The Distressed Pregnancy Phenotype: Antenatal Depression, Anxiety and Pregnancy-Specific Stress as Predictors of Preterm Birth and Fetal Growth Restriction

Abstract

Background: Antenatal depression, anxiety, and pregnancy-specific stress may adversely influence pregnancy through behavioral, neuroendocrine, inflammatory, and placental pathways. This study evaluated whether antenatal psychological distress predicted preterm birth and fetal growth restriction. Methods: This prospective observational cohort included 93 singleton pregnancies followed at Kandar Hospital from October 2025 to April 2026. Psychological status was assessed during pregnancy using validated screening instruments for depressive symptoms, anxiety, and pregnancy-specific stress. Participants were followed until delivery. Associations with preterm birth, fetal growth restriction, low birth weight, NICU admission, and delivery outcomes were examined using univariate and multivariable analyses. Results: Thirty-eight women (40.9%) screened positive for at least one psychological-distress domain. Preterm birth occurred in 31.6% of distressed versus 10.9% of non-distressed women, while fetal growth restriction occurred in 26.3% versus 9.1%, respectively. These associations persisted after adjustment for established maternal and obstetric risk factors. Psychological distress remained associated with preterm birth (adjusted OR 4.30, 95% CI 1.40–13.21) and fetal growth restriction (adjusted OR 3.64, 95% CI 1.11–11.95). Low birth weight and NICU admission were also more frequent among distressed mothers. Conclusion: Antenatal psychological distress was independently associated with preterm birth and fetal growth restriction, supporting integrated obstetric and mental-health screening during pregnancy. Keywords: Antenatal depression; Anxiety; Fetal growth restriction; Pregnancy-specific stress; Preterm birth