The association between outdoor artificial light at night exposure and antenatal depression and anxiety symptoms: A retrospective cohort study in China

Background: Outdoor artificial light at night (ALAN) has emerged as a significant source of environmental pollution, however its association with antenatal depression and anxiety symptoms has been rarely explored before. Methods: This study was based on a cohort study conducted at the Maternal and Child Health Care Center in Ma'anshan City, Anhui Province, China, which ultimately included 1047 pregnant women. Depression and anxiety symptoms were evaluated utilizing the self-administered Patient Health Questionnaire (PHQ-9) and the 7-item Generalized Anxiety Scale (GAD-7), respectively. Exposure levels to outdoor ALAN were calculated utilizing satellite data and the participants' usual addresses. Logistic regression and restricted cubic spline were used to assess the association between exposure to outdoor ALAN and depression and anxiety symptoms in pregnant women. Results: After adjusting for confounding factors, high ALAN exposure during the pre-pregnancy period (ORdepression = 3.16, 95% CI: 1.14-8.75; ORanxiety = 3.09, 95% CI: 1.51-6.28) and first trimester (ORdepression = 2.90, 95% CI: 1.13-7.45; ORanxiety = 3.11, 95% CI: 1.55-6.25) were associated with increased risks of antenatal depression and anxiety symptoms. Restricted cubic spline analyses showed the above associations were not nonlinear. Conclusion: Our study is the first to propose that exposure to high levels of outdoor ALAN three months before pregnancy and during the first trimester of pregnancy is a risk factor for antenatal depression and anxiety symptoms.