Impact of Antepartum Psychosocial Stress on Pregnancy Outcomes - A Prospective Study from a Developing Country

Psychosocial stress in pregnancy can cause interference in the maternal-fetal immunological system, which can have both short- and long-term implications. The presence of a standard screening process leads to early initiation of counseling and psychiatry referral in severe conditions.

The objective of this study was to develop a specific scoring system to categorize women into different grades of psychosocial stress, thereby determining its impact on outcomes and risk of postpartum depression (PPD).

This prospective cohort study was conducted in a tertiary care hospital in South India. The study recruited 226 participants after taking the institute's ethical clearance. A novel validated questionnaire based on 25 stressors was administered antenatally, and pregnancy outcomes were documented. Receiver operating characteristic curves were used to assess the predictability of adverse maternal-fetal. P < 0.05 was considered statistically significant. Youden's index was calibrated to identify a scoring cutoff to predict adverse outcomes.

A higher level of maternal education was associated with increased levels of maternal stress ( P < 0.001). Elevated stress scores were associated with increased risk of preeclampsia ( P = 0.05), composite adverse maternal outcomes ( P = 0.014), and fetal outcomes ( P = 0.016) later in pregnancy. The optimum cutoff stress score to identify risk of adverse outcomes was identified as 7.5, whereas the risk of PPD is increased with stress score levels above 6.5. A higher level of stress score was associated with increased risk of PPD ( P < 0.001).

The novel prenatal stress scoring system is a good predictor of adverse maternal and perinatal outcomes in a low-middle-income hospital setting.