These data suggest that in a three-country cohort of pregnant women matched on age, number of weeks pregnant, and number of previous pregnancies, significant differences existed with regard to both optimism/pessimism and health-related quality of life. According to the LOT-R, Ghanaian pregnant women in our sample were the most optimistic and Chinese women in our sample were the least optimistic of the matched sets. Interestingly, Ghanaian women sampled also reported higher levels of pessimism than Chinese and U.S. women sampled. This is consistent with research that suggests optimism and pessimism may not be mutually exclusive constructs. [28] Physical functioning, general health, vitality, and role emotional subscales of the SF-12 also indicate significant differences by country per our samples -U.S. women sampled had the lowest physical functioning and vitality scores, Ghanaian women sampled had the highest physical functioning and general health scores, and Chinese women sampled had the lowest general health scores and highest vitality scores.