Archives of women's mental health · 2026
Prenatal anxiety, tobacco use, and infant birth weight: a multilevel analysis of PRAMS data.
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Chung Sunghyun, Watkins Lawrence
Аннотация
PURPOSE: Maternal anxiety is a clinically relevant mental health concern during pregnancy and may contribute to reduced fetal growth, particularly when co-occurring with prenatal tobacco use. To examine the individual and contextual associations of maternal anxiety and prenatal tobacco use with infant birth weight using 2021-2023 Pregnancy Risk Assessment Monitoring System data. The analytic sample included 29,288 mothers nested within 11 states or jurisdictions.
METHODS: Two-level linear mixed models were estimated to predict continuous infant birth weight, with a random slope for maternal anxiety to assess whether the anxiety-birth weight association varied across states or jurisdictions.
RESULTS: Prenatal tobacco use was associated with an approximately 219-gram reduction in birth weight (p < .001), while maternal anxiety was associated with an approximately 60-gram reduction (p < .001). State-level prevalence of anxiety and tobacco use did not directly predict birth weight; however, the association between maternal anxiety and birth weight varied across states or jurisdictions.
CONCLUSIONS: These findings support integrated prenatal care approaches that combine maternal mental health screening, tobacco cessation support, and attention to contextual systems that may shape maternal and infant health.
METHODS: Two-level linear mixed models were estimated to predict continuous infant birth weight, with a random slope for maternal anxiety to assess whether the anxiety-birth weight association varied across states or jurisdictions.
RESULTS: Prenatal tobacco use was associated with an approximately 219-gram reduction in birth weight (p < .001), while maternal anxiety was associated with an approximately 60-gram reduction (p < .001). State-level prevalence of anxiety and tobacco use did not directly predict birth weight; however, the association between maternal anxiety and birth weight varied across states or jurisdictions.
CONCLUSIONS: These findings support integrated prenatal care approaches that combine maternal mental health screening, tobacco cessation support, and attention to contextual systems that may shape maternal and infant health.