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Preconception Mental Health Predicts Pregnancy Complications and Adverse Birth Outcomes: A National Population-Based Study

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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.

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Acknowledgments

We would like to acknowledge the generous funding that supported this research. WPW received funding from the University of Wisconsin Institute for Research on Poverty. LEW was supported by a grant from the Graduate School of the University of Wisconsin, Madison (PI: Witt) and a pre-doctoral NRSA Training Grant (T32 HS00083; PI: Smith). EWH was supported by NIH (T32 HD049302; PI: Sarto). We would also like to acknowledge the members of the Lifecourse Epidemiology and Family Health (LEAF) Lab (PI: Witt) for their review of the paper. We would also like to thank the anonymous reviewers for their helpful comments and suggestions.

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Correspondence to Whitney P. Witt.

Appendices

Appendix 1

See Table 4.

Table 4 Appendix 1 Characteristics of sample by live birth and multivariable analysis of the odds of non-live birth (including abortions)

Appendix 2

See Table 5.

Table 5 Appendix 2 Polychotomous multivariable analysis of the odds of high birth weight (≥4,000 g)

Appendix 3

See Fig. 3.

Fig. 3
figure 3

Adjusted predicted probabilities of obstetric outcomes for all explanatory variables

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Witt, W.P., Wisk, L.E., Cheng, E.R. et al. Preconception Mental Health Predicts Pregnancy Complications and Adverse Birth Outcomes: A National Population-Based Study. Matern Child Health J 16, 1525–1541 (2012). https://doi.org/10.1007/s10995-011-0916-4

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