Mandala Coloring in Late Pregnancy

Anxiety, depression and poor sleep are common in the last months of pregnancy and often occur together. Medication options during pregnancy are limited, so simple, safe non-drug methods are needed. Mandala coloring is an art therapy technique in which a person colors circular patterns; it helps focus attention on the present moment and may have a calming effect. This randomized controlled trial will examine whether mandala coloring during the third trimester reduces depression, anxiety and stress, improves sleep, and reduces fear of childbirth. It will also look at birth outcomes and the childbirth experience. Pregnant women at 28 weeks of gestation who attend the obstetrics outpatient clinics of Malatya Training and Research Hospital will be randomly assigned to a mandala coloring group or a control group. Women in the mandala group will color two mandalas a week at home for 8 weeks (16 mandalas in total, about 20-30 minutes per session). Women in the control group will receive routine antenatal care only and will be offered the mandala materials after the study ends.

Inclusion Criteria: * • Presenting to the Obstetrics and Gynecology Outpatient Clinics of Malatya Training and Research Hospital * Being in the 28th week of gestation * Being 18 years of age or older * Having a singleton, low-risk (healthy) pregnancy * Being able to understand and speak Turkish and being literate * Agreeing to participate in the study voluntarily * Having no physical limitation preventing mandala coloring (being able to use hand and arm movements) Exclusion Criteria: * Having a diagnosed psychiatric disorder or currently using psychotropic medication * Having a diagnosed sleep disorder or currently using sleep medication * Having a visual or cognitive impairment that prevents mandala coloring or completing the questionnaires * Currently participating in another psychological, art-based or mind-body program (e.g., art therapy, yoga, meditation, mindfulness) * Having a diagnosed pregnancy complication (e.g., preeclampsia, gestational diabetes, placenta previa, threatened preterm labor) at enrollment Withdrawal Criteria: * Developing a pregnancy complication requiring hospitalization or giving birth before the posttest assessment * Using any pharmacological or non-pharmacological method for anxiety, depression or sleep problems during the study * Not completing at least 75% of the coloring sessions (12 of 16) in the intervention group * Withdrawing consent at any time