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Peer-reviewedCC BY-NC 4.0Risk Management and Healthcare Policy

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

  • Yalan Li1,2
  • Chenghua Liu3
  • Yanhong Li4
  • Liqiong Huang3
  • Min Hu5
  • Peng Yuan6
  • Wenyao Zhang6
  • Xue Xiao1,7
  • Fang Liu1,2
  • Xin Li1,6,8
8 affiliations
  1. 1Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
  2. 2Department of Psychiatry, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, People’s Republic of China
  3. 3Department of Obstetrics and Gynecology, Shanghai Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
  4. 4Clinical Laboratory, The People’s Hospital of Lincang, Lincang, 677000, People’s Republic of China
  5. 5Department of Psychosomatic Medicine, Chengdu Southwest Rehabilitation Hospital, Chengdu, 610041, People’s Republic of China
  6. 6Department of Obstetrics and Gynecology, Bazhong Maternal and Child Health Hospital, Bazhong, Sichuan, 636024, People’s Republic of China
  7. 7Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, People’s Republic of China
  8. 8Department of Medical Genetics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, People’s Republic of China
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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.

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Cite

BibTeXRIS
BibTeX
@article{li2026association,
  title = {{Association of Conception Mode with Antenatal Anxiety, Depression, and Delivery Outcomes: A Multicenter Cohort Study}},
  author = {Yalan Li and Chenghua Liu and Yanhong Li and Liqiong Huang and Min Hu and Peng Yuan and Wenyao Zhang and Xue Xiao and Fang Liu and Xin Li},
  journal = {Risk Management and Healthcare Policy},
  year = {2026},
  month = oct,
  doi = {10.2147/rmhp.s630224},
  url = {https://doi.org/10.2147/rmhp.s630224},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Association of Conception Mode with Antenatal Anxiety, Depression, and Delivery Outcomes: A Multicenter Cohort Study
AU  - Yalan Li
AU  - Chenghua Liu
AU  - Yanhong Li
AU  - Liqiong Huang
AU  - Min Hu
AU  - Peng Yuan
AU  - Wenyao Zhang
AU  - Xue Xiao
AU  - Fang Liu
AU  - Xin Li
PY  - 2026
DA  - 2026/10/27
JO  - Risk Management and Healthcare Policy
DO  - 10.2147/rmhp.s630224
UR  - https://doi.org/10.2147/rmhp.s630224
AB  - 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.
SN  - 1179-1594
ER  -