Prior research has documented an association between prenatal father involvement and positive outcomes for maternal and child health, including increased prenatal care usage, decreased smoking and alcohol consumption, and a reduction in low birth weight (Alio et al. 2010; Martin et al. 2007; Singer, 2012). Using the father’s name on the birth certificate as a proxy for father involvement, others have shown an association between lack of prenatal father involvement and increased risk for preterm birth, small for gestational age, and infant mortality (Luo, Wilkins, and Kramer 2004; Alio et al., 2011). While these studies have helped establish a theoretical and empirical basis for the notion that a father’s commitment to the mother during pregnancy carries real-world implications for her health, many of the studies suffer from crude approximations of father involvement that fail to capture the dynamic nature of parents’ prenatal experience (Alio et al, 2010; Singer, 2012).

We contribute to this line of research by investigating a broad set of prenatal indicators intended to help isolate the factors most related to maternal health complications during pregnancy and at the time of birth. Drawing on data collected through the Paternity Establishment Study (PES), a longitudinal birth cohort study of approximately 800 Texas mothers who gave birth outside of marriage in 2013, we investigate the predictors of maternal pregnancy complications through two related research questions. First, we examine the association between pregnancy complications and ten prenatal indicators indented to capture 1) parents’ commitment prior to conception, 2) prenatal relationship quality, and 3) prenatal father involvement. Second, given that much of the parents’ prenatal experience is unobserved by the medical or policy communities, we investigate two observable events during the prenatal period that may signal an increased risk of pregnancy complications and provide an access point for policy to intervene—fathers’ attendance at the 20-week ultrasound, and fathers’ attendance at the birth itself.

Overall, we find 19.7 percent of unmarried mothers report serious health complications during pregnancy or at the time of birth. Mothers with pregnancy complications are significantly more likely to report several poor prenatal experiences, including unintended pregnancies, doubts about paternity from the father’s family, break ups and worsening relationships during pregnancy, family violence, and a lack of instrumental or financial support from the father. In multivariate models, however, we find that these prenatal variables are highly correlated with one another and fail to predict pregnancy complications when considered jointly. In subsequent models, we find that indicators of a poor prenatal experience are associated with fathers’ absence from the 20-week ultrasound, which is itself predictive of pregnancy complications. Additionally, we find a strong and significant relationship between fathers’ absence from the birth and increased odds of pregnancy complications, an effect that remains unaccounted for even when controlling for all prenatal factors and fathers’ absence from the ultrasound. We urge further research into the implications of fathers’ birth attendance as a signal for pregnancy complications and other negative outcomes, especially in view of its usefulness as a point of intervention.