Mental Health in Early Pregnancy and Spontaneous Abortion Risk: A Prospective Cohort Study

Objective: This study aims to explore the relationship between maternal mental health during early pregnancy and the risk of spontaneous abortion (SA), especially in the context of the Coronavirus disease 2019 pandemic.

Methods: We conducted a prospective cohort study involving 4088 pregnant women at a maternal-child health hospital in China from January to December 2022. During the first trimester, we assessed depression, anxiety, and stress levels using the Depression, Anxiety, and Stress Scale (DASS-21). Pregnancy outcomes were monitored, and univariate and multiple logistic analyses were performed to identify the risk factors. These factors were then used to develop a nomogram model.

Results: Significant differences were found in maternal age, number of embryonic arrests, history of abortion, assisted reproduction, and environmental exposure between the SA group (n = 302) and the normal pregnancy group (n = 3786). After adjusting for potential confounders, higher scores on the DASS-21 subscales were independently associated with an increased risk of SA: Depression (OR [Odds Ratio] = 1.54, 95% CI [Confidence Interval]: 1.39-1.71, P < .001), Anxiety (OR = 1.61, 95% CI: 1.44-1.80, P < .001), and Stress (OR = 1.69, 95% CI: 1.31-2.20, P < .001). The model achieved a concordance index of 0.87 (95% CI: 0.86-0.90) and demonstrated a well-fitted calibration curve, indicating its good clinical applicability.

Conclusion: Our findings indicate that mental health conditions are significantly associated with an increased risk of SA. The nomogram model also demonstrated strong predictive accuracy, indicating its potential usefulness in clinical settings.