Infant Emergency Department Visits, Readmission, and Mortality by Maternal Anxiety Disorder during Pregnancy Occurring with and without Other Mental Health Conditions: A Retrospective Cohort Study

Infant Emergency Department Visits, Readmission, and Mortality by Maternal Anxiety Disorder during Pregnancy Occurring with and without Other Mental Health Conditions: A Retrospective Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Infant Emergency Department Visits, Readmission, and Mortality by Maternal Anxiety Disorder during Pregnancy Occurring with and without Other Mental Health Conditions: A Retrospective Cohort Study Rebecca J. Baer, Scott P. Oltman, Deborah Adeyemi, Ribka Amsalu, and 16 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7687467/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 23 Dec, 2025 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted 10 You are reading this latest preprint version Abstract Background While a link between maternal anxiety diagnoses and adverse maternal and infant outcomes has been reported, there is a paucity of data regarding infant outcomes through the first year of life in those born to individuals with anxiety only and anxiety comorbid with other mental health conditions. Method The sample included 5,836,541 singleton liveborn infants in California from 2007–2020. Anxiety with and without depression or a non-depression mental health condition during pregnancy were identified from ICD codes from hospital discharge records. Adverse infant outcomes evaluated included emergency department (ED) visit, readmission, or death in the first year of life. Log-linear regression was used to calculate the crude (cRR) and adjusted (aRR) relative risk and 95% confidence interval (CI) of each outcome by mental health condition grouping. To fully consider the potential influence of co-variants, we examined four different adjusted risk calculations. Patterns of comorbidity and infant outcomes were also examined within payer for birth (as an indicator of income) and racial/ethnic groupings. Results Infants of birthing people diagnosed with anxiety alone or anxiety and depression had reduced ED visits (cRRs 0.93 and 0.85, respectively) and readmissions (cRRs 0.85 and 0.83) but an increased risk of death (cRRs 1.40 and 1.75) compared to those without any mental health condition. Infants of people with diagnoses of anxiety and other non-depression conditions during pregnancy faced higher risks across all metrics (ED visits and readmissions cRRs 1.14–1.20, death cRRs 2.07–3.81). Observed were often tempered in fully adjusted models. Conclusions Maternal anxiety diagnosis during pregnancy was associated with an elevated risk of infant death and was exacerbated by the presence of another mental health condition. These relationships were not explained by the presence of other related risks. These findings underscore the need for interventions for birthing people with anxiety, and particularly for those with comorbid mental health conditions. anxiety depression mental health disorder adverse outcome infant emergency department readmission infant death Figures Figure 1 Figure 2 Background Maternal anxiety is common, with approximately 15% of pregnant people receiving a diagnosis of anxiety during pregnancy, and its association with adverse birth outcomes is well-documented.(1, 2) Data have shown that pregnant people with anxiety during pregnancy are at increased risk for adverse birth outcomes like preterm birth (PTB, birth < 37 completed weeks of gestation), low birth weight (LBW, birthweight < 2500 grams), small for gestational age (SGA, birthweight for sex and gestational age < 10th percentile), and infant mortality).(3–10) Maternal diagnosis of anxiety during pregnancy has also been associated with long-term neurodevelopmental delays, behavioral and emotional difficulties, impaired bonding, and an increased risk for illness and death in infants.(8, 10–12) The occurrence of other mental health conditions (e.g. depression, schizophrenia, bipolar disorder) during pregnancy are also related to an increased risk of adverse birth and infant outcomes. (4, 8, 9, 13–20) ` While a link between maternal anxiety diagnoses and maternal and infant outcomes during the first year of life has been reported,(8, 10, 13, 14) there is a paucity of data regarding infant outcomes through the first year of life in those born to individuals with anxiety only and anxiety comorbid with other mental health conditions. This is especially true with respect to diagnostic patterns among vulnerable populations, including racially/ethnically marginalized or low-income groups, who are known to be at increased risk for experiencing anxiety during pregnancy and for having adverse maternal and infant outcomes in the year after birth.(2, 4, 8) Further, understanding whether having a comorbid mental health condition is uniquely related to an increased risk in infants is critical for designing personalized care plans and for better understanding the causal underpinnings of anxiety and adverse infant outcome relationships. It is also critical to evaluate these relationships while considering other maternal and infant factors (e.g. PTB, SGA) given established associations with maternal anxiety and with infant outcomes.(3–6, 8, 21, 22) Here, we examine the risk of infant readmission, emergency room visits, and death in the first year of life among those born to pregnant individuals with an anxiety disorder alone, an anxiety disorder with depression, an anxiety disorder with a non-depression mental health condition, and among individuals with co-occurring anxiety disorder, depression, and another mental health condition during pregnancy. To fully consider the potential influence of co-variants, we examined sequentially adjusted risk calculations. Patterns of comorbidity and infant outcomes were also examined within payer for birth (as an indicator of income) and racial/ethnic groupings. Materials/Subjects and Methods Sample The sample was drawn from all California live-born infants between 2007 and 2020. Birth certificates, maintained by California Vital Statistics, were linked to hospital discharge, emergency department (ED), and ambulatory surgery records maintained by the California Department of Health Care Access and Information (HCAI).(23) Hospital discharge, ED, and ambulatory surgery files provided diagnoses and procedure codes based on the International Classification of Diseases (ICD), as reported to HCAI by the healthcare facilities.(24, 25) The study sample was restricted to non-anomalous singletons with linked birth records for the birthing person and infant (Fig. 1 ). Anxiety and other mental health conditions. Mental health diagnosis during pregnancy was identified by the presence of a diagnostic code in any HCAI record during pregnancy or for the birth admission. Mental health conditions were grouped as anxiety disorder alone, anxiety and depression, anxiety and other mental health diagnosis (e.g. schizophrenia, bipolar disorder, personality disorder), and anxiety, depression, and other mental health diagnosis (Appendix 1). The reference population was birthing people without any mental health diagnosis on a pregnancy or birth HCAI record. People who had a mental health diagnosis without a diagnosis of anxiety disorder were excluded from the study, for an analytical sample of 126,495 birthing people with an anxiety diagnosis and 5,710,046 birthing people with no mental health diagnosis (Fig. 1 ). Infant Outcomes Infant outcomes in the first year of life included an ED visit, hospital readmission, and/or death. ED visits and readmissions were captured from HCAI records. Death of a liveborn infant was obtained from vital statistics and/or HCAI records (discharge status = died). Final cause of death was reported by California Vital Statistics as a single ICD-10 code for all study years. Cause of death was grouped as perinatal complications, sudden unexpected infant death, non-accidental trauma, and other ICD-10 diagnoses (Appendix 1). Selection of these cause of death groups follows previous literature (8) and aimed to allow large enough cell sizes as well as clinically meaningful groups. Infant and maternal covariates. Additional infant and maternal covariates were also considered. Gestational age and PTB (< 37 weeks gestation) were determined by the best obstetric estimate from birth certificate records. SGA was defined as a birthweight below the 10th percentile for gestational age and sex(26) using data from birth certificate records. Sociodemographic factors for birthing people included reported racial/ethnic group, education level, expected payer for birth, participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC),(27) and adequacy of prenatal care (calculated using gestational age at delivery, month of gestation at first prenatal care visit, and number of prenatal care visits)(28, 29) and were obtained from birth certificate records. Racial/ethnic group associations were calculated as being part of a group versus not to assess how patterns within a specific group compared to the rest of the population. Maternal health conditions and exposures included diabetes (preexisting or gestational), hypertension (preexisting or gestational), smoking during pregnancy (reported as number of cigarettes by trimester on birth certificate records), and drug or alcohol use during pregnancy. These variables were obtained from HCAI and birth certificate records (Appendix 1). Other maternal covariates included maternal age at the time of birth and parity, recorded in birth certificate records. Statistical Analysis. The risk of infant ED visit, readmission, or death was estimated by PTB, SGA, socio-demographic factors, age and parity, and maternal health conditions and exposures using Poisson log-linear regression with no adverse infant outcome as the reference population. The risk of anxiety disorder overall and by subgroups of other mental health conditions was estimated by PTB, SGA, sociodemographic factors, maternal age, parity, health conditions, and exposures using Poisson log-linear regression with no adverse infant outcome as the reference population. Estimates of the relative risk (RR) of adverse infant outcomes and 95% confidence interval (CI) were calculated sequentially using Poisson log-linear regression. For model 1, the unadjusted risk was calculated for each adverse infant outcome. For the adjusted models, the entrance of a potential covariate into any model required a significant (p < 0.05) association between anxiety disorder and the potential covariates. Model 2 included adjustment for PTB. Model 3 included adjustment for PTB, significant maternal sociodemographic factors, maternal age at delivery, and parity. Model 4 included all factors in the third model plus significant health conditions and exposures for the birthing person. The risk was also examined within payer (public or non-public) and racial/ethnicity grouping (Asian, Black, Hispanic, Other (includes American Indian/Alaska Native, Native Hawaiian/Pacific Islander, “Other race”, “multiracial” (two or more racial groups indicated), unknown/not stated), and by non-Hispanic White). Artificial intelligence (chatgpt.com) was used to create a figure displaying these relative risks. Infant cause of death was examined across each maternal anxiety group and the risk of each cause of death was estimated in the same sequential fashion as the other adverse infant outcomes. All analyses were performed using Statistical Analysis Software version 9.4 (SAS, Cary, NC). Methods and protocols for the study were approved by the Committee for the Protection of Human Subjects within the Health and Human Services Agency of the State of California. Results The sample included 5,836,541 births, of whom 126,495 (2.2%) had an anxiety disorder diagnosis during pregnancy or at birth as recorded in an HCAI record. Of the 126,495 birthing people with a diagnosis of an anxiety disorder, 89,297 (70.6%) had a documented anxiety disorder alone, 29,840 (23.6%) had a diagnosis of anxiety and depression (but no other mental health diagnosis), 5,357 (4.2%) had anxiety and a non-depression mental health diagnosis, and 2,001 (1.6%) had anxiety with depression and another mental health diagnosis. Risk factors for adverse infant outcomes included PTB, education < 12 years, public insurance, WIC participation, inadequate prenatal care, < 18 years of age at delivery, infection, smoking during pregnancy, and drug/alcohol use during pregnancy (Table 1 ). When compared to all other racial/ethnicity groups, Hispanic, Black, American Indian/Alaska Native, and Native Hawaiian/Pacific Islander groups were found to be more likely to have an infant with an ED visit, readmission, or death in the first year while Asian and White groups were less likely (Table 1 ). Table 1 Association of infant and birthing person factors with adverse infant outcome No ED Visit, Readmission or Death ED Visit Readmission Death n (%) n (%) n (%) n (%) cRR cRR cRR cRR Sample 3,815,284 1,722,714 548,636 17,076 Infant factors Preterm birth < 37 weeks 219,116 (5.7) 123,083 (7.1) 58,058 (10.8) 8,756 (51.3) 1.2 (1.2, 1.2) 1.8 (1.8, 1.8) 18.2 (17.7, 18.8) ≥ 37 weeks 3,591,328 (94.1) 1,597,305 (92.7) 479,869 (89.1) 7,582 (44.4) Reference Small for gestational age c 318,448 (8.4) 153,702 (8.9) 49,779 (9.2) 2,039 (11.9) 1.1 (1.0, 1.1) a 1.1 (1.1, 1.1) 1.5 (1.4, 1.6) Birthing person socio-demographic factors Racial/ethnic group c Hispanic 1,741,941 (45.7) 1,041,710 (60.5) 296,945 (55.1) 8,591 (50.3) 1.5 (1.5, 1.5) 1.4 (1.4, 1.4) 1.2 (1.2, 1.2) Non-Hispanic Asian 632,715 (16.6) 136,795 (7.9) 63,090 (11.7) 1,750 (10.3) 0.5 (0.5, 0.5) 0.7 (0.7, 0.7) 0.6 (0.5, 0.6) Black 156,081 (4.1) 116,104 (6.7) 29,849 (5.5) 1,966 (11.5) 1.4 (1.4, 1.4) 1.3 (1.3, 1.3) 3.0 (2.9, 3.2) Other 197,813 (5.2) 74,443 (4.3) 25,488 (4.7) 1,268 (7.4) 1.0 (1.0, 1.0) a 1.0 (1.0, 1.0) a 1.3 (1.2, 1.4) American Indian/Alaska Native 11,902 (0.3) 6,059 (0.4) 1,870 (0.4) 83 (0.5) 1.1 (1.1, 1.1) 1.1 (1.0, 1.1) a 1.6 (1.3, 1.9) Native Hawaiian/Pacific Islander 13,950 (0.4) 7,612 (0.4) 2,583 (0.4) 110 (0.6) 1.1 (1.1, 1.2) 1.3 (1.2, 1.3) 1.8 (1.5, 2.1) “Other” 2,121 (0.1) 954 (0.1) 289 (0.1) d 1.0 (0.9, 1.1) 1.0 (0.9, 1.1) 1.1 (0.6, 2.0) Multiracial 80,904 (2.1) 32,423 (1.9) 10,221 (1.9) 403 (2.4) 0.9 (0.9, 0.9) 0.9 (0.9, 0.9) 1.1 (1.0, 1.2) a White 1,086,734 (28.5) 353,661 (20.5) 123,264 (22.9) 3,501 (20.5) 0.7 (0.7, 0.7) 0.8 (0.8, 0.8) 0.6 (0.6, 0.7) Education (years) 12 2,167,378 (56.8) 707,381 (41.1) 248,643 (46.2) 7,013 (41.1) 0.7 (0.7, 0.7) 0.7 (0.7, 0.7) 0.6 (0.6, 0.6) Payer for birth Private 2,044,189 (53.6) 589,739 (34.2) 216,546 (40.2) 6,395 (37.5) Reference Public 1,507,414 (39.5) 1,053,869 (61.2) 294,394 (54.7) 9,497 (55.6) 1.8 (1.8, 1.8) 1.7 (1.7, 1.7) 2.0 (1.9, 2.1) TRICARE (Active Duty Military) 18,431 (0.5) 5,714 (0.3) 1,991 (0.4) 64 (0.4) 1.1 (1.0, 1.1) a 1.0 (1.0, 1.1) 1.1 (0.9, 1.4) Other 245,250 (6.4) 73,392 (4.3) 25,705 (4.8) 1,120 (6.6) 1.03 (1.0, 1.0) a 1.0 (1.0, 1.0) 1.5 (1.4, 1.6) WIC participation No 2,127,705 (55.8) 596,300 (34.6) 225,192 (41.8) 7,852 (46.0) Reference Yes 1,649,863 (43.2) 1,111,038 (64.5) 308,088 (57.2) 8,683 (50.9) 1.8 (1.8, 1.8) 1.6 (1.6, 1.7) 1.4 (1.4, 1.5) Adequacy of prenatal care b Adequate plus/adequate 2,761,556 (72.4) 1,218,460 (70.7) 389,150 (72.3) 9,745 (57.1) Reference Intermediate 534,618 (14.0) 237,599 (13.8) 70,504 (13.1) 1,688 (9.9) 1.01 (1.0, 1.0) a 0.9 (0.9, 1.0) a 0.9 (0.9, 0.9) Inadequate 374,881 (9.8) 199,258 (11.6) 57,399 (10.7) 2,423 (14.2) 1.1 (1.1, 1.1) 1.1 (1.1, 1.1) 1.8 (1.7, 1.9) Other birthing person factors Age at delivery (years) 34 837,556 (22.0) 262,945 (15.3) 99,609 (18.5) 3,096 (18.1) 0.7 (0.7, 0.7) 0.8 (0.8, 0.8) 0.8 (0.8, 0.8) Parity Nulliparous 1,487,757 (39.0) 668,191 (38.8) 201,613 (37.4) 6,975 (40.9) 0.99 (1.0, 1.0) a 0.9 (0.9, 0.9) 1.1 (1.0, 1.1) a Multiparous 2,324,378 (60.9) 1,053,250 (61.1) 336,588 (62.5) 9,988 (58.5) Reference Health conditions/exposures Diabetes None 3,407,644 (89.3) 1,561,940 (90.7) 483,160 (89.7) 15,363 (90.0) Reference Gestational diabetes 367,170 (9.6) 144,966 (8.4) 48,723 (9.1) 1,341 (7.9) 0.9 (0.9, 0.9) 0.9 (0.9, 1.0) a 0.8 (0.8, 0.9) Pre-existing diabetes 40,470 (1.1) 15,808 (0.9) 6,753 (1.3) 372 (2.2) 0.9 (0.9, 0.9) 1.2 (1.1, 1.2) 2.5 (2.3, 2.7) Hypertension None 3,479,416 (91.2) 1,584,916 (92.0) 493,274 (91.6) 14,898 (87.3) Reference Gestational hypertension 117,996 (3.1) 45,433 (2.6) 13,989 (2.6) 407 (2.4) 0.9 (0.9, 0.9) 0.9 (0.8, 0.9) 0.8 (0.7, 0.9) Pre-existing hypertension 50,355 (1.3) 20,674 (1.2) 6,967 (1.3) 464 (2.7) 0.9 (0.9, 0.9) 1.0 (1.0, 1.0) 2.1 (2.0, 2.3) Preeclampsia 147,110 (3.9) 62,384 (3.6) 21,545 (4.0) 1,157 (6.8) 0.96 (1.0, 1.0) a 1.0 (1.0, 1.1) a 1.9 (1.8, 2.0) Infection c 309,394 (8.1) 188,580 (11.0) 55,501 (10.3) 2,771 (16.2) 1.2 (1.2, 1.3) 1.3 (1.2, 1.3) 2.2 (2.1, 2.3) Smoked during pregnancy c 72,455 (1.9) 52,686 (3.1) 14,252 (2.7) 1,004 (5.9) 1.4 (1.4, 1.4) 1.3 (1.3, 1.4) 3.2 (3.0, 3.4) Drug/alcohol use during pregnancy c 60,351 (1.6) 34,207 (2.0) 11,392 (2.1) 939 (5.5) 1.2 (1.2, 1.2) 1.3 (1.3, 1.3) 3.6 (3.4, 3.8) WIC: Special Supplemental Nutrition Program for Women, Infants, and Children cRR: unadjusted relative risk a p<0.05 b Based on Kotelcheck and colleagues(29) c versus no d n < 11 A higher proportion of people with a diagnosis of anxiety during pregnancy were self-reported Non-Hispanic Black, American Indian/Alaska Native, multi-racial, or White compared to birthing people without a mental health diagnosis. The majority of people with or without an anxiety disorder had an education > 12 years, have private insurance, and had adequate prenatal care, although these rates were higher among people with a diagnosis of anxiety. People with an anxiety disorder during pregnancy were more likely to have a PTB, have gestational diabetes, preexisting diabetes, gestational hypertension, preexisting hypertension, preeclampsia, infection, smoked during pregnancy, and used drugs/alcohol during pregnancy compared to people without a mental health diagnosis. These patterns were generally consistent across subgroups with anxiety (anxiety alone, anxiety and depression, anxiety and non-depression mental health diagnosis, or anxiety, depression, and other mental health diagnosis) (Supplemental table 1 ). In unadjusted models, birthing people with an anxiety disorder alone, or anxiety and depression only were less likely to have an infant with an ED visit (crude relative risks (cRRs) 0.85–0.93) or readmission in the first year of life (cRR 0.83–0.85) but were more likely to experience an infant death (cRR 1.50–1.75) compared to birthing people without a mental health diagnosis. In the fully adjusted model, birthing people with anxiety alone or anxiety and depression were less likely to have an infant with a readmission (adjusted risk ratios (aRRs) 0.87 and 0.81, respectively), and those with anxiety and depression were less likely to have an infant with an ED visit (aRR 0.92). The risk of infant death was 1.18 to 1.19 in the final adjusted model for people with anxiety alone or anxiety and depression (Fig. 2 , supplemental table 2 ). In unadjusted models, birthing people with anxiety disorder and a non-depression mental health diagnosis were at increased risk of an infant with an ED visit (cRR 1.14 to 1.16) and infant death (cRR 2.07 to 3.81). The final adjusted model attenuated these risks (Fig. 2 , supplemental table 2 ). Unadjusted risk of infant death due to perinatal complications and sudden unexpected infant death were elevated among people with an anxiety disorder during pregnancy (perinatal complications cRR 1.30 to 5.25; sudden unexpected infant death cRR 1.52 to 3.70) compared to people without a mental health diagnosis. The risk of sudden unexpected infant death remained elevated among people with an anxiety disorder during pregnancy for the first two adjusted models, but were no longer significant in the final model. The sample size was too small to examine cause of death across subgroups of anxiety diagnoses separately, but together these infants were at an elevated risk of death due to perinatal complications in all models (cRR 5.25, final model aRR 1.77)(Table 2 ). Table 2 Cause of infant death by anxiety disorder. Without mental health diagnosis Anxiety only Anxiety and depression only Anxiety and non-depression mental health disorder only Anxiety, depression, and other diagnosis n (%) n (%) n (%) n (%) n (%) cRR (95% CI) cRR (95% CI) cRR (95% CI) cRR (95% CI) aRR1 (95% CI) aRR1 (95% CI) aRR1 (95% CI) aRR1 (95% CI) aRR2 (95% CI) aRR2 (95% CI) aRR2 (95% CI) aRR2 (95% CI) aRR3 (95% CI) aRR3 (95% CI) aRR3 (95% CI) aRR3 (95% CI) Survived to 1 year 5,710,046 89,297 29,840 5,357 2,001 Reference Perinatal complications 8,168 (0.1) 166 (0.2) 64 (0.2) 15 (0.3) 15 (0.8) 1.30 (1.12, 1.52) 1.50 (1.17, 1.92) 1.96 (1.18, 3.25) 5.25 (3.16, 8.71) 0.97 (0.84, 1.14) 0.98 (0.77, 1.25) 1.17 (0.70, 1.93) 2.53 (1.52, 4.20) 1.00 (0.85, 1.16) 1.02 (0.80, 1.30) 1.07 (0.65, 1.78) 2.39 (1.44, 3.97) 0.93 (0.80, 1.09) 0.92 (0.72, 1.18) 0.87 (0.52, 1.45) 1.77 (1.06, 2.96) Sudden unexpected infant death 2,312 (0.0) 55 (0.1) 24 (0.1) a a 1.52 (1.17, 1.99) 1.99 (1.33, 2.97) 3.70 (1.85, 7.40) b 1.47 (1.13, 1.92) 1.88 (1.26, 2.81) 3.44 (1.72, 6.89) b 1.73 (1.32, 2.26) 2.24 (1.50, 3.36) 2.95 (1.47, 5.91) b 1.21 (0.92, 1.59) 1.25 (0.83, 1.87) 1.01 (0.50, 2.04) b Non-accidental trauma 238 (0.0) a a a a 1.35 (0.55, 3.26) b b b 1.29 (0.53, 3.14) b b b 1.53 (0.63, 3.72) b b b 1.22 (0.50, 2.99) b b b Other 2,020 (0.0) 38 (0.0) 16 (0.1) a a 1.20 (0.87, 1.66) 1.52 (0.93, 2.48) 2.65 (1.10, 6.36) b 1.07 (0.78, 1.48) 1.27 (1.78, 2.08) 2.11 (0.88, 5.06) b 1.17 (0.85, 1.62) 1.41 (0.86, 2.31) 1.94 (0.81, 4.67) b 0.99 (0.72, 1.37) 1.08 (0.66, 1.77) 1.09 (0.45, 2.64) b cRR: unadjusted relative risk aRR1: adjusted for preterm birth aRR2: adjusted for preterm birth, education, payer, WIC participation, adequacy of prenatal care, birthing person age, and parity aRR3: adjusted for preterm birth, education, payer, WIC participation, adequacy of prenatal care, birthing person age, parity, gestational diabetes, gestational diabetes, preexisting HTN, gestational HTN, preeclampsia, infection, smoking, drug/alcohol use diagnosis a not displayed when n < 11 b not calculated when n < 5 Patterns of infant outcome risk stratified by anxiety group, payer, and racial/ethnic group were similar in magnitude, although they were often not found to be significant at p < 0.05 due, in part, to sample size. A notable difference was that infants born to those with anxiety alone and public health insurance were at slightly increased risk of an ED visit in all models. Unadjusted risk of infant death was highest among people with anxiety, depression, and another mental health diagnosis during pregnancy. Generally, people with anxiety alone or anxiety and depression were less likely to have an infant readmitted to the hospital during the first year of life (Fig. 2 , supplemental table 2 , supplemental table 3 ). Discussion Using a large population-based California sample, we found that birthing people with an anxiety disorder alone were less likely to have an infant with an ED visit or readmission during the first year of life, but were at higher risk of experiencing an infant death compared to people without a documented mental health diagnosis during pregnancy. In contrast, those with anxiety and a non-depression mental health diagnosis were more likely to have an infant with an ED visit or readmission during the first year of life, and were at an unadjusted 2.1 to 3.8-fold higher risk of experiencing an infant death. These associations held after adjusting for infant and maternal factors. For all groups with an anxiety disorder, patterns by payer for delivery and racial/ethnic group varied, but general findings matched the overall population results, with the exception of people with anxiety alone and public health insurance being at slightly increased risk of an infant with an ED visit. People with an anxiety disorder were more likely to experience an infant death due to perinatal complications and sudden unexpected infant death. These risks, however, were no longer significant in the fully adjusted model, indicating that the association was confounded by factors not related to mental health. Results in context of what is known Maternal anxiety during pregnancy has been associated with PTB, LBW, and SGA at birth,(3–7) and for adverse childhood outcomes like neurodevelopmental, behavioral, and emotional challenges.(11, 12) Other mental health conditions, such as depression, have also been shown to be associated with adverse infant outcomes (e.g. preterm birth, low birthweight). Notably, we previously demonstrated that people with a mental health disorder during pregnancy (including anxiety disorders) were at increased risk of having an infant with a visit to the ED, readmission, or death in the first year of life in a similar population-based sample but we did not examine outcomes by patterns of co-occurring mental health conditions.(8) The findings in this paper further evaluate infant health indicators among people with anxiety disorders during pregnancy. We found that infants born to people with a diagnosed anxiety disorder alone or anxiety with depression were less likely to have an ED visit or readmission but more likely to experience an infant death. These findings align with others and may highlight opportunities for interventions that improve access to resources and timely care among newborn parents with mental health conditions.(30, 31) Importantly, we made adjustments in a progressive fashion that demonstrated that infant PTB, in particular, affected the observed association between anxiety grouping and infant outcomes. This observed relationship was further supported by the findings related to the cause of infant death. Infants born to people with a diagnosis of anxiety were more likely to have a final cause of death of perinatal complications or sudden unexpected infant death, which have both been shown to be more common in infants with preterm birth.(32–35) In the final adjusted model, the risk of sudden unexpected infant death was no longer significant. Although these associations are important, the unadjusted risk of adverse outcomes is also relevant in a clinical setting. Notably, these findings align with those of previous investigators.(8–10, 36) Clinical implications This study highlights the vulnerability of infants born to people with anxiety disorders during pregnancy. Detection and treatment of mental health conditions during pregnancy and, importantly, support for parents within the year after birth may help mitigate adverse impacts.(37) Mental health conditions are underdiagnosed and undertreated during pregnancy.(38–40) Data indicate that racially/ethnically marginalized groups and people with low income are especially less likely to receive a diagnosis or treatment.(41–43) There are promising and efficacious treatments for anxiety during pregnancy, and more studies are needed examining how to implement these into clinical and community practices in general and equitably.(38, 44–48) Research Implications This study points to the importance of further investigation into potentially causal mechanisms for observed patterns particularly as they relate to the increased risk observed for infant death when anxiety occurs in isolation compared to when it co-occurs with depression and/or with other mental health conditions. While it is known that perinatal stress, immune, endocrine, microbiome, and placental-related factor patterns differ in people with mental health conditions and their infants and that such patterning is associated with adverse birth and infant outcomes,(21, 49–59) it is not known whether observed patterns differ by the co-occurrence of conditions. Better understanding of these patterns could be key to unlocking novel interventions and for identifying pregnant individuals and infants at increased risk. Strengths and Limitations This study is unique because it uses a large population-based sample to evaluate the risk of key health indicators during the first year of life for an infant. The dataset used has information regarding important comorbidities and infant factors that affected observed relationships. The sample is socially diverse and we are able to provide information about patterning by payer and by racial/ethnic group, although sample sizes became small for infant death. This study, however, is not without limitations. Most notably, we identified anxiety disorders from hospital discharge records. Anxiety disorder and other mental health conditions often go undiagnosed,(38) particularly in racial/ethnic minoritized, low-income, and non-English speaking individuals.(60) Additionally, clinical diagnoses of anxiety during pregnancy is often much lower than self-reported anxiety symptoms during pregnancy – particularly in minoritized racial/ethnic groups.(2) As such, it is important to recognize that this study represents an undercount of the burden of mental health conditions in general and especially in vulnerable subgroups. While we do not believe this underdiagnosis negates the study findings (as the inclusion of undiagnosed individuals in the unaffected comparison group would have pulled the RRs and their 95% CIs to the null), this likely underdiagnosis suggests that results regarding rates of disorders within groups should not be relied upon for public health planning and points to the importance of follow-up studies in clinical settings with universal screening. Also of note is that using an administrative database limits the information we have about the diagnosis, such as length of time with anxiety, treatment, and whether the anxiety continued into the postpartum period. Measurement and consideration of these factors will also be key as this work progresses. We also lack information about health care utilization outside the ED or hospital setting. Consideration of this information will be important in future work. Conclusion Anxiety diagnosis during pregnancy was found to elevate infant risk of death and was exacerbated by the presence of another mental health condition. Infants born to people with anxiety, depression, and other mental health conditions faced triple the risk of death in year one compared to those without anxiety or another mental health condition. Risk of adverse infant outcome was tempered in fully adjusted models suggesting that a multitude of factors influence observed patterns. Study insights underscore the need for stronger support for pregnant and postpartum parents with anxiety and more supportive interventions for their infants and families – overall and particularly, when the person is faced with comorbid mental health conditions. Abbreviations CI 95% confidence interval cRR crude relative risk ED emergency department HCAI California Department of Health Care Access and Information ICD International Classification of Diseases LBW low birth weight PTB preterm birth SAS Statistical Analysis Software SGA small for gestational age WIC Special Supplemental Nutrition Program for Women, Infants, and Children Declarations Ethics approval and consent to participate: Methods and protocols for the study were approved by the Committee for the Protection of Human Subjects within the Health and Human Services Agency of the State of California, which is guided by principles delineated in the Belmont Report. The study approval included a waiver of informed consent and has been ongoing since 2019 with annual reviews. The project number is 2019-024. Consent for publication: not applicable Competing interests: The authors declare that they have no competing interests Funding: None Author Contribution RJB was responsible of obtaining and linking the data, conducting the analysis, and drafting the manuscript; SPO, DA, RA, KCAB, BB, KCP, JNF, DG, AL, SMS, CP, LR, EER, KKR, MAS, AS, and KDT contributed to the conception and design of the work, interpretation of the results, and substantially revised the manuscript. contributed to the conception and design of the work, interpretation of the results, and substantially revised the manuscript; KMT and LJP contributed to the conception and design of the work, interpretation of the results, substantially revised the manuscript, and supervised all the work. All authors have approved the submitted version of the manuscript and agreed both to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature. Acknowledgements: Not applicable Data Availability The data that support the findings of this study are available from the California Department of Health Care Access and Information (https://hcai.ca.gov/data-and-reports/request-data/) and California Vital Statistics (https://www.cdph.ca.gov/Programs/CHSI/Pages/Data-Applications.aspx), but restrictions apply to the availability of these data, which were used under California Committee for the Protection of Human Subjects IRB for the current study, and so are not publicly available. References Fairbrother N, Janssen P, Antony MM, Tucker E, Young AH. 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Disparities in Screening and Treatment Patterns for Depression and Anxiety During Pregnancy: An Integrative Review. J Midwifery Womens Health. 2024. Additional Declarations No competing interests reported. Supplementary Files Appendix1.docx SupplementalTable1.docx Supplementaltable2.docx Supplementaltable3.docx Cite Share Download PDF Status: Published Journal Publication published 23 Dec, 2025 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted Editorial decision: Revision requested 02 Dec, 2025 Reviews received at journal 02 Nov, 2025 Reviews received at journal 19 Oct, 2025 Reviewers agreed at journal 14 Oct, 2025 Reviewers agreed at journal 10 Oct, 2025 Reviewers invited by journal 29 Sep, 2025 Editor invited by journal 26 Sep, 2025 Editor assigned by journal 24 Sep, 2025 Submission checks completed at journal 24 Sep, 2025 First submitted to journal 22 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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14:03:10","extension":"xml","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":136994,"visible":true,"origin":"","legend":"","description":"","filename":"5cc7f77589584d049806d31fa734a5e51structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7687467/v1/83e34bb30f093e15bd154dc0.xml"},{"id":93336000,"identity":"75bb942e-a833-4220-be5f-1b81d4c9f658","added_by":"auto","created_at":"2025-10-12 14:03:10","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":150440,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7687467/v1/3bfbf0c3b1d202698d9b1929.html"},{"id":93337824,"identity":"52358ae0-5f15-479d-b9c2-50fe4237f126","added_by":"auto","created_at":"2025-10-12 14:11:09","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":96663,"visible":true,"origin":"","legend":"\u003cp\u003eSample selection\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7687467/v1/55dcb9ae0abf9cc0f9f2ea52.jpg"},{"id":93338183,"identity":"589da76c-e7b4-44cd-bbd3-bcd00242701f","added_by":"auto","created_at":"2025-10-12 14:19:09","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":273544,"visible":true,"origin":"","legend":"\u003cp\u003eRelative Risk of adverse infant outcome by maternal anxiety diagnosis during pregnancy with or without comorbid mental health diagnosis\u003c/p\u003e\n\u003cp\u003ecRR: unadjusted relative risk\u003c/p\u003e\n\u003cp\u003eaRR1:\u003csup\u003e \u003c/sup\u003eadjusted for preterm birth\u003c/p\u003e\n\u003cp\u003eaRR2: adjusted for preterm birth, racial/ethnicity group, education, payer (when applicable), WIC participation, adequacy of prenatal care, birthing person age, and parity\u003c/p\u003e\n\u003cp\u003eaRR3: adjusted for preterm birth, racial/ethnicity group, education, payer (when applicable), WIC participation, adequacy of prenatal care, birthing person age, parity, gestational diabetes, gestational diabetes, preexisting HTN, gestational HTN, preeclampsia, infection, smoking, drug/alcohol use diagnosis\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7687467/v1/224f74b002ef7c9917d2b8c8.jpg"},{"id":99172908,"identity":"dcc152ea-050f-4846-a047-77f0d191a1cd","added_by":"auto","created_at":"2025-12-29 16:12:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2085541,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7687467/v1/3c21b8c4-0882-4a6e-87ff-d97cbcd56168.pdf"},{"id":93335992,"identity":"4a54a3f2-8514-41f6-b057-a53c0437a84e","added_by":"auto","created_at":"2025-10-12 14:03:09","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":13990,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7687467/v1/2906ee1fd0ab7a633bacea73.docx"},{"id":93335991,"identity":"b06b9a2c-9524-4eb2-96d6-30606ac0207a","added_by":"auto","created_at":"2025-10-12 14:03:09","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":26214,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementalTable1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7687467/v1/82d5a0fa9230c92b4fc5f807.docx"},{"id":93335995,"identity":"34421226-e8ab-4706-ba0c-bdf4ae9a08e2","added_by":"auto","created_at":"2025-10-12 14:03:09","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":20081,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaltable2.docx","url":"https://assets-eu.researchsquare.com/files/rs-7687467/v1/21a600651bec2219d691f903.docx"},{"id":93335998,"identity":"10685c4e-ae20-4faf-af85-7de66bc5b2e8","added_by":"auto","created_at":"2025-10-12 14:03:09","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":23541,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaltable3.docx","url":"https://assets-eu.researchsquare.com/files/rs-7687467/v1/af0bc5a56dec4e0cd77b2009.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Infant Emergency Department Visits, Readmission, and Mortality by Maternal Anxiety Disorder during Pregnancy Occurring with and without Other Mental Health Conditions: A Retrospective Cohort Study","fulltext":[{"header":"Background","content":"\u003cp\u003eMaternal anxiety is common, with approximately 15% of pregnant people receiving a diagnosis of anxiety during pregnancy, and its association with adverse birth outcomes is well-documented.(1, 2) Data have shown that pregnant people with anxiety during pregnancy are at increased risk for adverse birth outcomes like preterm birth (PTB, birth\u0026thinsp;\u0026lt;\u0026thinsp;37 completed weeks of gestation), low birth weight (LBW, birthweight\u0026thinsp;\u0026lt;\u0026thinsp;2500 grams), small for gestational age (SGA, birthweight for sex and gestational age\u0026thinsp;\u0026lt;\u0026thinsp;10th percentile), and infant mortality).(3\u0026ndash;10) Maternal diagnosis of anxiety during pregnancy has also been associated with long-term neurodevelopmental delays, behavioral and emotional difficulties, impaired bonding, and an increased risk for illness and death in infants.(8, 10\u0026ndash;12) The occurrence of other mental health conditions (e.g. depression, schizophrenia, bipolar disorder) during pregnancy are also related to an increased risk of adverse birth and infant outcomes. (4, 8, 9, 13\u0026ndash;20) `\u003c/p\u003e\u003cp\u003eWhile a link between maternal anxiety diagnoses and maternal and infant outcomes during the first year of life has been reported,(8, 10, 13, 14) there is a paucity of data regarding infant outcomes through the first year of life in those born to individuals with anxiety only and anxiety comorbid with other mental health conditions. This is especially true with respect to diagnostic patterns among vulnerable populations, including racially/ethnically marginalized or low-income groups, who are known to be at increased risk for experiencing anxiety during pregnancy and for having adverse maternal and infant outcomes in the year after birth.(2, 4, 8) Further, understanding whether having a comorbid mental health condition is uniquely related to an increased risk in infants is critical for designing personalized care plans and for better understanding the causal underpinnings of anxiety and adverse infant outcome relationships. It is also critical to evaluate these relationships while considering other maternal and infant factors (e.g. PTB, SGA) given established associations with maternal anxiety and with infant outcomes.(3\u0026ndash;6, 8, 21, 22)\u003c/p\u003e\u003cp\u003eHere, we examine the risk of infant readmission, emergency room visits, and death in the first year of life among those born to pregnant individuals with an anxiety disorder alone, an anxiety disorder with depression, an anxiety disorder with a non-depression mental health condition, and among individuals with co-occurring anxiety disorder, depression, and another mental health condition during pregnancy. To fully consider the potential influence of co-variants, we examined sequentially adjusted risk calculations. Patterns of comorbidity and infant outcomes were also examined within payer for birth (as an indicator of income) and racial/ethnic groupings.\u003c/p\u003e"},{"header":"Materials/Subjects and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eSample\u003c/h2\u003e\u003cp\u003eThe sample was drawn from all California live-born infants between 2007 and 2020. Birth certificates, maintained by California Vital Statistics, were linked to hospital discharge, emergency department (ED), and ambulatory surgery records maintained by the California Department of Health Care Access and Information (HCAI).(23) Hospital discharge, ED, and ambulatory surgery files provided diagnoses and procedure codes based on the International Classification of Diseases (ICD), as reported to HCAI by the healthcare facilities.(24, 25) The study sample was restricted to non-anomalous singletons with linked birth records for the birthing person and infant (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eAnxiety and other mental health conditions.\u003c/b\u003e Mental health diagnosis during pregnancy was identified by the presence of a diagnostic code in any HCAI record during pregnancy or for the birth admission. Mental health conditions were grouped as anxiety disorder alone, anxiety and depression, anxiety and other mental health diagnosis (e.g. schizophrenia, bipolar disorder, personality disorder), and anxiety, depression, and other mental health diagnosis (Appendix 1). The reference population was birthing people without any mental health diagnosis on a pregnancy or birth HCAI record. People who had a mental health diagnosis without a diagnosis of anxiety disorder were excluded from the study, for an analytical sample of 126,495 birthing people with an anxiety diagnosis and 5,710,046 birthing people with no mental health diagnosis (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eInfant Outcomes\u003c/h3\u003e\n\u003cp\u003eInfant outcomes in the first year of life included an ED visit, hospital readmission, and/or death. ED visits and readmissions were captured from HCAI records. Death of a liveborn infant was obtained from vital statistics and/or HCAI records (discharge status\u0026thinsp;=\u0026thinsp;died). Final cause of death was reported by California Vital Statistics as a single ICD-10 code for all study years. Cause of death was grouped as perinatal complications, sudden unexpected infant death, non-accidental trauma, and other ICD-10 diagnoses (Appendix 1). Selection of these cause of death groups follows previous literature (8) and aimed to allow large enough cell sizes as well as clinically meaningful groups.\u003c/p\u003e\u003cp\u003e\u003cb\u003eInfant and maternal covariates.\u003c/b\u003e Additional infant and maternal covariates were also considered. Gestational age and PTB (\u0026lt;\u0026thinsp;37 weeks gestation) were determined by the best obstetric estimate from birth certificate records. SGA was defined as a birthweight below the 10th percentile for gestational age and sex(26) using data from birth certificate records. Sociodemographic factors for birthing people included reported racial/ethnic group, education level, expected payer for birth, participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC),(27) and adequacy of prenatal care (calculated using gestational age at delivery, month of gestation at first prenatal care visit, and number of prenatal care visits)(28, 29) and were obtained from birth certificate records. Racial/ethnic group associations were calculated as being part of a group versus not to assess how patterns within a specific group compared to the rest of the population. Maternal health conditions and exposures included diabetes (preexisting or gestational), hypertension (preexisting or gestational), smoking during pregnancy (reported as number of cigarettes by trimester on birth certificate records), and drug or alcohol use during pregnancy. These variables were obtained from HCAI and birth certificate records (Appendix 1). Other maternal covariates included maternal age at the time of birth and parity, recorded in birth certificate records.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStatistical Analysis.\u003c/b\u003e The risk of infant ED visit, readmission, or death was estimated by PTB, SGA, socio-demographic factors, age and parity, and maternal health conditions and exposures using Poisson log-linear regression with no adverse infant outcome as the reference population.\u003c/p\u003e\u003cp\u003eThe risk of anxiety disorder overall and by subgroups of other mental health conditions was estimated by PTB, SGA, sociodemographic factors, maternal age, parity, health conditions, and exposures using Poisson log-linear regression with no adverse infant outcome as the reference population.\u003c/p\u003e\u003cp\u003eEstimates of the relative risk (RR) of adverse infant outcomes and 95% confidence interval (CI) were calculated sequentially using Poisson log-linear regression. For model 1, the unadjusted risk was calculated for each adverse infant outcome. For the adjusted models, the entrance of a potential covariate into any model required a significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) association between anxiety disorder and the potential covariates. Model 2 included adjustment for PTB. Model 3 included adjustment for PTB, significant maternal sociodemographic factors, maternal age at delivery, and parity. Model 4 included all factors in the third model plus significant health conditions and exposures for the birthing person. The risk was also examined within payer (public or non-public) and racial/ethnicity grouping (Asian, Black, Hispanic, Other (includes American Indian/Alaska Native, Native Hawaiian/Pacific Islander, \u0026ldquo;Other race\u0026rdquo;, \u0026ldquo;multiracial\u0026rdquo; (two or more racial groups indicated), unknown/not stated), and by non-Hispanic White). Artificial intelligence (chatgpt.com) was used to create a figure displaying these relative risks.\u003c/p\u003e\u003cp\u003eInfant cause of death was examined across each maternal anxiety group and the risk of each cause of death was estimated in the same sequential fashion as the other adverse infant outcomes.\u003c/p\u003e\u003cp\u003eAll analyses were performed using Statistical Analysis Software version 9.4 (SAS, Cary, NC). Methods and protocols for the study were approved by the Committee for the Protection of Human Subjects within the Health and Human Services Agency of the State of California.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe sample included 5,836,541 births, of whom 126,495 (2.2%) had an anxiety disorder diagnosis during pregnancy or at birth as recorded in an HCAI record. Of the 126,495 birthing people with a diagnosis of an anxiety disorder, 89,297 (70.6%) had a documented anxiety disorder alone, 29,840 (23.6%) had a diagnosis of anxiety and depression (but no other mental health diagnosis), 5,357 (4.2%) had anxiety and a non-depression mental health diagnosis, and 2,001 (1.6%) had anxiety with depression and another mental health diagnosis.\u003c/p\u003e\u003cp\u003eRisk factors for adverse infant outcomes included PTB, education\u0026thinsp;\u0026lt;\u0026thinsp;12 years, public insurance, WIC participation, inadequate prenatal care, \u0026lt;\u0026thinsp;18 years of age at delivery, infection, smoking during pregnancy, and drug/alcohol use during pregnancy (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). When compared to all other racial/ethnicity groups, Hispanic, Black, American Indian/Alaska Native, and Native Hawaiian/Pacific Islander groups were found to be more likely to have an infant with an ED visit, readmission, or death in the first year while Asian and White groups were less likely (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAssociation of infant and birthing person factors with adverse infant outcome\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo ED Visit, Readmission or Death\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eED Visit\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReadmission\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eDeath\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ecRR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ecRR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ecRR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ecRR\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSample\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3,815,284\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,722,714\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e548,636\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e17,076\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eInfant factors\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePreterm birth\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;37 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e219,116 (5.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e123,083 (7.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e58,058 (10.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8,756 (51.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.2 (1.2, 1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.8 (1.8, 1.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e18.2 (17.7, 18.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;37 weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3,591,328 (94.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,597,305 (92.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e479,869 (89.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7,582 (44.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSmall for gestational age\u003c/b\u003e\u003csup\u003e\u003cb\u003ec\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e318,448 (8.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e153,702 (8.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e49,779 (9.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2,039 (11.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.1 (1.0, 1.1)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.1 (1.1, 1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.5 (1.4, 1.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eBirthing person socio-demographic factors\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRacial/ethnic group\u003c/b\u003e\u003csup\u003e\u003cb\u003ec\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHispanic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,741,941 (45.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,041,710 (60.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e296,945 (55.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8,591 (50.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.5 (1.5, 1.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.4 (1.4, 1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.2 (1.2, 1.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-Hispanic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAsian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e632,715 (16.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e136,795 (7.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e63,090 (11.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1,750 (10.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.5 (0.5, 0.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.7 (0.7, 0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.6 (0.5, 0.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlack\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e156,081 (4.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e116,104 (6.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29,849 (5.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1,966 (11.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.4 (1.4, 1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.3 (1.3, 1.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.0 (2.9, 3.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e197,813 (5.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e74,443 (4.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25,488 (4.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1,268 (7.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.0 (1.0, 1.0)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.0 (1.0, 1.0)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.3 (1.2, 1.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAmerican Indian/Alaska Native\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11,902 (0.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6,059 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1,870 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e83 (0.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.1 (1.1, 1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.1 (1.0, 1.1)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.6 (1.3, 1.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNative Hawaiian/Pacific Islander\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13,950 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7,612 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2,583 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e110 (0.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.1 (1.1, 1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.3 (1.2, 1.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.8 (1.5, 2.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ldquo;Other\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2,121 (0.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e954 (0.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e289 (0.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.0 (0.9, 1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.0 (0.9, 1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.1 (0.6, 2.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMultiracial\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e80,904 (2.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32,423 (1.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10,221 (1.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e403 (2.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.9 (0.9, 0.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.9 (0.9, 0.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.1 (1.0, 1.2)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhite\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,086,734 (28.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e353,661 (20.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e123,264 (22.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3,501 (20.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.7 (0.7, 0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.8 (0.8, 0.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.6 (0.6, 0.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e619,083 (16.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e434,170 (25.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e123,036 (22.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3,734 (21.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.1 (1.1, 1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.2 (1.1, 1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.1 (1.0, 1.1)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e861,472 (22.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e515,706 (29.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e144,395 (26.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4,867 (28.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2,167,378 (56.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e707,381 (41.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e248,643 (46.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7,013 (41.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.7 (0.7, 0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.7 (0.7, 0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.6 (0.6, 0.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePayer for birth\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrivate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2,044,189 (53.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e589,739 (34.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e216,546 (40.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6,395 (37.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePublic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,507,414 (39.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,053,869 (61.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e294,394 (54.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9,497 (55.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.8 (1.8, 1.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.7 (1.7, 1.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.0 (1.9, 2.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTRICARE (Active Duty Military)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18,431 (0.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5,714 (0.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1,991 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e64 (0.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.1 (1.0, 1.1)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.0 (1.0, 1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.1 (0.9, 1.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e245,250 (6.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73,392 (4.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25,705 (4.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1,120 (6.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.03 (1.0, 1.0)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.0 (1.0, 1.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.5 (1.4, 1.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWIC participation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2,127,705 (55.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e596,300 (34.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e225,192 (41.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7,852 (46.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,649,863 (43.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,111,038 (64.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e308,088 (57.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8,683 (50.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.8 (1.8, 1.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.6 (1.6, 1.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.4 (1.4, 1.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAdequacy of prenatal care\u003c/b\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdequate plus/adequate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2,761,556 (72.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,218,460 (70.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e389,150 (72.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9,745 (57.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntermediate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e534,618 (14.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e237,599 (13.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e70,504 (13.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1,688 (9.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.01 (1.0, 1.0)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.9 (0.9, 1.0)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.9 (0.9, 0.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInadequate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e374,881 (9.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e199,258 (11.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e57,399 (10.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2,423 (14.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.1 (1.1, 1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.1 (1.1, 1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.8 (1.7, 1.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eOther birthing person factors\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge at delivery (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;18\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60,952 (1.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50,771 (3.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13,189 (2.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e517 (3.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.4 (1.4, 1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.4 (1.4, 1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.8 (1.7, 2.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18\u0026ndash;34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2,916,656 (76.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,408,955 (81.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e425,822 (79.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13,454 (78.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e837,556 (22.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e262,945 (15.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e99,609 (18.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3,096 (18.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.7 (0.7, 0.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.8 (0.8, 0.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.8 (0.8, 0.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eParity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNulliparous\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1,487,757 (39.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e668,191 (38.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e201,613 (37.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6,975 (40.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.99 (1.0, 1.0)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.9 (0.9, 0.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.1 (1.0, 1.1)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMultiparous\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2,324,378 (60.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,053,250 (61.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e336,588 (62.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9,988 (58.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eHealth conditions/exposures\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDiabetes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3,407,644 (89.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,561,940 (90.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e483,160 (89.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15,363 (90.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGestational diabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e367,170 (9.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e144,966 (8.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48,723 (9.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1,341 (7.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.9 (0.9, 0.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.9 (0.9, 1.0)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.8 (0.8, 0.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePre-existing diabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40,470 (1.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15,808 (0.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6,753 (1.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e372 (2.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.9 (0.9, 0.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.2 (1.1, 1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.5 (2.3, 2.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHypertension\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3,479,416 (91.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1,584,916 (92.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e493,274 (91.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14,898 (87.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGestational hypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e117,996 (3.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45,433 (2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13,989 (2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e407 (2.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.9 (0.9, 0.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.9 (0.8, 0.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.8 (0.7, 0.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePre-existing hypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50,355 (1.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20,674 (1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6,967 (1.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e464 (2.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.9 (0.9, 0.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.0 (1.0, 1.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.1 (2.0, 2.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreeclampsia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e147,110 (3.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62,384 (3.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21,545 (4.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1,157 (6.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.96 (1.0, 1.0)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.0 (1.0, 1.1)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.9 (1.8, 2.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eInfection\u003c/b\u003e\u003csup\u003e\u003cb\u003ec\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e309,394 (8.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e188,580 (11.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e55,501 (10.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2,771 (16.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.2 (1.2, 1.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.3 (1.2, 1.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.2 (2.1, 2.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSmoked during pregnancy\u003c/b\u003e\u003csup\u003e\u003cb\u003ec\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e72,455 (1.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52,686 (3.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14,252 (2.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1,004 (5.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.4 (1.4, 1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.3 (1.3, 1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.2 (3.0, 3.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDrug/alcohol use during pregnancy\u003c/b\u003e\u003csup\u003e\u003cb\u003ec\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60,351 (1.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34,207 (2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11,392 (2.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e939 (5.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.2 (1.2, 1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.3 (1.3, 1.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.6 (3.4, 3.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eWIC: Special Supplemental Nutrition Program for Women, Infants, and Children\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003ecRR: unadjusted relative risk\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ea\u003c/sup\u003ep\u0026lt;0.05\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003eb\u003c/sup\u003eBased on Kotelcheck and colleagues(29)\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ec\u003c/sup\u003eversus no\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ed\u003c/sup\u003en \u0026lt; 11\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eA higher proportion of people with a diagnosis of anxiety during pregnancy were self-reported Non-Hispanic Black, American Indian/Alaska Native, multi-racial, or White compared to birthing people without a mental health diagnosis. The majority of people with or without an anxiety disorder had an education\u0026thinsp;\u0026gt;\u0026thinsp;12 years, have private insurance, and had adequate prenatal care, although these rates were higher among people with a diagnosis of anxiety. People with an anxiety disorder during pregnancy were more likely to have a PTB, have gestational diabetes, preexisting diabetes, gestational hypertension, preexisting hypertension, preeclampsia, infection, smoked during pregnancy, and used drugs/alcohol during pregnancy compared to people without a mental health diagnosis. These patterns were generally consistent across subgroups with anxiety (anxiety alone, anxiety and depression, anxiety and non-depression mental health diagnosis, or anxiety, depression, and other mental health diagnosis) (Supplemental table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn unadjusted models, birthing people with an anxiety disorder alone, or anxiety and depression only were less likely to have an infant with an ED visit (crude relative risks (cRRs) 0.85\u0026ndash;0.93) or readmission in the first year of life (cRR 0.83\u0026ndash;0.85) but were more likely to experience an infant death (cRR 1.50\u0026ndash;1.75) compared to birthing people without a mental health diagnosis. In the fully adjusted model, birthing people with anxiety alone or anxiety and depression were less likely to have an infant with a readmission (adjusted risk ratios (aRRs) 0.87 and 0.81, respectively), and those with anxiety and depression were less likely to have an infant with an ED visit (aRR 0.92). The risk of infant death was 1.18 to 1.19 in the final adjusted model for people with anxiety alone or anxiety and depression (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, supplemental table \u003cspan refid=\"MOESM2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). In unadjusted models, birthing people with anxiety disorder and a non-depression mental health diagnosis were at increased risk of an infant with an ED visit (cRR 1.14 to 1.16) and infant death (cRR 2.07 to 3.81). The final adjusted model attenuated these risks (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, supplemental table \u003cspan refid=\"MOESM2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eUnadjusted risk of infant death due to perinatal complications and sudden unexpected infant death were elevated among people with an anxiety disorder during pregnancy (perinatal complications cRR 1.30 to 5.25; sudden unexpected infant death cRR 1.52 to 3.70) compared to people without a mental health diagnosis. The risk of sudden unexpected infant death remained elevated among people with an anxiety disorder during pregnancy for the first two adjusted models, but were no longer significant in the final model. The sample size was too small to examine cause of death across subgroups of anxiety diagnoses separately, but together these infants were at an elevated risk of death due to perinatal complications in all models (cRR 5.25, final model aRR 1.77)(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCause of infant death by anxiety disorder.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWithout mental health diagnosis\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAnxiety only\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAnxiety and depression only\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAnxiety and non-depression mental health disorder only\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eAnxiety, depression, and other diagnosis\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ecRR (95% CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ecRR (95% CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ecRR (95% CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ecRR (95% CI)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eaRR1 (95% CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eaRR1 (95% CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eaRR1 (95% CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eaRR1 (95% CI)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eaRR2 (95% CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eaRR2 (95% CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eaRR2 (95% CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eaRR2 (95% CI)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eaRR3 (95% CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eaRR3 (95% CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eaRR3 (95% CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eaRR3 (95% CI)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurvived to 1 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5,710,046\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e89,297\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29,840\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5,357\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2,001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerinatal complications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8,168 (0.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e166 (0.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e64 (0.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15 (0.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e15 (0.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e1.30 (1.12, 1.52)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.50 (1.17, 1.92)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e1.96 (1.18, 3.25)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e5.25 (3.16, 8.71)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.97 (0.84, 1.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.98 (0.77, 1.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.17 (0.70, 1.93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e2.53 (1.52, 4.20)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.00 (0.85, 1.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.02 (0.80, 1.30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.07 (0.65, 1.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e2.39 (1.44, 3.97)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.93 (0.80, 1.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.92 (0.72, 1.18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.87 (0.52, 1.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e1.77 (1.06, 2.96)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSudden unexpected infant death\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2,312 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55 (0.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24 (0.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e1.52 (1.17, 1.99)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.99 (1.33, 2.97)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e3.70 (1.85, 7.40)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e1.47 (1.13, 1.92)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e1.88 (1.26, 2.81)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e3.44 (1.72, 6.89)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e1.73 (1.32, 2.26)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e2.24 (1.50, 3.36)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e2.95 (1.47, 5.91)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.21 (0.92, 1.59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.25 (0.83, 1.87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.01 (0.50, 2.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-accidental trauma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e238 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.35 (0.55, 3.26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.29 (0.53, 3.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.53 (0.63, 3.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.22 (0.50, 2.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2,020 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16 (0.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.20 (0.87, 1.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.52 (0.93, 2.48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e2.65 (1.10, 6.36)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.07 (0.78, 1.48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.27 (1.78, 2.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.11 (0.88, 5.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.17 (0.85, 1.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.41 (0.86, 2.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.94 (0.81, 4.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.99 (0.72, 1.37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.08 (0.66, 1.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.09 (0.45, 2.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003ecRR: unadjusted relative risk\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eaRR1: adjusted for preterm birth\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eaRR2: adjusted for preterm birth, education, payer, WIC participation, adequacy of prenatal care, birthing person age, and parity\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eaRR3: adjusted for preterm birth, education, payer, WIC participation, adequacy of prenatal care, birthing person age, parity, gestational diabetes, gestational diabetes, preexisting HTN, gestational HTN, preeclampsia, infection, smoking, drug/alcohol use diagnosis\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003ea\u003c/sup\u003enot displayed when n\u0026thinsp;\u0026lt;\u0026thinsp;11\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003eb\u003c/sup\u003enot calculated when n\u0026thinsp;\u0026lt;\u0026thinsp;5\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003ePatterns of infant outcome risk stratified by anxiety group, payer, and racial/ethnic group were similar in magnitude, although they were often not found to be significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 due, in part, to sample size. A notable difference was that infants born to those with anxiety alone and public health insurance were at slightly increased risk of an ED visit in all models. Unadjusted risk of infant death was highest among people with anxiety, depression, and another mental health diagnosis during pregnancy. Generally, people with anxiety alone or anxiety and depression were less likely to have an infant readmitted to the hospital during the first year of life (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, supplemental table \u003cspan refid=\"MOESM2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, supplemental table \u003cspan refid=\"MOESM3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eUsing a large population-based California sample, we found that birthing people with an anxiety disorder alone were less likely to have an infant with an ED visit or readmission during the first year of life, but were at higher risk of experiencing an infant death compared to people without a documented mental health diagnosis during pregnancy. In contrast, those with anxiety and a non-depression mental health diagnosis were more likely to have an infant with an ED visit or readmission during the first year of life, and were at an unadjusted 2.1 to 3.8-fold higher risk of experiencing an infant death. These associations held after adjusting for infant and maternal factors.\u003c/p\u003e\u003cp\u003eFor all groups with an anxiety disorder, patterns by payer for delivery and racial/ethnic group varied, but general findings matched the overall population results, with the exception of people with anxiety alone and public health insurance being at slightly increased risk of an infant with an ED visit. People with an anxiety disorder were more likely to experience an infant death due to perinatal complications and sudden unexpected infant death. These risks, however, were no longer significant in the fully adjusted model, indicating that the association was confounded by factors not related to mental health.\u003c/p\u003e\n\u003ch3\u003eResults in context of what is known\u003c/h3\u003e\n\u003cp\u003eMaternal anxiety during pregnancy has been associated with PTB, LBW, and SGA at birth,(3\u0026ndash;7) and for adverse childhood outcomes like neurodevelopmental, behavioral, and emotional challenges.(11, 12) Other mental health conditions, such as depression, have also been shown to be associated with adverse infant outcomes (e.g. preterm birth, low birthweight). Notably, we previously demonstrated that people with a mental health disorder during pregnancy (including anxiety disorders) were at increased risk of having an infant with a visit to the ED, readmission, or death in the first year of life in a similar population-based sample but we did not examine outcomes by patterns of co-occurring mental health conditions.(8)\u003c/p\u003e\u003cp\u003eThe findings in this paper further evaluate infant health indicators among people with anxiety disorders during pregnancy. We found that infants born to people with a diagnosed anxiety disorder alone or anxiety with depression were less likely to have an ED visit or readmission but more likely to experience an infant death. These findings align with others and may highlight opportunities for interventions that improve access to resources and timely care among newborn parents with mental health conditions.(30, 31)\u003c/p\u003e\u003cp\u003eImportantly, we made adjustments in a progressive fashion that demonstrated that infant PTB, in particular, affected the observed association between anxiety grouping and infant outcomes. This observed relationship was further supported by the findings related to the cause of infant death. Infants born to people with a diagnosis of anxiety were more likely to have a final cause of death of perinatal complications or sudden unexpected infant death, which have both been shown to be more common in infants with preterm birth.(32\u0026ndash;35) In the final adjusted model, the risk of sudden unexpected infant death was no longer significant. Although these associations are important, the unadjusted risk of adverse outcomes is also relevant in a clinical setting. Notably, these findings align with those of previous investigators.(8\u0026ndash;10, 36)\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eClinical implications\u003c/h2\u003e\u003cp\u003eThis study highlights the vulnerability of infants born to people with anxiety disorders during pregnancy. Detection and treatment of mental health conditions during pregnancy and, importantly, support for parents within the year after birth may help mitigate adverse impacts.(37) Mental health conditions are underdiagnosed and undertreated during pregnancy.(38\u0026ndash;40) Data indicate that racially/ethnically marginalized groups and people with low income are especially less likely to receive a diagnosis or treatment.(41\u0026ndash;43) There are promising and efficacious treatments for anxiety during pregnancy, and more studies are needed examining how to implement these into clinical and community practices in general and equitably.(38, 44\u0026ndash;48)\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eResearch Implications\u003c/h3\u003e\n\u003cp\u003eThis study points to the importance of further investigation into potentially causal mechanisms for observed patterns particularly as they relate to the increased risk observed for infant death when anxiety occurs in isolation compared to when it co-occurs with depression and/or with other mental health conditions. While it is known that perinatal stress, immune, endocrine, microbiome, and placental-related factor patterns differ in people with mental health conditions and their infants and that such patterning is associated with adverse birth and infant outcomes,(21, 49\u0026ndash;59) it is not known whether observed patterns differ by the co-occurrence of conditions. Better understanding of these patterns could be key to unlocking novel interventions and for identifying pregnant individuals and infants at increased risk.\u003c/p\u003e\n\u003ch3\u003eStrengths and Limitations\u003c/h3\u003e\n\u003cp\u003eThis study is unique because it uses a large population-based sample to evaluate the risk of key health indicators during the first year of life for an infant. The dataset used has information regarding important comorbidities and infant factors that affected observed relationships. The sample is socially diverse and we are able to provide information about patterning by payer and by racial/ethnic group, although sample sizes became small for infant death. This study, however, is not without limitations. Most notably, we identified anxiety disorders from hospital discharge records. Anxiety disorder and other mental health conditions often go undiagnosed,(38) particularly in racial/ethnic minoritized, low-income, and non-English speaking individuals.(60) Additionally, clinical diagnoses of anxiety during pregnancy is often much lower than self-reported anxiety symptoms during pregnancy \u0026ndash; particularly in minoritized racial/ethnic groups.(2) As such, it is important to recognize that this study represents an undercount of the burden of mental health conditions in general and especially in vulnerable subgroups. While we do not believe this underdiagnosis negates the study findings (as the inclusion of undiagnosed individuals in the unaffected comparison group would have pulled the RRs and their 95% CIs to the null), this likely underdiagnosis suggests that results regarding rates of disorders within groups should not be relied upon for public health planning and points to the importance of follow-up studies in clinical settings with universal screening.\u003c/p\u003e\u003cp\u003eAlso of note is that using an administrative database limits the information we have about the diagnosis, such as length of time with anxiety, treatment, and whether the anxiety continued into the postpartum period. Measurement and consideration of these factors will also be key as this work progresses. We also lack information about health care utilization outside the ED or hospital setting. Consideration of this information will be important in future work.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAnxiety diagnosis during pregnancy was found to elevate infant risk of death and was exacerbated by the presence of another mental health condition. Infants born to people with anxiety, depression, and other mental health conditions faced triple the risk of death in year one compared to those without anxiety or another mental health condition. Risk of adverse infant outcome was tempered in fully adjusted models suggesting that a multitude of factors influence observed patterns. Study insights underscore the need for stronger support for pregnant and postpartum parents with anxiety and more supportive interventions for their infants and families \u0026ndash; overall and particularly, when the person is faced with comorbid mental health conditions.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003e95% confidence interval\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ecRR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ecrude relative risk\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eED\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eemergency department\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHCAI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCalifornia Department of Health Care Access and Information\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eICD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInternational Classification of Diseases\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLBW\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003elow birth weight\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePTB\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003epreterm birth\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSAS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eStatistical Analysis Software\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSGA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003esmall for gestational age\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eWIC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eSpecial Supplemental Nutrition Program for Women, Infants, and Children\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eEthics approval and consent to participate:\u003c/h2\u003e\u003cp\u003e Methods and protocols for the study were approved by the Committee for the Protection of Human Subjects within the Health and Human Services Agency of the State of California, which is guided by principles delineated in the Belmont Report. The study approval included a waiver of informed consent and has been ongoing since 2019 with annual reviews. The project number is 2019-024.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003cp\u003enot applicable\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting interests:\u003c/h2\u003e\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003eNone\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eRJB was responsible of obtaining and linking the data, conducting the analysis, and drafting the manuscript; SPO, DA, RA, KCAB, BB, KCP, JNF, DG, AL, SMS, CP, LR, EER, KKR, MAS, AS, and KDT contributed to the conception and design of the work, interpretation of the results, and substantially revised the manuscript. contributed to the conception and design of the work, interpretation of the results, and substantially revised the manuscript; KMT and LJP contributed to the conception and design of the work, interpretation of the results, substantially revised the manuscript, and supervised all the work. All authors have approved the submitted version of the manuscript and agreed both to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature.\u003c/p\u003e\u003ch2\u003eAcknowledgements:\u003c/h2\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data that support the findings of this study are available from the California Department of Health Care Access and Information (https://hcai.ca.gov/data-and-reports/request-data/) and California Vital Statistics (https://www.cdph.ca.gov/Programs/CHSI/Pages/Data-Applications.aspx), but restrictions apply to the availability of these data, which were used under California Committee for the Protection of Human Subjects IRB for the current study, and so are not publicly available.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eFairbrother N, Janssen P, Antony MM, Tucker E, Young AH. Perinatal anxiety disorder prevalence and incidence. J Affect Disord. 2016;200:148 − 55.\u003c/li\u003e\n\u003cli\u003eDennis CL, Falah-Hassani K, Shiri R. Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis. Br J Psychiatry. 2017;210(5):315 − 23.\u003c/li\u003e\n\u003cli\u003eDing XX, Wu YL, Xu SJ, Zhu RP, Jia XM, Zhang SF, et al. Maternal anxiety during pregnancy and adverse birth outcomes: a systematic review and meta-analysis of prospective cohort studies. J Affect Disord. 2014;159:103 − 10.\u003c/li\u003e\n\u003cli\u003eBaer RJ, Chambers CD, Bandoli G, Jelliffe-Pawlowski LL. Risk of preterm birth by subtype among Medi-Cal participants with mental illness. Am J Obstet Gynecol. 2016;215(4):519.e1-9.\u003c/li\u003e\n\u003cli\u003eLiou SR, Wang P, Cheng CY. Effects of prenatal maternal mental distress on birth outcomes. Women Birth. 2016;29(4):376 − 80.\u003c/li\u003e\n\u003cli\u003eGelaye B, Sanchez SE, Andrade A, Gómez O, Coker AL, Dole N, et al. 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Factors Related to Seeking Help for Postpartum Depression: A Secondary Analysis of New York City PRAMS Data. Int J Environ Res Public Health. 2020;17(24).\u003c/li\u003e\n\u003cli\u003eOltman SP, Rogers EE, Baer RJ, Amsalu R, Bandoli G, Chambers CD, et al. Early Newborn Metabolic Patterning and Sudden Infant Death Syndrome. JAMA Pediatr. 2024;178(11):1183-91.\u003c/li\u003e\n\u003cli\u003eBandoli G, Baer RJ, Owen M, Kiernan E, Jelliffe-Pawlowski L, Kingsmore S, et al. Maternal, infant, and environmental risk factors for sudden unexpected infant deaths: results from a large, administrative cohort. J Matern Fetal Neonatal Med. 2022;35(25):8998–9005.\u003c/li\u003e\n\u003cli\u003eMontgomery M, Conrey E, Okoroh E, Kroelinger C. Estimating the Burden of Prematurity on Infant Mortality: A Comparison of Death Certificates and Child Fatality Review in Ohio, 2009–2013. Matern Child Health J. 2020;24(2):135 − 43.\u003c/li\u003e\n\u003cli\u003eKroll ME, Kurinczuk JJ, Hollowell J, Macfarlane A, Li Y, Quigley MA. Ethnic and socioeconomic variation in cause-specific preterm infant mortality by gestational age at birth: national cohort study. Arch Dis Child Fetal Neonatal Ed. 2020;105(1):56–63.\u003c/li\u003e\n\u003cli\u003ePavlov M, Steiner N, Kessous R, Weintraub AY, Sheiner E. Obstetric and neonatal outcome in patients with anxiety disorders. J Matern Fetal Neonatal Med. 2014;27(13):1339-42.\u003c/li\u003e\n\u003cli\u003eZivin K, Zhang X, Tilea A, Clark SJ, Hall SV. Relationship between Depression and Anxiety during Pregnancy, Delivery-Related Outcomes, and Healthcare Utilization in Michigan Medicaid, 2012–2021. Healthcare (Basel). 2023;11(22).\u003c/li\u003e\n\u003cli\u003eCox EQ, Sowa NA, Meltzer-Brody SE, Gaynes BN. The Perinatal Depression Treatment Cascade: Baby Steps Toward Improving Outcomes. J Clin Psychiatry. 2016;77(9):1189 − 200.\u003c/li\u003e\n\u003cli\u003eGoodman JH, Tyer-Viola L. Detection, Treatment, and Referral of Perinatal Depression and Anxiety by Obstetrical Providers. Journal of Women's Health. 2010;19(3):477 − 90.\u003c/li\u003e\n\u003cli\u003eKoerner R, Rechenberg K, Rinaldi K, Duffy A. Are Providers Adequately Screening for Anxiety Symptoms During Pregnancy? Nursing for Women's Health. 2024;28(2):109 − 16.\u003c/li\u003e\n\u003cli\u003eAyyash M, McNitt M, Miller ME, Swain M. Racial \u0026amp; ethnic disparities in prenatal care \u0026amp; pregnancy outcomes - an ongoing challenge. American Journal of Obstetrics \u0026amp; Gynecology. 2023;228(1):S694-S5.\u003c/li\u003e\n\u003cli\u003eJuntunen CL, Pietrantonio KR, Hirsch JK, Greig A, Thompson MN, Ross DE, et al. Guidelines for psychological practice for people with low-income and economic marginalization: Executive summary. American Psychologist. 2022;77(2):291–303.\u003c/li\u003e\n\u003cli\u003eFaisal-Cury A, Levy RB, Azeredo CM, Matijasevich A. Prevalence and associated risk factors of prenatal depression underdiagnosis: A population-based study. International Journal of Gynecology \u0026amp; Obstetrics. 2021;153(3):469 − 75.\u003c/li\u003e\n\u003cli\u003eGuo X, Guo X, Wang R, Zhang Y. Effects of Perinatal Cognitive Behavioral Therapy on Delivery Mode, Fetal Outcome, and Postpartum Depression and Anxiety in Women. Comput Math Methods Med. 2022;2022:8304405.\u003c/li\u003e\n\u003cli\u003eChallacombe FL, Tinch-Taylor R, Sabin K, Potts L, Lawrence V, Howard L, et al. Exposure-based cognitive-behaviour therapy for anxiety-related disorders in pregnancy (ADEPT): Results of a feasibility randomised controlled trial of time-intensive versus weekly CBT. J Affect Disord. 2024;344:414 − 22.\u003c/li\u003e\n\u003cli\u003eSkovbjerg S, Sumbundu A, Kolls M, Kjærbye-Thygesen A, Fjorback LO. The effect of an adapted Mindfulness-Based Stress Reduction program on mental health, maternal bonding and birth outcomes in psychosocially vulnerable pregnant women: a study protocol for a randomized controlled trial in a Danish hospital-based outpatient setting. BMC Complement Med Ther. 2023;23(1):364.\u003c/li\u003e\n\u003cli\u003eZafman KB, Riegel ML, Levine LD, Hamm RF. An interactive childbirth education platform to improve pregnancy-related anxiety: a randomized trial. Am J Obstet Gynecol. 2023;229(1):67.e1-.e9.\u003c/li\u003e\n\u003cli\u003ePonting C, Mahrer NE, Zelcer H, Dunkel Schetter C, Chavira DA. Psychological interventions for depression and anxiety in pregnant Latina and Black women in the United States: A systematic review. Clin Psychol Psychother. 2020;27(2):249 − 65.\u003c/li\u003e\n\u003cli\u003eRoss KM, Mander H, Rinne G, Okun M, Hobel C, Coussons-Read M, et al. Pregnancy-specific anxiety and gestational length: The mediating role of diurnal cortisol indices. Psychoneuroendocrinology. 2023;153:106114.\u003c/li\u003e\n\u003cli\u003eGalley JD, Mashburn-Warren L, Blalock LC, Lauber CL, Carroll JE, Ross KM, et al. Maternal anxiety, depression and stress affects offspring gut microbiome diversity and bifidobacterial abundances. Brain Behav Immun. 2023;107:253 − 64.\u003c/li\u003e\n\u003cli\u003eÖzdamar Ünal G, Hekimler Öztürk K, Erkılınç G, Dönmez F, Kumbul Doğuç D, Özmen Ö, et al. Maternal prenatal stress and depression-like behavior associated with hippocampal and cortical neuroinflammation in the offspring: An experimental study. Int J Dev Neurosci. 2022;82(3):231 − 42.\u003c/li\u003e\n\u003cli\u003eGustafsson HC, Sullivan EL, Nousen EK, Sullivan CA, Huang E, Rincon M, et al. Maternal prenatal depression predicts infant negative affect via maternal inflammatory cytokine levels. Brain Behav Immun. 2018;73:470 − 81.\u003c/li\u003e\n\u003cli\u003eZijlmans MA, Korpela K, Riksen-Walraven JM, de Vos WM, de Weerth C. Maternal prenatal stress is associated with the infant intestinal microbiota. Psychoneuroendocrinology. 2015;53:233 − 45.\u003c/li\u003e\n\u003cli\u003eTartour AI, Chivese T, Eltayeb S, Elamin FM, Fthenou E, Seed Ahmed M, et al. Prenatal psychological distress and 11β-HSD2 gene expression in human placentas: Systematic review and meta-analysis. Psychoneuroendocrinology. 2024;166:107060.\u003c/li\u003e\n\u003cli\u003eSumption LA, Garay SM, John RM. Low serum placental lactogen at term is associated with postnatal symptoms of depression and anxiety in women delivering female infants. Psychoneuroendocrinology. 2020;116:104655.\u003c/li\u003e\n\u003cli\u003eLiu H, Liu Y, Huang K, Yan S, Hao J, Zhu P, et al. Gender-specific associations of pregnancy-related anxiety with placental epigenetic patterning of glucocorticoid response genes and preschooler's emotional symptoms and hyperactivity. BMC Pediatr. 2021;21(1):479.\u003c/li\u003e\n\u003cli\u003eLitzky JF, Deyssenroth MA, Everson TM, Lester BM, Lambertini L, Chen J, et al. Prenatal exposure to maternal depression and anxiety on imprinted gene expression in placenta and infant neurodevelopment and growth. Pediatr Res. 2018;83(5):1075-83.\u003c/li\u003e\n\u003cli\u003eDingsdale H, Nan X, Garay SM, Mueller A, Sumption LA, Chacón-Fernández P, et al. The placenta protects the fetal circulation from anxiety-driven elevations in maternal serum levels of brain-derived neurotrophic factor. Transl Psychiatry. 2021;11(1):62.\u003c/li\u003e\n\u003cli\u003eCreeth HDJ, John RM. The placental programming hypothesis: Placental endocrine insufficiency and the co-occurrence of low birth weight and maternal mood disorders. Placenta. 2020;98:52 − 9.\u003c/li\u003e\n\u003cli\u003eEakley R, Lyndon A. Disparities in Screening and Treatment Patterns for Depression and Anxiety During Pregnancy: An Integrative Review. J Midwifery Womens Health. 2024.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"anxiety, depression, mental health disorder, adverse outcome, infant, emergency department, readmission, infant death","lastPublishedDoi":"10.21203/rs.3.rs-7687467/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7687467/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eWhile a link between maternal anxiety diagnoses and adverse maternal and infant outcomes has been reported, there is a paucity of data regarding infant outcomes through the first year of life in those born to individuals with anxiety only and anxiety comorbid with other mental health conditions.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e\u003cp\u003eThe sample included 5,836,541 singleton liveborn infants in California from 2007\u0026ndash;2020. Anxiety with and without depression or a non-depression mental health condition during pregnancy were identified from ICD codes from hospital discharge records. Adverse infant outcomes evaluated included emergency department (ED) visit, readmission, or death in the first year of life. Log-linear regression was used to calculate the crude (cRR) and adjusted (aRR) relative risk and 95% confidence interval (CI) of each outcome by mental health condition grouping. To fully consider the potential influence of co-variants, we examined four different adjusted risk calculations. Patterns of comorbidity and infant outcomes were also examined within payer for birth (as an indicator of income) and racial/ethnic groupings.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eInfants of birthing people diagnosed with anxiety alone or anxiety and depression had reduced ED visits (cRRs 0.93 and 0.85, respectively) and readmissions (cRRs 0.85 and 0.83) but an increased risk of death (cRRs 1.40 and 1.75) compared to those without any mental health condition. Infants of people with diagnoses of anxiety and other non-depression conditions during pregnancy faced higher risks across all metrics (ED visits and readmissions cRRs 1.14\u0026ndash;1.20, death cRRs 2.07\u0026ndash;3.81). Observed were often tempered in fully adjusted models.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eMaternal anxiety diagnosis during pregnancy was associated with an elevated risk of infant death and was exacerbated by the presence of another mental health condition. These relationships were not explained by the presence of other related risks. These findings underscore the need for interventions for birthing people with anxiety, and particularly for those with comorbid mental health conditions.\u003c/p\u003e","manuscriptTitle":"Infant Emergency Department Visits, Readmission, and Mortality by Maternal Anxiety Disorder during Pregnancy Occurring with and without Other Mental Health Conditions: A Retrospective Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-12 14:03:05","doi":"10.21203/rs.3.rs-7687467/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-02T12:53:35+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-02T13:47:18+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-19T16:32:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"163358512301514774977884660463710470674","date":"2025-10-15T01:06:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"282660377603153136099222120583993698466","date":"2025-10-10T14:34:52+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-29T05:39:58+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-26T17:05:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-24T08:49:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-24T08:45:56+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2025-09-22T18:41:59+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f1a5b10d-841f-49c0-af0a-399a0a010b94","owner":[],"postedDate":"October 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-29T16:10:41+00:00","versionOfRecord":{"articleIdentity":"rs-7687467","link":"https://doi.org/10.1186/s12884-025-08603-y","journal":{"identity":"bmc-pregnancy-and-childbirth","isVorOnly":false,"title":"BMC Pregnancy and Childbirth"},"publishedOn":"2025-12-23 15:58:16","publishedOnDateReadable":"December 23rd, 2025"},"versionCreatedAt":"2025-10-12 14:03:05","video":"","vorDoi":"10.1186/s12884-025-08603-y","vorDoiUrl":"https://doi.org/10.1186/s12884-025-08603-y","workflowStages":[]},"version":"v1","identity":"rs-7687467","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7687467","identity":"rs-7687467","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}