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<sec> <title>BACKGROUND</title> Mental health disorders such as anxiety and depression are common among individuals of child-bearing age. Such disorders can affect pregnancy and postpartum well-being. This study aims to study the impact of prenatal mental health on the pregnancy journey, and highlights the utility of mobile health technologies like PowerMom for symptom tracking and screening. </sec> <sec> <title>OBJECTIVE</title> We collected data in a decentralized digital trial using the PowerMom platform to investigate to the impact of maternal mental health throughout pregnancy. The goal was to understand how anxiety and depression influence pregnancy-related symptoms, pregnancy outcomes, and postpartum well-being. </sec> <sec> <title>METHODS</title> Survey data were collected via PowerMom, a bilingual mobile research platform that integrates patient-reported outcomes, wearable data, and electronic health records. Participants were divided into two cohorts: those who reported receiving treatment for anxiety or depression during pregnancy (n=571) and those who reported not receiving treatment (n=1505). We compared self-reported symptoms, pre-pregnancy conditions, complications from past pregnancies, delivery outcomes, and postpartum mental health between cohorts, using Fisher’s exact test and the Kruskal-Wallis test for statistical analysis. </sec> <sec> <title>RESULTS</title> Participants receiving treatment for anxiety or depression reported higher instances of physical symptoms compared to those untreated, with significant differences for 13 symptoms including fatigue (80.2% vs. 65.4%, adjusted p<0.001), nausea and/or vomiting (69.7% vs. 52.7%, adjusted p<0.001), and stomach cramping and/or abdominal pain (64.0% vs. 50.4%, adjusted p<0.001). Participants receiving treatment also had higher prevalence of several conditions prior to pregnancy than those not receiving treatment with significant differences noted in 4 out of 10 conditions: endometriosis (14.0% vs. 8.8%, adjusted p=0.007), hypertension (10.9% vs. 3.9%, adjusted p<0.001), eating disorder (7.7% vs. 3.1%, adjusted p<0.001), and heart disease (2.8% vs. 0.5%, adjusted p<0.001). Participants receiving treatment also reported higher prevalence of complications in past pregnancies than those not receiving treatment with significant differences noted in 2 out of 7 complications: high blood pressure (9.9% vs. 5.8%, adjusted p=0.016) and preeclampsia (9.2% vs. 5.5%, adjusted p=0.021). No significant differences were observed in mode of delivery, epidural use, stillbirth and miscarriage rates between the two cohorts. Postpartum, treated participants reported significantly higher mental health composite scores, indicating more severe mental health symptoms. A higher percentage of treated participants were at high risk for having perinatal mood disorder (45.8%), compared to untreated participants (18.4%, p<0.001). </sec> <sec> <title>CONCLUSIONS</title> The PowerMom platform demonstrated its value in facilitating remote, scalable data collection for maternal mental health research. Pregnant individuals reporting treatment for anxiety or depression experienced more physical symptoms and worse postpartum mental health outcomes than untreated individuals. These findings underscore the potential for mobile health technologies to support future interventional studies aimed at improving maternal mental health outcomes during pregnancy. </sec>