Prepregnancy Stressful Life Events and Perinatal Mental Health Disorders From Pregnancy to 3 Years After Childbirth: An Observational Study.

Abstract

The associations of prepregnancy stressful life events with perinatal mental health disorders at multiple time points are not fully understood. This study aims to assess the associations of prepregnancy stressful life events with occurrences of maternal mental health disorders from pregnancy to 3 years after childbirth. This retrospective cohort study included 1,994 women who had experienced childbirth from July 2020 to June 2021 in Huai'an, China, on the basis of the Grandmothers, Mothers, and Their Children's Health study. Participants' stressful life events 1 year before pregnancy included conflict with partners and family members; physical, sexual, or emotional abuse; deaths of friends or relatives; and financial stress. Maternal mental health disorders (including anxiety and depression) were determined during pregnancy and 1 year and 3 years after childbirth. Modified Poisson regression models were used to assess the associations, and the Shapley method was used to estimate the relative contributions of specific stressors. Data were collected during 2020-2023 and were analyzed during July 2024-February 2025. A total of 602 (30.2%) participants experienced prepregnancy stressful life events; 494 (24.8%), 432 (21.7%), and 240 (12.0%) participants were screened for mental health disorders during pregnancy, 1 year after childbirth, and 3 years after childbirth, respectively. Prepregnancy stressful life events were associated with 2.20-fold (95% CI=1.90, 2.56), 2.07-fold (95% CI=1.76, 2.43), and 2.98-fold (95% CI=2.34, 3.79) increased risks of maternal mental health disorders during pregnancy, 1 year after childbirth, and 3 years after childbirth, respectively. The associations were more evident for comorbid anxiety and depression as well as for persistent maternal mental health disorders. Financial stress and family conflicts were primary contributors to perinatal maternal mental health disorders. Prepregnancy stressful life events were associated with maternal mental health disorders from pregnancy to 3 years after childbirth. Financial stress and family conflicts were primary contributors to these associations. These findings highlight the importance of consistent mental health monitoring during pregnancy and during the years after childbirth, particularly among those who experience stressful life events.