Maternal age and psychological well-being in early pregnancy: a cross-sectional analysis

Psychological well-being in early pregnancy may differ by maternal age and by sociodemographic, economic, and reproductive circumstances. This study examined the associations of maternal age and other participant characteristics with screen-positive anxiety symptoms, screen-positive depressive symptoms, perceived stress, and composite psychological distress during the first trimester.

A total of 1,282 women attending routine antenatal care at 10-12 weeks of gestation were included. Participants were classified into three maternal age categories: 18-29, 30-34, and ≥35 years. Psychological symptoms were assessed using the Edinburgh Postnatal Depression Scale, the Perceived Stress Scale, and the State-Trait Anxiety Inventory. Composite psychological distress was defined as meeting the prespecified threshold for screen-positive anxiety symptoms, screen-positive depressive symptoms, or high perceived stress. Associations were examined using multivariable logistic and linear regression models.

Mean state anxiety, trait anxiety, Edinburgh Postnatal Depression Scale, and perceived stress scores increased across maternal age categories. Screen-positive anxiety symptoms were present in 15.9, 23.2, and 33.0% of women aged 18-29, 30-34, and ≥35 years, respectively (p < 0.001); the corresponding prevalence of composite psychological distress was 28.9, 35.2, and 47.4% (p < 0.001). After adjustment, each one-category increase in maternal age was associated with higher odds of composite psychological distress (adjusted odds ratio [aOR] = 1.58, 95% CI 1.35-1.84; p < 0.001) and screen-positive anxiety symptoms (aOR = 1.76, 95% CI 1.48-2.10; p < 0.001), as well as a 0.20-point increase in perceived stress score (95% CI 0.11-0.29; p < 0.001). Conception through assisted reproductive technology and perceived financial strain were associated with higher odds of both binary outcomes. Perceived financial strain and work and career pressure were associated with higher perceived stress scores, whereas being currently married was associated with a lower score.

Maternal age, conception through assisted reproductive technology, perceived financial strain, work and career pressure, and marital status were associated with psychological outcomes in early pregnancy. Prospective studies are needed to confirm these findings and identify feasible screening and support strategies for routine antenatal care.