Associations Between Mental Health Conditions and Adverse Pregnancy Outcomes Among Active-Duty Servicewomen

Active-duty servicewomen (ADSW) are at increased risk for mental health conditions compared to civilian women. Research suggests women with mental health conditions experience serious pregnancy complications at rates 50% higher than those without mental health conditions; yet research in military populations is limited.

To explore associations between mental health conditions and adverse pregnancy outcomes among ADSW.

Department of Defence data were used to identify a cohort of live birth pregnancies among ADSW that started and ended between October 2016 and December 2021. Mental health conditions diagnosed in the year prior to or during pregnancy (trauma/stressor-related disorders, anxiety/panic, depression, eating disorders and suicidal ideation/attempt) and adverse pregnancy outcomes (hypertensive disorders of pregnancy, gestational diabetes, peripartum cardiomyopathy, postpartum haemorrhage and preterm birth) were identified using ICD-10-CM codes. Mental health conditions were assessed as any diagnosis or none, and as a count of comorbid diagnoses (1, 2 or 3+). Modified Poisson regression models estimated adjusted risk ratios (RR) with 95% confidence intervals (CI) to quantify associations of mental health diagnoses with adverse pregnancy outcomes, overall and stratified by demographic characteristics.

Overall, 62,729 deliveries among 54,471 ADSW were included. Deliveries among ADSW with diagnosed mental health conditions relative to those with none demonstrated increased risk for adverse pregnancy outcomes (RR 1.07, 95% CI 1.04, 1.11). Deliveries among ADSW with 3+ mental health conditions had the highest risk for an adverse pregnancy outcome (RR 1.17, 95% CI 1.10, 1.25). Individually, mental health conditions were associated with increased risk of preterm birth (RR 1.18, 95% CI 1.10, 1.26) and gestational diabetes (RR 1.14, 95% CI 1.06, 1.22).

This study highlights the increased risk for adverse pregnancy outcomes among ADSW with mental health conditions. Enhanced screening and subsequent treatment of these mental health diagnoses can be a mechanism to decrease adverse pregnancy outcomes.