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

Jing Zhao, Miao Guo, He Ren, Yang Pan, Shurong Li, Ping Chen Department of Obstetrics and Gynecology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, 450003, People’s Republic of ChinaCorrespondence: Ping Chen, Department of Gynecology and Obstetrics, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, People’s Republic of China, Tel +8613783589566, Fax +86037166262974, Email pingping6768@126.comBackground: 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.Keywords: adverse pregnancy history, anxiety, insomnia, post-traumatic stress disorder, mental health, attention bias modification