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

BACKGROUND: 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. OBJECTIVE: To explore associations between mental health conditions and adverse pregnancy outcomes among ADSW. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.