Impact of Adverse Pregnancy History and Demographics on Antenatal Mental Health: A Cross-Sectional Study of 897 Women

Abstract

Background: Common mental health disorders among pregnant women—including anxiety, insomnia, and post-traumatic stress disorder (PTSD)—significantly impair maternal well-being, quality of life, and pregnancy outcomes. Objective: This study aimed to investigate the prevalence and influencing factors (specifically adverse pregnancy history and demographics) of anxiety, insomnia, and PTSD to inform targeted interventions. Methods: A cross-sectional survey was conducted among 897 pregnant women in China from June 9, 2024, to June 9, 2025. Participants completed validated questionnaires: a general information form, the Insomnia Severity Index (ISI), the Generalized Anxiety Disorder Scale (GAD-7), and the Impact of Event Scale-Revised (IES-R). Adverse pregnancy history was defined to include miscarriage, stillbirth, and preterm birth. Multiple stepwise linear regression analysis was performed to identify factors influencing mental health outcomes. Results: Among 897 participants, the prevalence of clinically significant symptoms was: anxiety 13.9% (n=125, GAD-7 ≥10), insomnia 28.4% (n=255, ISI ≥8), and PTSD 24.1% (n=216, IES-R ≥33). The mean scores were: GAD-7 (5.64 ± 4.28), ISI (6.83 ± 5.25), and IES-R (22.43 ± 17.84). Multiple stepwise linear regression analysis indicated that adverse pregnancy history was a significant risk factor for anxiety (β = 1.53, p < 0.05), insomnia (β = 1.22, p < 0.05), and PTSD (β = 5.38, p < 0.05). Conversely, continuous employment and higher family income were inversely associated with symptom severity (p < 0.05). Conclusion: Anxiety, insomnia, and PTSD are prevalent among pregnant women in China. Adverse pregnancy history increases susceptibility, while maintaining active employment may serve as a protective factor. This finding opens new avenues for future effective interventions aimed at alleviating negative emotions among pregnant women.