in these associations has yet to be systematically examined.

Objective:

To investigate the associations of smartphone addiction and time‑specific smartphone use with prenatal depression and anxiety, and to assess the mediating role of sleep quality in these associations.

Methods:

This cross-sectional observational study enrolled 537 pregnant women. Smartphone use characteristics, sleep quality, and prenatal depression and anxiety were assessed using the Smartphone Addiction Scale-Short Version (SAS-SV), objective total weekly smartphone screen time recorded by the device and self-reported duration of smartphone use after waking and duration of bedtime smartphone use, the Pittsburgh Sleep Quality Index (PSQI), the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7), respectively. Independent associations were examined using binary logistic regression, nonlinear dose–response relationships were explored with restricted cubic spline (RCS) models, and the mediating role of sleep quality was tested through mediation analysis.

Results:

The prevalence of moderate-to-severe prenatal depression and anxiety was 8.8% and 5.8%, respectively. After adjusting for covariates, smartphone addiction was significantly associated with increased risks of depression (OR=3.008, 95% CI: 1.538–6.150) and anxiety (OR=7.022, 95% CI: 2.775–20.985). Duration of smartphone use after waking ≥61 minutes and duration of bedtime smartphone use ≥91 minutes were also significantly associated with elevated risks of mood disorders. Restricted cubic spline (RCS) analyses further revealed distinct nonlinear patterns across different exposure dimensions: the dose-response curves for duration of smartphone use after waking with depression and anxiety risks displayed U-shaped and J-shaped patterns, respectively, while the curve for total weekly use with anxiety risk exhibited a U-shaped pattern. Mediation analyses indicated that sleep quality significantly mediated the associations of duration of bedtime smartphone use, total weekly use, and smartphone addiction with prenatal depression, with mediation proportions of 47.04%, 30.06%, and 31.28%, respectively. The anxiety model demonstrated highly consistent mediating pathways, with corresponding proportions of 37.00%, 26.23%, and 22.72%, all of which were statistically significant.

Conclusions:

Smartphone addiction and excessive use during high-risk periods after waking and bedtime were significantly associated with elevated risks of prenatal depression and anxiety, with sleep quality serving as an important mediating pathway. Precisely targeting pathological addiction and screen exposure during these periods, together with protecting sleep health, may offer greater clinical value than simply restricting total screen time.