Association of Self-Rated Health in Pregnancy With Maternal Childhood Experiences, Socioeconomic Status, Parity, and Choice of Antenatal Care Providers: Cross-Sectional Study.

Background: During pregnancy, self-rated health (SRH) and self-rated mental health (SRMH) are key indicators of health status and predictors of future health care needs. The relationship between pregnant women's health perceptions and their choice of antenatal care providers, midwives, or general practitioners (GPs) is not known. Factors like childhood experiences and socioeconomic status are important determinants of health throughout life. Understanding these health determinants can help health care providers better address the diverse needs of pregnant women. Objective: This study aims to assess how SRH and SRMH during pregnancy are associated with maternal childhood experiences, socioeconomic status, parity, and antenatal care provided by midwives or GPs. Methods: An anonymous, web-based cross-sectional survey was conducted from January to March 2022 among pregnant women in Norway, distributed via Facebook and Instagram. The survey included questions on SRH, SRMH, socioeconomic status, childhood perceptions, and antenatal program participation. Pearson's chi-squared test and logistic regression models were used to explore associations and estimate odds ratios for good SRH and SRMH. Results: Among 1402 participants, 94.7% (1328/1402) reported good or very good health before pregnancy, dropping to 67.8% (950/1402) during pregnancy (P<.001). Reporting your childhood as good was associated with better SRH compared with those who reported average or difficult childhood (70.2% [755/1076] vs 64% [114/178] vs 53.2% [74/139]; P<.001). This corresponds to 48% lower odds of good SRH for those reporting a difficult childhood compared to those reporting a good childhood (OR 0.52, 95% CI 0.36-0.76). Financial security and higher education were associated with better SRH (both P<.001). First-time mothers reported better SRH than those with previous births (73.9% [533/722] vs 61.4% [417/680]; P<.001). For SRMH, 89.9% (1260/1402) reported good or very good SRMH before pregnancy, decreasing to 73.1% (1024/1401) during pregnancy (P<.001). Women who reported a good childhood, financial security, higher education, and first-time mothers reported better SRMH during pregnancy (P<.001 for all). Nearly all women participated in the antenatal program, regardless of their subjective health, and most expressed satisfaction. Among participants, 55.6% (753/1354) received shared antenatal care, 38.6% (520/1354) were seen only by midwives, and 6% (81/1354) only by GPs. The proportion of women receiving antenatal care solely from a midwife decreased with declining SRH, from 42.6% (78/183) among those with very good SRH to 27.3% (15/55) among those with poor SRH. Conclusions: A difficult maternal childhood, low socioeconomic status, and having given birth before were associated with poorer SRH and SRMH during pregnancy. Both midwives and GPs played vital roles in providing antenatal care, though few women received antenatal care exclusively from GPs. The likelihood of physician involvement in care increased slightly with worsening health.