Epidemiology of mental disorders during pregnancy and link to birth outcome: a large-scale retrospective observational database study including 38,000 pregnancies

  • Stephanie WallwienerEmail author
  • Maren Goetz
  • Anne Lanfer
  • Andrea Gillessen
  • Marc Suling
  • Manuel Feisst
  • Christof Sohn
  • Markus Wallwiener
Maternal-Fetal Medicine



To investigate the real-life epidemiology of mental disorders during pregnancy and their impact on birth outcome in an unselected low-risk population in Germany.


Claims data of the Techniker Krankenkasse (TK) were analyzed as part of a retrospective observational study over a one-year period from 01/2008 to 12/2008 including 38,174 pregnant women. ICD-10 codes were clustered into four diagnostic groups: depression, anxiety disorders, somatoform/dissociative disorders and acute stress reactions. The relationship between mental disorders, birth mode and infant weight was tested using chi-squared tests and multivariate logistic regression. Main outcome measures included the prevalence of mental disorders during pregnancy, performed cesarean sections and infants born underweight.


N = 16,639 cases with at least one diagnosis from the four mental disorder diagnostic groups were identified: 9.3% cases of depression, 16.9% cases with an anxiety disorder, 24.2% cases with a somatoform/dissociative disorder, and 11.7% cases of acute stress reactions. Women diagnosed with a mental disorder were more likely to deliver their child by cesarean section ([depression: OR =1.26 (95% CI 1.14–1.39); anxiety: OR 1.11 (95% CI 1.02–1.19); somatoform disorders: OR 1.12 (95% CI 1.05–1.20); acute stress reactions: OR 1.17 (95% CI 1.07–1.28)]. Furthermore, infants of women diagnosed with an ICD-10 code for depression during pregnancy were more likely to be underweight and/or delivered preterm [OR =1.34 (95% CI 1.06–1.69)].


We observed substantially high prevalence rates of mental disorders during pregnancy which urgently warrant more awareness for validated screening and adequate treatment options.


Pregnancy Depression Anxiety Prevalence Cesarean section Birthweight 



Techniker Krankenkasse kindly provided data for the analyzes.

Author contributions

SW, MG: study concept, interpretation of data, manuscript writing and editing. AL, AG, MS: study concept and design, data analysis, manuscript editing. MF: data analysis, manuscript writing. CS, MW: manuscript writing and editing.


This work was supported by the Institute of Women’s Health, Tübingen, Germany. They had no role in the design and conduct of the study; in the collection, analysis, the interpretation of the data; or in the preparation, review, or approval of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Federal Insurance Office of Germany (Bundesversicherungsamt, Reference Number IT 5 - 8269 - 70/2014, approved on 16 January 2014).


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyUniversity of HeidelbergHeidelbergGermany
  2. 2.Techniker KrankenkasseHamburgGermany
  3. 3.Institute of Medical Biometry and InformaticsUniversity of HeidelbergHeidelbergGermany

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