Stress Spectrum in Pregnancy: Association with Socio-Economic, Educational, and Cultural Factors
Keywords:
Pregnancy, Stress, Socio-Economic Factors, Cultural Aspects, Stress Biomarkers, Saliva Cortisol Levels
Abstract
Introduction: The multifaceted nature of stress during pregnancy is known to influence maternal health, pregnancy outcomes, and fetal development. Objective: This study aims to explore the association between stress during pregnancy and socio-economic, educational, and cultural factors in Tbilisi, Georgia. Methods: A cross-sectional study was conducted among 398 pregnant women in Tbilisi, Georgia, utilizing a pregnancy-specific questionnaire approved by the University of Georgia's ethics board. Saliva cortisol levels were measured in a focus group of 95 pregnant women who self-reported stress. Statistical analysis was performed using SPSSv.23.0. Results: Two groups were identified: Group I (n = 172), comprising women who self-reported stress and had elevated cortisol levels (n = 95), and Group II (n = 226), who did not report stress. In Group I, saliva cortisol levels indicated mild stress in 30.5%, moderate stress in 34.7%, and high stress in 34.7%. Occupational stress factors were more prominent in Group I compared to Group II: job-related stress (OR = 1.59, p = 0.02, CI = 95%), overtime work (OR = 3.05, p = 0.001, CI = 95%), and continued work throughout pregnancy (OR = 1.82, p = 0.01, CI = 95%). Environmental stress was more prevalent among women living alone or with a partner (OR = 1.59, p = 0.03, CI = 95%). Relationship stress was significantly lower in Group I (p = 0.01), while psychological stress, such as spontaneous abortion, was higher (OR = 2.19, p = 0.001, CI = 95%). Educational levels did not differ significantly between groups. Conclusions: Self-reported stress is closely linked to elevated cortisol levels during pregnancy. Findings highlight the importance of addressing psychological, social, and occupational factors in prenatal care, to address the improvement of maternal and fetal health outcomes in the future.
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References
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25. Bruschettini M, van den Hove DLA, Gazzolo D, Steinbusch HWM, Blanco CE. Lowering the dose of antenatal steroids: The effects of a single course of betamethasone on somatic growth and brain cell proliferation in the rat. American Journal of Obstetrics and Gynecology. 2006; 194:1341–1346. (PubMed) (Google Scholar) (Ref list)
26. Coe CL, Lubach GR. Developmental consequences of antenatal dexamethasone treatment in nonhuman primates. Neuroscience and Biobehavioral Review. 2005; 29:227–235. (PubMed) (Google Scholar) (Ref list)
27. Uno H, Eisele S, Sakai A, Shelton S, Baker E, DeJesus O, et al. Neurotoxicity
28. of glucocorticoids in the primate brain. Hormone and Behavior. 1994; 28:336–348. (PubMed) (Google Scholar) (Ref list)
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30. Davis EP, Townsend EL, Gunnar MR, Georgieff MK, Guiang SF, Cifuentes RF, et al. Effects of prenatal corticosteroid exposure on regulation of stress physiology in healthy premature infants. Psychoneuroendocrinology. 2004; 29:1028–1036. (PubMed) (Google Scholar) (Ref list)
31. Davis EP, Townsend EL, Gunnar MR, Guiang SF, Lussky RC, Cifuentes RF, et al. Antenatal betamethasone treatment has a persisting influence on infant HPA axis regulation. Journal of Perinatology. 2006;26(3):147–153. (PubMed) (Google Scholar) (Ref list)
32. MacArthur BA, Howie RN, Dezoete JA, Elkins J. School progress and cognitive development of 6-year-old children whose mothers were treated antenatally with betamethasone. Pediatrics. 1982; 70:99–105. (PubMed) (Google Scholar) (Ref list)
33. Spinillo A, Viazzo F, Colleoni R, Chiara A, Cerbo RM, Fazzi E. Two-year infant neurodevelopmental outcomes after single or multiple antenatal courses of corticosteroids to prevent complications of prematurity. American Journal of Obstetrics and Gynecology. 2004;191(1):217–224. (PubMed) (Google Scholar) (Ref list)
34. Oliver Gruebner, Michael A Rapp, Mazda Adli, Ulrike Kluge, Sandro Galea, Andreas Heinz. Cities and Mental Health. Dtsch Arztebl Int. 2017 Feb 24;114(8):121–127. doi: 10.3238/arztebl.2017.0121
35. Jeronimo Cortina, Shana Hardin. The Geography of Mental Health, Urbanicity, and Affluence. Int J Environ Res Public Health. 2023 Apr 7;20(8):5440. doi: 10.3390/ijerph20085440
36. Julia M Goodman, Mina Colon, Erika K Cottrell, Jeanne-Marie Guise. Work as a social risk factor in pregnancy: a systematic review of screening practices related to working conditions and family leave among pregnant adults. 2022 Dec 1;50(1):32–43. doi: 10.1111/birt.12695
37. Retno Widowati, Rini Kundaryanti, Destia Ayuwan Julian, Albiruni Raushanfikri. Pregnancy and work stress: investigation of factors relating to the stress level of pregnant working women in Indonesia. https://doi.org/10.1016/j.gaceta.2020.12.011. Volume 35, Supplement 1, 2021, Pages S38-S41
38. Mona Al-Mutawtah, Emma Campbell, Hans-Peter Kubis, Mihela Erjavec. Women’s experiences of social support during pregnancy: a qualitative systematic review. BMC Pregnancy Childbirth. 2023 Nov 10; 23:782. doi: 10.1186/s12884-023-06089-0
39. Diana Cuenca 1. Pregnancy loss: Consequences for mental health. 2023 Jan 23; 3:1032212. doi: 10.3389/fgwh.2022.1032212. Front Glob Womens Health
2. Mulder EJ, Robles de Medina PG, Huizink AC, Van den Bergh BR, Buitelaar JK, Visser GH. Prenatal maternal stress: effects on pregnancy and the (unborn) child. Early Hum Dev. 2002; 70:314. (PubMed) (Google Scholar)
3. Zietlow AL, Nonnenmacher N, Reck C, Ditzen B, Müller M. Front Psychol. Emotional stress during pregnancy - associations with maternal anxiety disorders, infant cortisol reactivity, and mother-child interaction at pre-school age. 2019; 10:2179. (PMC free article) (PubMed) (Google Scholar)
4. Mary E Coussons-Read. Effects of prenatal stress on pregnancy and human development: mechanisms and pathways. Obstet Med. 2013; 6:52–57. (PMC free article) (PubMed) (Google Scholar)
5. Milad MP, Klock SC, Moses S, Chatterton R. Stress and anxiety do not result in pregnancy wastage. Hum Reprod 1998; 13: 2296–300 (PubMed) (Google Scholar) (Ref list)
6. Lobel M. J Behav. Conceptualizations, measurement, and effects of prenatal maternal stress on birth outcomes. Med 1994; 17: 225–72 (PubMed) (Google Scholar) (Ref list)
7. Orr ST, James SA, Casper R. Psychosocial stressors and low birthweight: development of a questionnaire. Dev Behav Pediatr 1992; 13: 343–7 (PubMed) (Google Scholar)
8. Dong Y, Yu JL. An overview of morbidity, mortality, and long-term outcomes of late preterm birth. World J Pediatrics 2011; 7: 199–204 (PubMed) (Google Scholar) (Ref list)
9. Davis EP, Glynn LM, Waffarn F, Sandman CA. Prenatal maternal stress programs infant stress regulation. J Child Psychol Psychiatry 2011; 52: 119–29 (PMC free article) (PubMed) (Google Scholar) (Ref list)
10. Mary E Coussons-Read. Effects of prenatal stress on pregnancy and human development: mechanisms and pathways Obstet Med. 2013 Jun; 6(2): 52–57. Published online 2013 May 3. doi: 10.1177/1753495X12473751
11. Kinsella MT, Monk C. Impact of maternal stress, depression, and anxiety on fetal neurobehavioral development. Clin Obstet Gynecol. 2009; 52:425–440. (PMC free article) (PubMed) (Google Scholar) (Ref list)
12. Mbiydzenyuy NE, Hemmings SM, Qulu L. Front. Prenatal maternal stress and offspring aggressive behavior: Intergenerational and transgenerational inheritance. Behav Neurosci. 2022; 16:977416. (PMC free article) (PubMed) (Google Scholar) (Ref list)
13. Weinstock M. The potential influence of maternal stress hormones on the development and mental health of the offspring. Brain, Behavior, and Immunity 2005;19(4):296-308.
14. Munck A, Guyre PM, Holbrook NJ. Physiological functions of glucocorticoids in stress and their relation to pharmacological actions. Endocrine Reviews. 1984;5(1):25–44. (PubMed) (Google Scholar) (Ref list)
15. King BR, Nicholson RC, Smith R. Placental corticotrophin-releasing hormone, local effects, and fetomaternal endocrinology. Stress. 2001; 4:219–233. (PubMed) (Google Scholar) (Ref list)
16. Kapoor A, Dunn E, Kostaki A, Andrews MH, Matthews SG. Fetal programming of the hypothalamic-pituitary-adrenal function: prenatal stress and glucocorticoids. Journal of Physiology. 2006; 572:31–44. (PMC free article) (PubMed) (Google Scholar) (Ref list)
17. Catalani A, Casolini P, Cigliana G, Scaccianoce S, Consoli C, Cinque C, et al. Maternal corticosterone influences behavior, stress response, and corticosteroid receptors in the female rat. Pharmacology, Biochemistry, and Behavior. 2002; 73:105–114. (PubMed) (Google Scholar) (Ref list)
18. Scaccianoce S, Catalani A, Lombardo K, Consoli C, Angelucci L. Maternal glucocorticoid hormone influences nerve growth factor expression in the developing rat brain. Developmental Neuroscience. 2001; 12(13):2881–2884. (PubMed) (Google Scholar) (Ref list)
19. Trejo JL, Cuchillo I, Machin C, Rua C. Maternal adrenalectomy at the early onset of gestation impairs the postnatal development of the rat hippocampal formation: effects on cell numbers and differentiation, connectivity, and calbindin-D28K immunoreactivity. Journal of Neuroscience Research. 2000; 62:644–667. (PubMed) (Google Scholar) (Ref list)
20. Uno H, Eisele S, Sakai A, Shelton S, Baker E, DeJesus O, et al. Neurotoxicity of glucocorticoids in the primate brain. Hormone and Behavior. 1994; 28:336–348. (PubMed) (Google Scholar) (Ref list)
21. Uno H, Lohmiller L, Thieme C, Kemnitz JW, Engle MJ, Roecker EB, et al. Brain damage induced by prenatal exposure to dexamethasone in fetal macaques. I. Hippocampus. Brain Research Developmental Brain Research. 1990; 53:157–167. (PubMed) (Google Scholar) (Ref list)
22. Coe CL, Lubach GR. Developmental consequences of antenatal dexamethasone treatment in nonhuman primates. Neuroscience and Biobehavioral Review. 2005; 29:227–235. (PubMed) (Google Scholar) (Ref list)
23. Hauser J, Dettling-Artho A, Pilloud S, Maier C, Feldon J, Pryce CR. Effects of prenatal dexamethasone treatment on postnatal physical, endocrine, and social development in the common marmoset monkey. Endocrinology. 2007;148(4):1813–1822. (PubMed) (Google Scholar) (Ref list)
24. Brabham T, Phelka A, Zimmer C, Nash A, Lopez JF, Vazquez D. Effects of prenatal dexamethasone on spatial learning and response to stress are influenced by maternal factors. American Journal of Physiology - Regulatory, Integrative, Comparative, and Physiology. 2000; 279: R1899–1909. (PubMed) (Google Scholar) (Ref list)
25. Bruschettini M, van den Hove DLA, Gazzolo D, Steinbusch HWM, Blanco CE. Lowering the dose of antenatal steroids: The effects of a single course of betamethasone on somatic growth and brain cell proliferation in the rat. American Journal of Obstetrics and Gynecology. 2006; 194:1341–1346. (PubMed) (Google Scholar) (Ref list)
26. Coe CL, Lubach GR. Developmental consequences of antenatal dexamethasone treatment in nonhuman primates. Neuroscience and Biobehavioral Review. 2005; 29:227–235. (PubMed) (Google Scholar) (Ref list)
27. Uno H, Eisele S, Sakai A, Shelton S, Baker E, DeJesus O, et al. Neurotoxicity
28. of glucocorticoids in the primate brain. Hormone and Behavior. 1994; 28:336–348. (PubMed) (Google Scholar) (Ref list)
29. French N, Hagan R, Evans SF, Godfrey M, Newnham J. Repeated antenatal corticosteroids: Size at birth and subsequent development. American Journal of Obstetrics and Gynecology. 1999; 180:114–121. (PubMed) (Google Scholar) (Ref list)
30. Davis EP, Townsend EL, Gunnar MR, Georgieff MK, Guiang SF, Cifuentes RF, et al. Effects of prenatal corticosteroid exposure on regulation of stress physiology in healthy premature infants. Psychoneuroendocrinology. 2004; 29:1028–1036. (PubMed) (Google Scholar) (Ref list)
31. Davis EP, Townsend EL, Gunnar MR, Guiang SF, Lussky RC, Cifuentes RF, et al. Antenatal betamethasone treatment has a persisting influence on infant HPA axis regulation. Journal of Perinatology. 2006;26(3):147–153. (PubMed) (Google Scholar) (Ref list)
32. MacArthur BA, Howie RN, Dezoete JA, Elkins J. School progress and cognitive development of 6-year-old children whose mothers were treated antenatally with betamethasone. Pediatrics. 1982; 70:99–105. (PubMed) (Google Scholar) (Ref list)
33. Spinillo A, Viazzo F, Colleoni R, Chiara A, Cerbo RM, Fazzi E. Two-year infant neurodevelopmental outcomes after single or multiple antenatal courses of corticosteroids to prevent complications of prematurity. American Journal of Obstetrics and Gynecology. 2004;191(1):217–224. (PubMed) (Google Scholar) (Ref list)
34. Oliver Gruebner, Michael A Rapp, Mazda Adli, Ulrike Kluge, Sandro Galea, Andreas Heinz. Cities and Mental Health. Dtsch Arztebl Int. 2017 Feb 24;114(8):121–127. doi: 10.3238/arztebl.2017.0121
35. Jeronimo Cortina, Shana Hardin. The Geography of Mental Health, Urbanicity, and Affluence. Int J Environ Res Public Health. 2023 Apr 7;20(8):5440. doi: 10.3390/ijerph20085440
36. Julia M Goodman, Mina Colon, Erika K Cottrell, Jeanne-Marie Guise. Work as a social risk factor in pregnancy: a systematic review of screening practices related to working conditions and family leave among pregnant adults. 2022 Dec 1;50(1):32–43. doi: 10.1111/birt.12695
37. Retno Widowati, Rini Kundaryanti, Destia Ayuwan Julian, Albiruni Raushanfikri. Pregnancy and work stress: investigation of factors relating to the stress level of pregnant working women in Indonesia. https://doi.org/10.1016/j.gaceta.2020.12.011. Volume 35, Supplement 1, 2021, Pages S38-S41
38. Mona Al-Mutawtah, Emma Campbell, Hans-Peter Kubis, Mihela Erjavec. Women’s experiences of social support during pregnancy: a qualitative systematic review. BMC Pregnancy Childbirth. 2023 Nov 10; 23:782. doi: 10.1186/s12884-023-06089-0
39. Diana Cuenca 1. Pregnancy loss: Consequences for mental health. 2023 Jan 23; 3:1032212. doi: 10.3389/fgwh.2022.1032212. Front Glob Womens Health
Published
2025-03-15
How to Cite
Masiukovichi, N., Nikoleishvili, E., & Caudle, W. (2025). Stress Spectrum in Pregnancy: Association with Socio-Economic, Educational, and Cultural Factors. European Scientific Journal, ESJ, 21(39), 1. https://doi.org/10.19044/esj.2025.v21n39p1
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Copyright (c) 2025 N. Masiukovichi, E. Nikoleishvili, W.M. Caudle
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