Psychological Vulnerability During Pregnancy and Its Obstetric Consequences: A Multidimensional Approach

Background/Objectives: Maternal depression, anxiety, perceived stress, and resilience are recognized determinants of perinatal health, yet routine psychological screening is still uncommon in Romanian obstetric practice. This study examined how these four psychological factors relate to preterm birth, gestational hypertension, intra-uterine growth restriction (IUGR), and low birth weight in primiparous women. Methods: In a cross-sectional study at a tertiary maternity center in Timișoara (February 2024-February 2025), 240 women at 20-28 weeks' gestation completed the Edinburgh Postnatal Depression Scale (EPDS), Generalized Anxiety Disorder-7 (GAD-7), Perceived Stress Scale-10 (PSS-10), and Connor-Davidson Resilience Scale-25 (CD-RISC-25). Obstetric outcomes were abstracted from medical records. Pearson correlations described bivariate associations; multivariate logistic regression assessed independent effects after mutual adjustment. Results: Preterm birth occurred in 21% of pregnancies, gestational hypertension in 17%, IUGR in 15%, and low birth weight in 21%. Higher EPDS, GAD-7, and PSS-10 scores correlated positively with each complication (r = 0.19-0.36; p < 0.02), whereas CD-RISC-25 scores showed inverse correlations (r = -0.22 to -0.29; p ≤ 0.012). In the fully adjusted model, GAD-7 remained the only independent psychological predictor of the composite obstetric outcome (β = 0.047; 95% CI 0.010-0.083; p = 0.013). Perceived stress approached significance; depression and resilience were no longer significant after adjustment. Conclusions: Generalized anxiety was the most robust psychological determinant of adverse obstetric outcomes, with perceived stress, depression, and lower resilience showing contributory roles at the unadjusted level. Incorporating brief instruments such as the GAD-7, PSS-10, and CD-RISC-25 into routine prenatal care could facilitate early identification of at-risk pregnancies and inform targeted preventive interventions.