Background:​ Maternal stress and anxiety are associated with adverse pregnancy outcomes, but the association with future childhood injuries is unclear, especially risk of orthopedic fractures.

Methods:​ We conducted a longitudinal study of 773,339 newborns in Quebec, Canada between 2006 and 2018. We identified women with stress or anxiety disorders before or after delivery, and computed the incidence of future operative fractures in offspring. We estimated hazard ratios (HR) with 95% confidence intervals (CI) for the association of maternal stress and anxiety disorders with the risk of pediatric fractures, adjusted for maternal and infant characteristics.

Results:​ Incidence of any fracture was higher for maternal stress (20.5 per 10,000 person-years) and anxiety (19.8 per 10,000 person-years) than no disorder (15.3 per 10,000 person-years). Maternal stress was associated with 1.17 times the risk of pediatric fractures (95% CI 1.00–1.38), and anxiety was associated with 1.26 times the risk (95% CI 1.07–1.47), compared with no disorder. Stress was predominantly linked with fall-related fractures (HR 1.26, 95% CI 1.06–1.50), and anxiety with assault-related fractures (HR 2.97, 95% CI 1.50–5.89). The association of stress with fall-related fractures was more prominent after 36 months of age, whereas anxiety was linked with assault-related fractures before 6 months.

Conclusion:​ Stress and anxiety disorders before or after delivery are associated with the future risk of fractures in children. Women with a history of stress or anxiety disorders may benefit from counselling and social support for child fracture prevention.