Low wellbeing among pregnant women in Denmark and associated factors: A population-based study

Background

Maternal mental health during pregnancy is a key determinant of later maternal and child health and a potential driver of social inequalities in health. Low well-being and depressive symptoms are associated with adverse health behaviors, psychosocial strain, and negative perinatal outcomes, underscoring the need for population-level monitoring and early intervention. The aim was to assess the prevalence of low well-being and depressive symptoms in pregnancy in Denmark and associated psychosocial and perinatal factors.

Methods

This population-based study used patient-reported outcome data collected prior to the first midwife consultation across six maternity units in three Danish regions. Well-being and depressive symptoms were assessed using the WHO-5 Well-Being Index and the Major Depression Inventory-2 (MDI-2). Questionnaire data were linked with national register data on pregnancy and birth outcomes (n = 34,886). Logistic regression analyses were applied.

Results

Approximately one in four women reported low (16%) or very low (8%) well-being. Both low and very low well-being were strongly associated with poor self-rated health, fatigue, nausea, psychosocial strain, and pregnancy-related concerns. It was also linked to adverse health behaviors, including reduced physical activity, nicotine use, and lower adherence to dietary recommendations. Very low well-being was associated with increased risk of pre-eclampsia, preterm birth, and caesarean section. Depressive symptoms further amplified these risks.

Conclusions

Low well-being among pregnant women is common and is associated with both behavioral and clinical risk factors. Systematic use of patient-reported measures in antenatal care may support early identification of pregnant women in vulnerable situations and enable targeted, preventive interventions. Strengthening mental health screening in pregnancy has potential to improve population health outcomes and reduce inequalities across generations.

Key messages

• Low well-being in pregnancy is common and associated with poor health, psychosocial strain, adverse health behaviors and adverse pregnancy and birth outcomes.

• Systematic use of patient-reported measures in antenatal care may support early identification of pregnant women in vulnerable situations and enable targeted, preventive interventions.