Mental health in expectant mothers after medically assisted reproduction and spontaneous conception: the nuMoM2b study.

BACKGROUND

Mental health disorders are common during pregnancy and affect up to 20% of individuals. Women who conceive via medically assisted reproduction (MAR) may face increased psychological stress due to treatment burden and uncertainty, potentially elevating their risk of mental health conditions. However, evidence comparing mental health in women conceiving via MAR versus spontaneous conception remains inconsistent.

METHODS

We analyzed data from 9289 nulliparous women in the prospective US-based nuMoM2b cohort, including 196 who conceived via assisted reproductive technology (ART), 170 via intrauterine insemination (IUI), and 8923 spontaneously. Perceived stress, depressive and anxiety symptoms were assessed during pregnancy using validated instruments. Propensity score matching adjusted for baseline confounders. Associations between mode of conception and mental health outcomes during early and mid-pregnancy were evaluated using linear and logistic regression models.

RESULTS

In the unadjusted analysis of the full cohort during early pregnancy, women who conceived via ART or IUI reported significantly lower scores for stress (mean difference: -1.502, p = 0.002 and -2.246, p < 0.001), depression (-0.656, p = 0.036 and -1.073, p = 0.001), and anxiety (-0.948, p = 0.148 and -2.153, p = 0.002) compared to those with spontaneous conception. However, after propensity score matching on baseline confounders, differences were attenuated and mostly non-significant. A tendency remained suggesting slightly higher symptoms in the ART group and lower symptoms in the IUI group.

CONCLUSIONS

Women who conceived via MAR did not experience significantly worse mental health during pregnancy than those who conceived spontaneously. These findings are reassuring given the growing use of MAR and the clinical importance of maternal mental health.