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The association between prenatal psychological distress, sociodemographic disparities, and adverse birth outcomes in the United States: Findings from the ECHO birth cohort
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2026
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Abstract
Background Prior research suggests links between prenatal psychological distress (PPD) and adverse birth outcomes. Yet, effects of independent and comorbid PPD domains, sociodemographic variations, and timing of exposure remain inconsistent. Aim This study examined associations between PPD, preterm birth (PTB), and other birth outcomes, and assessed variations by maternal race/ethnicity and age. Methods This retrospective cohortutilized data from the ECHO Program. PPD was assessed using the 10-item Edinburgh Prenatal Depression Scale, 3-item EPDS anxiety subscale, 10-item perceived stress scale, and/or PPD identified from medical records. Multivariate logistic regression examined associations, adjusting sequentially for cohort, maternal age, race/ethnicity, smoking, and alcohol consumption (Model 1), household income (Model 2), and pre-pregnancy body mass index (Model 3). Analyses were stratified by maternal racial/ethnicity and age. Sensitivity analysis investigated associations by PPD assessment time and social support. Findings In total, 6656 pregnancies were included. PPD was associated with higher odds of PTB (aOR = 1.34, 95%CI 1.10–1.63, p = 0.00). Higher associations appeared among Black (aOR = 1.66, 95%CI 0.98, 2.80, p = 0.06) and Hispanic women (aOR = 1.58, 95%CI 1.14, 2.20, p = 0.01), and women <25 years (aOR = 1.64, 95%CI 1.32,2.04, p = 0.00). Depression or anxiety assessed in the first trimester and perceived stress in the third trimester increased PTB odds, whereas adequate social support reduced odds (aOR = 0.76, 95%CI 0.39,1.48, p = 0.42). Conclusion PPD increases the risk of adverse birth outcomes, with effects varying by maternal race, age, and timing of exposure assessment. Adequate social support may buffer effects. Longitudinal prospective research and mechanistic studies are needed to establish causal pathways and identify vulnerability windows. © 2026 The Authors.