Association of antenatal perceived stress and depressive symptoms with birth weight and gestational age: a prospective cohort study within the Action Against Stunting Hub, India

Background Evidence on the association of pregnancy specific perceived stress and depressive symptoms with adverse birth outcomes, including preterm birth (PTB) and low birth weight (LBW), remains limited and inconsistent in India. Objective This study aimed to estimate the prevalence of elevated perceived stress and elevated depressive symptoms during the third trimester of pregnancy and examine their associations with birth weight, gestational age, low birth weight (LBW), and preterm birth (PTB) in an Indian cohort. Methods A prospective cohort study was conducted within the Action Against Stunting Hub mother child cohort in Hyderabad, India between June 2021 and December 2022. Of the 717 pregnant women enrolled in their third trimester, 616 with available psychosocial data were included in the analysis. Perceived stress, depressive symptom scores and social support were assessed using Perceived Stress Scale 10(PSS-10), Edinburgh Postnatal Depression Scale (EPDS) and Multidimensional Scale for Perceived Social Support (MSPSS) respectively. Gestational age was determined using a hierarchical approach and birth weight was measured within 12 h of delivery. Associations between maternal perceived stress and depressive symptoms scores with birth outcomes were examined using descriptive statistics and multivariable linear and logistic regression analyses ( p < 0.05). Results The prevalence of elevated perceived stress and elevated depressive symptoms among pregnant women during the third trimester was 17.4 and 21.4%, respectively. After adjusting for covariates, each one-point increase in maternal perceived stress score (β = −5.84 g (95%CI −11.49, −0.19, p = 0.04)) and depressive symptom scores (β = −7.45g (95%CI −13.72, −1.17, p = 0.02)) was significantly associated with lower birth weight, but not with gestational age. However, no association between maternal perceived stress and depressive symptom scores was observed with either LBW and PTB using multivariable logistic regression. Conclusion Third trimester maternal perceived stress and depressive symptom scores were associated with modest reductions in birth weight but not with gestational age, LBW, or PTB. Although the observed effect on birth weight was small, these findings highlight the importance of recognizing and addressing maternal psychological well being during antenatal care.