Preconception mental health predicts pregnancy complications and adverse birth outcomes: a national population-based study

Abstract

Pregnancy complications and poor birth outcomes can affect the survival and long-term health of children. The preconception period represents an opportunity to intervene and improve outcomes; however little is known about women's mental health prior to pregnancy as a predictor of such outcomes. We sought to determine if and to what extent women's preconception mental health status impacted subsequent pregnancy complications, non-live birth, and birth weight using a nationally representative, population-based sample. We used pooled 1996-2006 data from the nationally-representative Medical Expenditure Panel Survey (MEPS). Poor preconception mental health was defined as women's global mental health rating of "fair" or "poor" before conception. Logistic regression was used to assess the association between preconception mental health and pregnancy complications, non-live birth, and having a low birth weight baby within the follow up period. Poor preconception mental health was associated with increased odds of experiencing any pregnancy complication (AOR 1.40, 95% CI: 1.02-1.92), having a non-live birth (AOR 1.48, 95% CI: 0.96-2.27), and having a low birth weight baby (AOR 1.99, 95% CI: 1.00-3.98), all controlling for maternal age, race/ethnicity, marital status, education, health insurance status, income, and number of children in the household. Significant racial and ethnic disparities exist for pregnancy complications and non-live births, but not for low birth weight. Women's preconception mental health is a modifiable risk factor that stands to reduce the incidence of adverse pregnancy complications and birth outcomes.

Fig. 1. Conceptual framework of the preconception determinants of ddverse obstetric outcomes

Figure 1 displays the conceptual framework that informs our work by combining Misra and colleagues’ framework of perinatal health, a life course developmental perspective, and a model of health determinants. As the perinatal framework posits that perinatal health and associated outcomes are influenced by cumulative effects of events across the lifespan and intergenerational effects, we display the trajectory of the maternal experience in this framework. The far left box represents distal determinants (including genetic, physical environment, social environment, and life events) that can impact outcomes through more proximal preconception determinants including behavior, physiology, and psychology, represented by the boxes within the circle. Specifically, our model illustrates that poor preconception mental health may increase the risk for several obstetric outcomes (far right box), while accounting for individual-level risk factors.

Fig. 2. Adjusted predicted probabilities of obstetric outcomes for main explanatory variables

Figure 2 displays the adjusted average predicted probabilities of each of the three outcomes (any complication, non-live birth, and LBW, respectively) with respect to the main explanatory variables, controlling for maternal age, marital status, education, insurance, income, and the number of children in the household. The dashed lines on the chart represent the weighted prevalence estimates for each outcome. Delta method standard errors of the probabilities were used to construct 95% confidence intervals, which are represented by the vertical bars. Graphical depiction of the predicted probabilities of each outcome for all independent variables may be found in Appendix 3.