BACKGROUND: Mental health disorders and substance use during pregnancy have been linked to adverse perinatal outcomes. Early identification may improve maternal and neonatal health. This study evaluated the impact of mental health disorder severity and alcohol consumption on perinatal outcomes. METHODS: A cohort of 2,014 pregnant women was screened with the AC-OK instrument for mental health and substance use problems between July 2016 and December 2019. Of these, 193 screened positive and underwent assessment for anxiety, depression, post-traumatic stress disorder (PTSD), and alcohol use. Moderate-to-severe symptoms were defined as PHQ-9 ≥ 15 for depression, GAD-7 ≥ 10 for anxiety, and PCL-5 ≥ 33 for PTSD. Perinatal outcomes -including gestational monitoring, pregnancy complications, delivery outcomes, neonatal parameters, and postpartum complications- were compared between women with and without moderate-to-severe mental health disorders, and between alcohol users and non-users. Group differences were assessed using Student's t-test or chi-square test. Associations between head circumference < 10th percentile and mental health problems or alcohol consumption were evaluated using logistic regression. A p-value ≤ 0.05 was considered significant. RESULTS: Neonates of mothers with moderate-to-severe anxiety more often required resuscitation (25.7% vs. 11.4%; p = 0.05) and had lower head circumference percentiles (34.38 vs. 46.72; p = 0.016). Infants of mothers with PTSD also had reduced head circumference percentiles (34.30 vs. 46.39; p = 0.025). Maternal alcohol consumption was associated with lower neonatal head circumference percentiles (37.65 vs. 48.12; p = 0.014). Anxiety, depression, PTSD, and alcohol use were significantly associated with neonatal head circumference below the 10th percentile (p = 0.006; p = 0.002; p = 0.007; p = 0.026, respectively). No significant associations were observed for other maternal or neonatal outcomes. CONCLUSIONS: Moderate-to-severe anxiety, depression, PTSD, and alcohol use during pregnancy were associated with reduced neonatal head circumference. These findings underscore the importance of early screening and intervention for maternal mental health and alcohol use. Further research is warranted to clarify long-term neurodevelopmental implications. TRIAL REGISTRATION: WOMAP (Woman Mental Health and Addictions on Pregnancy), registered at ClinicalTrials.gov (NCT06965270) on March 20, 2025; retrospectively registered.
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