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Abbreviations: EFA -Exploratory Factor Analysis, CFA – Confirmatory Factor Analysis

Table-2: Number of domains and description of included scales developed on pregnant women

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Response Format and Rating Scales

All scale articles were found to be self-report scales. 23 scales are rating scales (4 to 7 points scales), whereas 3 scales did not mention their types.

Domains of the Scale:

The factors were spread from unidimensional to 8 dimensions. The number of scale domains are subdivided into 7 categories. 2 scales (7.69%) reported 8 domains, 1 scale (3.84) 6 domains, 4 scales

(15.38%) 5 domains, 8 scales (30.76) 4 domains, 5 sales (19.23%) 3 domains, 4 scales (15.38%) 2 domains, and only 2 scales (15.38%) reported unidimensional.

Country of Study:

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The 3 scale studies (11.53%) are conducted in two countries(USA and India). 2 scale studies conducted in five countries (UK, Netherlands, Japan, Iran, and Turkey) and 1 scale studies conducted in 10 countries (Canada, Australia, Czech, Bangladesh, Korea, Malaysia, Sri Lanka, Saudi Arab, Korea, and Pakistan).

Specific Issues Covered by Scales:

Six (6) scales emphasise on pregnancy related anxiety (23.7%), 6 scales on maternal stress (23.7%), 3 scales on quality of life (11.53%), 2 scales on depression (7.69%), 2 scales on women empowerment (7.69%) and one scale deals on family support (3.84%), self-evaluation (3.84%), awareness (3.84%), body understanding (3.84%), social capital (3.84%), pregnancy experience (3.84%), and pre- post bonding (3.84%). The maximum number of scales are developed to deal the issues like anxiety and stress.

Discussion:

Development of psychological health scales are designed to assess a particular construct and get it valuable and relevant for specific culture. Many scales are validated on various languages and country specific samples. It is a well-known phenomenon that the pregnancy period is crucial for both mother and her baby. Biaggi et al (2016) wrote that psychosocial stressor and hormonal changes trigger mental health. Untreated mental health issues could have an adverse effect on mother and baby. Initially, the objective of this study was to find out the published scales on pregnant women and examine its psychometric properties. These scales provide 12 specific mental health areas and tightly adhere to issues like anxiety, stress, depression, fear, family support, body understanding, social capital, women empowerment, bonding, and pregnancy experience.

Psychometric Properties of the Scale

The findings indicate that the number of scales developed during last decade increased comparatively to the earlier decades. These elevated numbers justify the awareness and consciousness of societies towards maternal mental health globally. Out of these scales, a wide range of sample size have been used. It ranged between sample size 20 (Jonnah et al 2025) to 1144 (Huizink et al 2016) pregnant women. The scale items are ranged between 5 to 70 items. Pre and post bonding scale are reported 5 items (Cuijilts et al2016), and questionnaire for measuring pregnancy anxiety, sleep quality, knowledge level, and birth readiness mentioned 70 items (Jonnah et al 2025). All scales are recognized as self-reported and diverse rating point scales like 3-point scale to 7-point scale. Most scales used a 4 and 5-point rating point scale. Apart from that, 24 scales reported internal consistency Cronbach alpha, 12 scales mentioned exploratory and confirmatory factor analysis, 7 scale studies performed only exploratory factor analysis. To screen mental health issue, cut off scores to determine the severity of issues, 5 scales, 2 scales for depression (Aydogan Gedik S et al, 2015; Kitamur et al 2025), 2 scales or anxiety (Bayrampour et al 2023; Somerville et al 2014), and 1 scale related to self-evaluation (Afulani et al, 2021) are mentioned area under curve sensitivity and specificity. Besides these, variety of statistics to achieve psychometric properties are performed in scales like content validity (3 scales), construct validity (5 scales), concurrent validity (4 scales), cross cultural validity (1 scale), convergent validity (4 scales), divergent and criterion validity (2 scales), and finally 2 scales used multidimensional scaling.

Domains of Published Scales:

The published scales prominently emphasise on anxiety, stress, quality of life, depression, etc. Out of these scales, 6 scales concentrated on anxiety, 6 scales on stress, 3 scales on quality of life and others on specific area such as self-evaluation, social capital, pregnancy experience, bonding, and family support. If we take a glance, in the last one decade 2016-2025 four scales are included whereas 2 scales in the second decade 2005-2014. Anxiety scales assess various conditions of anxiety like self-related, family related,

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society related and others of pregnancy specific concerns. Jonnah et al (2024) mentioned in his scale about general anxiety, sleep quality, knowledge level anxiety and birth readiness. Durat et al (2018) extracted a domain motherhood constellation. Apart from that, self-centred fear, fear of childbirth, fear of change (Purkhajuee et al 2016), concerned about appearance (Huinzik et al 2016), acute anxiety and adjustment. General worry, specific fear, perfectionism, control and trauma (Somerville et al 2014) are mentioned in these scales. Moreover, family level anxiety issues are concentrated to birth process, baby health and wellbeing, during pregnancy wellbeing, postpartum issues, marital relationship, and worries about bearing a handicapper child (Bayrampour et al 2023; Durat et al 2018; Pukhajuee et al 2026; Huinzik et al 2016). Societal level anxiety in pregnant women can be seen towards career, finance, and support (Bayrampour et al, 2023), social anxiety (Somerville et al 2014). There are various concern areas explored by respective authors which originate from various cultural and different settings. Jannah et al (2024) extracted a domain of knowledge level in his scale, whereas birth readiness and support (Bayrampour et al, 2023), control and trauma (Somerville et al, 2014) domains are classified into other domains. Nevertheless, extracted and identified domains in anxiety scales represent culture and region-specific anxiety issues.

The second objective of the study was to examine the number of domains included in the study. Most of the scales included stress scale on pregnant women. The number of domains is ranged from 2 -8, identified as general and specific stress. General stress reflects non targeted concern experience during pregnancy such as daily coping, general health or social environment. General stress is discovered in scales as general pregnancy stress, relationship strain (Frazier et al 2018), stress related to physical and psychological changes, coping in daily life, health of mother and baby, maternal role, family support health care services, social atmosphere and work life reconciliation (Kin et al 2018), general health, confinement and delivery (Pop et al 2011). On the other hand, specific stress is known as concern about perceived social support, pregnancy specific concern, intimate partner relationship, financial concern. Another domain identified as specific stress is pregnancy related, hospital provider related, work related, spouse related (Diversee et al 2018), concern about baby and birth, physical symptoms, body image, emotional and relationship (Kazi et al 2009).

Two scales are contained to assess depression. A recent scale developed by Aydogan depression screening scale assesses 4 domains namely low energy, pessimism, worthlessness-guilt, depressed mood (Aydogan Gedik et al 2025). Whereas, another published scale is mental health screening questionnaire compass five domains i.e., antenatal depression, tokophobia, fetal bonding disorder, suicidality, and emesis (Kitamur et al 2025). Furthermore, three scales comprise quality of life. Out of the three, two scales assess quality of life of pregnant women, and specific quality of life questionnaire for physiological pregnancy characterized with four domains. First one is exposed to 4 domains i.e., physical activities of daily living, social and psychological (Yogeshwar al 2025). However, a specific quality of life scale pointed out 4 domains, physical, psychological, social relationship and environmental (Vachova et al 2013). The third scale that measures quality of life in pregnancy scaly extracted five domains perception of general satisfaction, emotional domains, physical domains, social support system, and social domains (Esraoze et al 2024). Overall, except one or two domains, mostly assess the same domains. Two empowerment scales for pregnant women are included, first is pregnant women empowerment scale designed with five extracted domains i.e., self-efficacy, self-esteem, future image, support and assurance from others, joy of an addition to the family (Kameda et al 2008). The second scale is developed by Borghei et al (2016) extracted domains for Iranian pregnant women empowerment with three domains educational empowerment, autonomy and socio-political.

The rest of the seven included scales measure scattered areas in the welfare of pregnant women and their mental health. So, these scales are not categorized specifically. These scales cover the specific context like interoceptive awareness, self-evolution, family support, social capital, body understanding, bonding and pregnancy experience. In recent years, multidimensional assessment of interoceptive awareness scale developed in 2025 with 8 domains namely noticing, not distracting, not worrying, attention regulation, emotional awareness, self-regulation, body listening, and trusting. (Crossland et al 2025).

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Afulani et al (2021) developed Prenatal Care Scale for people of colour, and identified three domains dignity and respect, communication and autonomy, responsive and supportive care. In addition, developed scale extracted unidimensional scale of family support for newly pregnant women (Uuddin et al 2021), 4 domains i.e., structural bonding, structural bridging, social contribution and cognitive boding in social capital assessment tool in pregnancy maternal health (Agampodi et al 2019), 3 domains related to appearance, weight, and physical in body understanding measure for pregnancy scale (Kirk et al 2019). Unidimensional scale of pre- and post-natal bonding scale (Cuijlits et al 2016), and in last 2 domains uplifts and hassles in pregnancy experience scale brief version.

Conclusion:

Psychometric properties and scale domains are the most important subject matter of any measurement scale. This study reviews the published scale development articles with terms of inclusion and exclusion criteria. In addition, current decade (2016 to 2015) is more concentrated to development of maternal mental health scales globally with more than 12 domains of anxiety, depression, maternal stress, and pregnancy experience, prenatal care, family support, body understanding, women empowerment, bonding, quality of life and social capital with robust psychometric properties. This comprehensive review on a developed scale provides a platform to investigators working in the field of women mental health. Classified domains in self, family social and occupation level encompasses the actual scene of pregnancy period and support to investigators study concepts during respective period.

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