Impact of post-recurrent pregnancy loss depression and anxiety on subsequent live birth rates: A nationwide population-based cohort study.

BACKGROUND: Depression and anxiety are common disorders in women with recurrent pregnancy loss (RPL). but their combined impact with other comorbidities on live births remains understudied. OBJECTIVE: To compare live birth rates between RPL women with and without anxiety, depression, and other comorbidities. METHODS: This retrospective cohort study used Taiwan's National Health Insurance Research Database (NHIRD) from 2003 to 2020. From 507,001 eligible women aged 18-49, we established subcohorts with anxiety (n = 57,164), depression (n = 10,925), and both (n = 2799), alongside 1:1 propensity score-matched controls. Live birth rates and adjusted hazard ratios (aHR) were assessed using Cox regression. RESULTS: Approximately 30 % of women with RPL developed mental disorders and increased with age. The live birth rate was lower in the pooled mental disorders cohort than in all controls (3.73 versus 8.19 per 1000 person-years) with an adjusted HR of 0.52 (95 % confidence interval (CI) = 0.49-0.54). The live birth rate in all women with RPL decreased with increasing age, approximately 44-fold higher in 18-29-year-olds than in 40-49-year-olds (aHR = 36.4). Sociodemographic disadvantages further compromised outcomes: low income (≤ NTD 20,000) or blue-collar roles predicted lower birth rates, whereas income > NTD 40,000 (aHR = 1.73) and white-collar jobs (aHR = 1.10) improved likelihoods. Live birth rates were significantly reduced by baseline hypertension (aHR = 0.54), dyslipidemia (aHR = 0.71), diabetes (aHR = 0.76), and asthma (aHR = 0.87). CONCLUSION: Psychiatric disorders post-RPL, sociodemographic disadvantages, advanced age, and specific cardiometabolic/respiratory comorbidities significantly reduce live birth success.