A small German study found that fathers whose babies were born preterm reported more anxiety six weeks after birth than fathers whose partners had uncomplicated full-term pregnancies.
The findings also point to elevated emotional symptoms during pregnancy. However, the study was exploratory, used questionnaires rather than clinical diagnoses, and cannot show that threatened preterm labor or preterm birth caused the symptoms.
What the study found
Researchers followed 116 fathers recruited at Frankfurt University Hospital between 2013 and 2017. The fathers were divided into three groups: 45 whose partners had no threatened preterm labor and later delivered at term, 33 whose partners experienced threatened preterm labor but delivered at term, and 38 whose babies were born preterm.
Fathers completed questionnaires during late pregnancy and again six weeks after birth. The measures assessed depressive symptoms using the 10-item Edinburgh Postnatal Depression Scale and current anxiety using the state anxiety scale of the State-Trait Anxiety-Depression Inventory.
During pregnancy, fathers in the preterm-birth group reported depression scores 2.09 points higher than fathers in the uncomplicated full-term group. Their anxiety scores were 2.97 points higher. The study reported one-sided p-values of 0.016 for depression and 0.003 for anxiety.
At six weeks after birth, fathers whose babies were born preterm had state-anxiety scores 1.84 points higher than fathers in the uncomplicated full-term group. Anxiety in the threatened-preterm-labor group whose babies were born at term was not significantly different from either comparison group.
Symptoms did not clearly worsen over time
Average depression scores did not differ significantly among the three groups six weeks after birth. Symptoms decreased from pregnancy to the six-week assessment in all groups, and the groups did not have statistically different symptom trajectories.
The study also used the EPDS cutoff of 10 as an indicator of elevated depressive symptoms, not as a diagnosis. During pregnancy, 36% of fathers in the threatened-preterm-labor/preterm-birth group reached or exceeded that cutoff, compared with 28% in the threatened-preterm-labor/full-term-birth group and 9% in the uncomplicated full-term group.
At six weeks, 17% of fathers in the threatened-preterm-labor/full-term-birth group were above the cutoff, compared with 7% and 5% in the other groups. Those differences were not statistically significant.
The neonatal intensive care context
The preterm-birth group delivered at an average of 32.2 weeks of pregnancy, compared with 38.6 weeks in the threatened-preterm-labor group whose babies were born at term. Seventy-four percent of babies in the preterm-birth group went to a neonatal intensive care unit.
Within that group, fathers whose babies had been in intensive care had higher depression scores than fathers whose babies had not: 5.86 compared with 2.25. At the six-week assessment, 12 babies remained hospitalized, including 11 from the preterm-birth group.
These details provide important context for interpreting the results. A preterm birth may involve hospitalization, medical uncertainty and changes in family routines, but this study did not establish which experiences accounted for the reported symptoms.
Why the results need careful interpretation
Only 88 of the 116 fathers completed the six-week survey. The groups were small, and the research included just one prenatal assessment and one assessment after birth. It therefore does not describe fathers’ mental health in later months.
The prenatal questionnaires were also completed at different stages of pregnancy: approximately 28.6 weeks for the preterm-birth group, 30.6 weeks for the threatened-preterm-labor/full-term-birth group and 35.1 weeks for the uncomplicated group. That difference in timing could account for some of the prenatal group differences.
The threatened-preterm-labor/full-term-birth group had a higher proportion of fathers with past mental illness than the other groups—31% compared with about 5%—although past mental illness did not predict scores within that group. The main analysis did not incorporate mothers’ mental health, the degree of prematurity or whether babies remained in intensive care.
The researchers described the work as exploratory and used one-sided significance tests based on a predicted direction. The source notes that borderline findings, such as the six-week anxiety result with p = 0.041, are easier to reach with one-sided than with standard two-sided tests.
What this adds to the wider picture
A 2023 meta-analysis cited in the research estimated that about 17% of fathers of preterm infants experienced depression and about 18% experienced anxiety during the first year after birth. Earlier research cited by the source found that 25% of fathers of preterm babies, compared with 12% of fathers of term babies, met a questionnaire threshold for anxiety six weeks after birth.
Together, these findings suggest that fathers may experience emotional strain during threatened preterm labor and after an early birth. They do not establish how common a clinical disorder is in any individual father, nor do they show that screening or other support changes outcomes.
The researchers said fathers could be included in screening for depression and anxiety when threatened preterm labor occurs, with follow-up after an early birth. The study’s broader relevance is that emotional support around a high-risk pregnancy or neonatal intensive care stay may need to consider fathers as well as mothers.
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