Depressive symptoms and associated factors among women preparing for pregnancy: a population-based study from the Seoul metropolitan preconception health management program.

backgroundDepressive symptoms during pregnancy and the postpartum period have been extensively studied; however, evidence regarding mental health in the preconception period remains limited. Women preparing for pregnancy undergo physiological changes, lifestyle adjustments, and psychosocial transitions, and emotional vulnerability may be heightened by reproductive stressors, including infertility. Nevertheless, population-based studies examining depressive symptoms and their associated lifestyle and reproductive factors during the preconception period remain scarce.

methodsThis cross-sectional study included 14,004 women aged 20-45 years who participated in the Seoul Metropolitan Preconception Health Management Program between 2019 and 2021. Depressive symptoms were assessed using the Korean-validated Hospital Anxiety and Depression Scale-Depression subscale (HADS-D), with scores ≥ 11 indicating elevated risk. Sociodemographic, lifestyle, nutritional, menstrual, and reproductive factors were assessed. A multivariable logistic regression model was used to identify factors independently associated with depressive symptoms.

resultsAmong the participants, 1,102 women (8.5%) exhibited elevated depressive symptoms. In a multivariable logistic regression model, depressive symptoms were independently associated with current smoking, passive smoking exposure, insomnia, binge eating, irregular menstruation, severe dysmenorrhea, infertility history, and previous pregnancy. Insomnia, binge eating, current smoking, and severe dysmenorrhea were each associated with more than twofold higher odds of depressive symptoms. In contrast, regular physical activity showed a clear dose-response association, with increasing physical activity level associated with progressively lower odds of depressive symptoms, whereas greater dysmenorrhea severity was associated with progressively higher proportions screening positive for depressive symptoms. Folic acid supplementation was also independently associated with reduced odds of depressive symptoms.

conclusionsDepressive symptoms were relatively common among women preparing for pregnancy and were closely associated with modifiable lifestyle factors, including smoking, sleep problems, and eating behaviors, as well as reproductive-related factors such as dysmenorrhea and infertility. These findings underscore the need to integrate systematic mental health screening and targeted lifestyle and reproductive health interventions into routine preconception and infertility care to improve women's psychological well-being and support healthier future pregnancies.