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Association of Conception Mode with Antenatal Anxiety, Depression, and Delivery Outcomes: A Multicenter Cohort Study

Year: 2026

Type: article

Abstract: Background: This study compared antenatal anxiety and depression risks across modes of conception and examined their associations with adverse maternal and neonatal outcomes and cesarean delivery without medical indication. Methods: This multicenter cohort included 3458 pregnant women receiving antenatal care at three Chinese obstetric centers from December 2023 to December 2025, including 1954 natural conceptions and 1504 conceptions after infertility treatment. Infertility treatment was classified as assisted reproductive technology, surgery, or medical treatment. Anxiety and depression risks were assessed at 26-28 weeks using the GAD-7 and EPDS. Multivariable logistic regression was performed. Results: Women conceiving after infertility treatment had higher risks of anxiety than those with natural conception (21.0% vs 14.0%, P<0.001) and depression (15.2% vs 12.5%, P=0.023). Assisted reproductive technology was independently associated with anxiety risk (aOR, 1.40; 95% CI, 1.12-1.74), whereas no infertility treatment pathway was associated with depression risk. Neither anxiety nor depression risk was associated with adverse maternal and neonatal outcomes, although assisted reproductive technology was associated with this outcome (aOR, 1.61; 95% CI, 1.32-1.96). Cesarean delivery without medical indication occurred in 16.5% of women and was associated with anxiety risk, depression risk, assisted reproductive technology, and medical treatment, with aORs of 1.88, 1.55, 1.43, and 1.53, respectively. Conclusion: Assisted reproductive technology was associated with increased antenatal anxiety risk. Positive anxiety and depression screens were associated with cesarean delivery without medical indication, supporting antenatal psychological screening, clinical assessment, and individualized counseling.

Source: Risk Management and Healthcare Policy

DOI: 10.2147/rmhp.s630224