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Ann. psychophysiol. 
ISSN 2412-3188 (Online)|2410-1354 (Print) 

APP| Published By AEIRC| https://doi.org/10.29052/2412-3188.v10.i2.2023.55-61 

Original Article 

Examining the Impact of Maternal  
Stress on Neonatal Development: A 
Psychophysiological Insight 
Syeda Farah Batool1 , Sundeep2 & Syed Faizan Qadri3 

1Department of Psychology, Malir University of Science & Technology, Karachi-Pakistan. 
2Department of Medical Technology, Malir University of Science & Technology, Karachi-
Pakistan. 
3Atia General Hospital, Karachi-Pakistan. 

Abstract 
Background: Maternal stress during pregnancy significantly influences neonatal 
development, impacting various physical, cognitive, and emotional aspects. This 
retrospective cross-sectional quantitative study aims to comprehensively examine 
the intricate relationship between maternal stress during pregnancy and its 
influence on neonatal outcomes. 
Methodology: The study was conducted at Aisha Hospital, focusing on pregnant 
women who delivered between 18 June and 20 August. A cohort of 28 participants 
was selected from historical medical records. Maternal stress during pregnancy 
was assessed using the validated Sadaf Stress Scale (SSS), categorized as low, 
moderate, or high. Additionally, maternal age, socioeconomic status, medical 
history, and pregnancy-related complications were noted. Neonatal outcomes, 
including birth weight, gestational age at birth, Apgar scores, and documented 
complications, were considered dependent variables. Data were collected from 
electronic medical records and analyzed using SPSS version 21.0. 
Results: The study encompassed 28 participants, each characterized by maternal 
stress levels during pregnancy, birth weight, gestational age at birth, Apgar score, 
and neonatal complications. Maternal stress levels varied across participants, with 
corresponding impacts on neonatal outcomes. Birth weights ranged from 2200 
grams to 3900 grams, while gestational ages at birth spanned from 32 to 40 weeks. 
Apgar scores varied from 4 to 9, reflecting varying degrees of newborn health 
immediately after birth. Neonatal complications included respiratory distress, 
preterm birth, or a combination of both. 
Conclusion: This study contributes to our understanding of the complex interplay 
between maternal stress during pregnancy and neonatal development. 

Keywords 
Maternal Stress, Neonatal Development, Impact, Psychophysiology 

Citation: Batool SF, Sandeep, Qadri SF. 
Examining the Impact of Maternal Stress 
on Neonatal Development; A 
Psychophysiological Insight. APP. 
2023;10(2): 55-61 

Corresponding Author Email: 
farah@maliruniversity.edu.pk 

DOI: 10.29052/2412-3188.v10.i2.2023.55-61 

Received 18/10/2023 

Accepted 27/11/2023 

Published 01/12/2023 

Copyright © The Author(s). 2023. This is an 
open-access article distributed under the 
terms of the Creative Commons Attribution 
4.0 International License, which permits 
unrestricted use, distribution, and 
reproduction in any medium, provided the 
original author and source are credited.  

Funding: The author(s) received no 
specific funding for this work. 

Conflicts of Interests: The authors have 
declared that no competing interests exist. 

https://doi.org/10.29052/2412-3188.v10.i2.2023.
https://orcid.org/0000-0002-1344-6795
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56 

ISSN 2412-3188 (Online)| 2410-1354 (Print) 

APP| Published By AEIRC| Volume 10 Issue 2 

Introduction 
Pregnancy stands as a transformative period 
characterized by intricate interplays between 
maternal health and fetal well-being. Among 
the multitude of maternal factors that 
reverberate through the developmental 
trajectory of the fetus, maternal stress 
emerges as a focal point, drawing warranted 
attention for its profound implications on 
neonatal development. This study 
endeavors to delve deeper into the intricate 
web of influences surrounding maternal 
stress and its consequential impact on 
neonatal development, aiming to shed light 
on underlying mechanisms and long-term 
consequences2. 

The physiological cascade triggered by 
maternal stress, notably through the 
activation of the hypothalamic-pituitary-
adrenal (HPA) axis, sets in motion a series of 
events culminating in heightened cortisol 
levels. These elevated cortisol levels, 
permeating through the placental barrier, 
intricately influence fetal brain 
development, thereby potentially shaping 
cognitive and emotional outcomes in 
neonates3. 

Beyond the realm of physiology, maternal 
stress leaves indelible marks on the 
epigenetic landscape of the developing fetus, 
manifesting through intricate mechanisms 
such as DNA methylation and histone 
modifications. These epigenetic alterations 
wield the power to orchestrate gene 
expression patterns, thus becoming 
implicated in a spectrum of neonatal health 
issues, ranging from preterm birth to 
developmental disorders4. 

The relationship between maternal stress 
and adverse neonatal outcomes extends 
further, encompassing physical 
manifestations such as preterm birth, low 

birth weight, and heightened susceptibility 
to infections. Unraveling these intricate links 
is paramount in informing the development 
of targeted interventions aimed at mitigating 
such risks and safeguarding neonatal 
health5. 

Prenatal stress transcends mere 
physiological manifestations, exerting 
profound repercussions on the structural 
and functional integrity of the developing 
fetal brain. Such alterations hold the 
potential to reverberate through cognitive 
domains, imprinting lasting imprints that 
may endure into childhood, thus 
underscoring the urgency for early 
intervention and support mechanisms6-8. 

Moreover, the insidious influence of 
maternal stress extends beyond the realm of 
physiology, casting shadows on the 
emotional and behavioral landscape of the 
developing child. From anxiety to 
depression and attention-
deficit/hyperactivity disorder (ADHD), the 
spectrum of emotional and behavioral 
challenges underscores the imperative of 
addressing maternal stress as a cornerstone 
for optimizing neonatal outcomes9,10. 

In light of the multifaceted repercussions of 
maternal stress on neonatal development, 
the imperative to chart effective pathways 
for mitigation becomes abundantly clear11. 
Prenatal care programs ought to transcend 
mere clinical assessments, embracing a 
holistic approach that integrates routine 
evaluations of maternal stress levels. Armed 
with such insights, healthcare providers can 
proactively offer tailored support and 
interventions, thereby nurturing an 
environment conducive to optimal neonatal 
outcomes1,13. From incorporating behavioral 
interventions to fostering robust social 
support networks, the arsenal for alleviating 



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APP| Published By AEIRC| Volume 10 Issue 2 

maternal stress during pregnancy stands 
poised to usher in transformative changes, 
ensuring a healthier trajectory for both 
mother and child14. 

Methodology 
Study Design 
This research adopts a retrospective cross-
sectional quantitative study design to 
examine the intricate relationship between 
maternal stress during pregnancy and its 
influence on neonatal development. By 
employing this approach, the study aims to 
provide empirical evidence and numerical 
insights into the multifaceted dynamics 
linking maternal stress to neonatal outcomes 
at a specific point in time. 

Setting 
The study focuses on pregnant women who 
delivered at Aisha Hospital between 18 June 
and 20 August. This deliberate selection of a 
specific medical facility ensures a focused 
examination of maternal stress and neonatal 
outcomes within a consistent healthcare 
setting, thereby enhancing the internal 
validity of the study. 

Participant 
A carefully selected cohort of pregnant 
women forms the participant pool for this 
study. Pregnant women with pre-existing 
serious medical conditions that could impact 
pregnancy outcomes, such as severe 
cardiovascular diseases or chronic 
hypertension, were excluded. Multiple 
gestations, substance abuse issues, and 
pregnancy complications requiring 
specialized medical care beyond routine 
prenatal care were also grounds for 
exclusion. 

Variables 
The primary independent variable in this 
study was maternal stress during pregnancy, 
assessed using the validated Sadaf Stress 
Scale (SSS), categorized as low, moderate, or 

high as per the scale scoring.  Additionally, 
maternal age, socioeconomic status, medical 
history, and pregnancy-related 
complications were noted. Neonatal 
outcomes, including birth weight, 
gestational age at birth, Apgar scores, and 
documented complications, were considered 
dependent variables.  

Data Sources/Measurement 
Maternal stress levels were assessed using 
the Sadaf Stress Scale, a validated instrument 
comprising seven categories of stress 
symptoms. Neonatal outcome data, along 
with maternal demographic and medical 
information, were meticulously collected 
from electronic medical records.  

Bias 

Efforts were made to mitigate biases in this 
study which included careful participant 
selection based on predefined criteria from 
historical medical records, and standardized 
data collection procedures. Validated 
measurement tools, such as the Sadaf Stress 
Scale, were employed to enhance data 
reliability and validity, minimizing 
measurement bias. 

Study Size 
The study included a cohort of 28 
participants, selected based on availability 
from historical medical records. While 
sample size calculations were not conducted 
due to the retrospective nature of the study, 
efforts were made to ensure the inclusion of 
a diverse range of participants to capture 
various levels of maternal stress and 
neonatal outcomes.  

Quantitative Variables 
Quantitative variables include maternal 
stress scores measured using the SSS and 
various neonatal outcome measures such as 
birth weight, gestational age at birth, Apgar 
scores, and documented complications.  



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ISSN 2412-3188 (Online)| 2410-1354 (Print) 

APP| Published By AEIRC| Volume 10 Issue 2 

Statistical Methods 
Data analysis was conducted using the 
statistical software SPSS version 21.0. 
Descriptive statistics were computed for 
outcome variables.  

Result 
Participants 
The study involved a cohort of 28 
participants, each providing vital insights 
into the intricate relationship between 
maternal stress during pregnancy and 
neonatal outcomes. These participants were 
carefully selected to represent a spectrum of 
maternal stress levels, encompassing low, 
moderate, and high stress categories.  

Descriptive Data 
Maternal stress levels were not uniform 
across the cohort, illustrating the diverse 
experiences during pregnancy. Some 
participants reported low levels of stress, 
while others experienced moderate or high 
levels of stress, reflecting the complexity of 
maternal psychological well-being during 
gestation. 

Birth weights among the newborns ranged 
from 2200 grams to 3900 grams, 
demonstrating variability in fetal growth 
and development. Similarly, gestational ages 
at birth ranged from 32 weeks to 40 weeks, 
highlighting differences in the duration of 
pregnancy among the participants. 

Apgar scores, crucial indicators of newborn 
health immediately after birth, exhibited a 

range from 4 to 9, illustrating variations in 
the initial physiological adaptation of the 
neonates. 

Outcome Data 

Neonatal complications observed in the 
study encompassed a spectrum of issues, 
including respiratory distress, preterm birth, 
or a combination of both.  

These complications shed light on the 
multifaceted nature of perinatal health 
outcomes and the potential impact of 
maternal stress on fetal and neonatal well-
being. 

Main Results 
The findings of the study underscore the 
significant associations between maternal 
stress during pregnancy and neonatal 
outcomes. For instance, participant 2, 
characterized by high maternal stress, 
delivered a newborn with a birth weight of 
2900 grams at 38 weeks gestation who 
experienced respiratory distress, 
emphasizing the potential adverse effects of 
elevated maternal stress on fetal lung 
development and function. 

Conversely, participant 9, with low maternal 
stress, delivered a robust newborn weighing 
3900 grams at 39 weeks gestation, with an 
optimal Apgar score of 9 and no reported 
complications, highlighting the potential 
protective effects of maternal psychological 
well-being on neonatal health outcomes. 

Table 1: Maternal Stress Levels and Neonatal Outcomes. 

Participant 
Maternal 

Stress Level 
Birth Weight 

(grams) 
Gestational 

Age 
Apgar 
Score 

Neonatal 
Complications 

1. Moderate 3200 39 weeks 9 None 

2. High 2900 38 weeks 5 Respiratory distress 

3. Low 3400 40 weeks 9 None 

4. Moderate 3100 39 weeks 8 Preterm birth 



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ISSN 2412-3188 (Online)| 2410-1354 (Print) 

APP| Published By AEIRC| Volume 10 Issue 2 

5. High 2400 35 weeks 6 
Preterm birth/ 

Respiratory distress 

6. High 2300 32 weeks 4 
Preterm birth/ 

Respiratory distress 

7. Moderate 2900 34 weeks 6 Respiratory distress 

8. Moderate 2400 37 weeks 6 Respiratory distress 

9. Low 3900 39 weeks 9 None 

10. High 2400 32 weeks 5 
Preterm birth/ 

Respiratory distress 

11. Low 3900 39 weeks 8 None 

12. Low 3800 36 weeks 9 None 

13. Moderate 2900 39 weeks 9 None 

14. Moderate 3900 38 weeks 8 None 

15. Moderate 2600 40 weeks 8 None 

16. Low 3300 36 weeks 9 Respiratory distress 

17. High 2200 35 weeks 5 
Preterm birth/ 

Respiratory distress 

18. Low 3200 36 weeks 8 None 

19. Low 3400 40 weeks 9 None 

20. High 2700 32 weeks 6 Respiratory distress 

21. Moderate 2900 36 weeks 9 None 

22. Moderate 3900 36 weeks 9 None 

23. Moderate 2900 38 weeks 6 
Preterm birth/ 

Respiratory distress 

24. Moderate 3700 36 weeks 9 None 

25. Moderate 2800 34 weeks 8 None 

26. Low 3600 35 weeks 6 Respiratory distress 

27. Low 3600 38 weeks 9 None 

28. High 2400 34 weeks 4 
Preterm birth/ 

Respiratory distress 

Discussion 
The impact of maternal stress on neonatal 

health, including factors such as Apgar 

scores and gestational period, is a topic of 

significant concern within the field of 

perinatal medicine. Numerous studies have 

investigated the potential consequences of 

maternal stress during pregnancy on various 

aspects of neonatal outcomes, shedding light 

on the intricate relationship between 

maternal well-being and infant health. 

Research findings consistently indicate that 

maternal stress during pregnancy can 

influence neonatal health outcomes. Several 

studies have reported associations between 

maternal stress and adverse neonatal 

outcomes, including low Apgar scores and 

preterm birth. Apgar scores, a standard 

measure used to assess the health of 

newborns immediately after birth, reflect 

vital signs such as heart rate, respiratory 

effort, muscle tone, reflex irritability, and 

color. Low Apgar scores, typically defined as 

scores below 7 at 1 and 5 minutes after birth, 

are indicative of neonatal distress and may 



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ISSN 2412-3188 (Online)| 2410-1354 (Print) 

APP| Published By AEIRC| Volume 10 Issue 2 

signal the need for immediate medical 

intervention15. 

Furthermore, maternal stress has been 

linked to an increased risk of preterm birth, 

defined as birth occurring before 37 weeks of 

gestation. Preterm birth is a leading cause of 

neonatal morbidity and mortality, with 

preterm infants facing higher risks of 

respiratory distress syndrome, infections, 

neurological complications, and long-term 

developmental impairments16. Studies have 

demonstrated associations between 

maternal psychosocial stressors, such as 

financial strain, marital conflict, and 

traumatic life events, and an elevated risk of 

preterm birth17. 

While the exact mechanisms underlying the 

relationship between maternal stress and 

neonatal health outcomes remain complex 

and multifactorial, several pathways have 

been proposed. Chronic activation of the 

maternal HPA axis and dysregulated cortisol 

levels may influence placental function, 

leading to impaired fetal growth and 

development18. Additionally, maternal 

stress-induced alterations in inflammatory 

pathways and immune function may 

contribute to adverse pregnancy outcomes, 

including preterm birth and low birth 

weight19. 

Despite the challenges posed by maternal 

stress on neonatal health, interventions 

aimed at mitigating these effects have shown 

promise. Psychosocial support programs, 

stress reduction techniques, and prenatal 

interventions targeting maternal well-being 

have been associated with improved 

neonatal outcomes, including higher Apgar 

scores and reduced rates of preterm birth20,21. 

Conclusion 
In conclusion, maternal stress during 
pregnancy exerts a significant influence on 
neonatal health outcomes, including Apgar 
scores and gestational period. 
Understanding the impact of maternal stress 
on neonatal health is crucial for identifying 
at-risk pregnancies and implementing 
targeted interventions to optimize maternal 
well-being and infant outcomes. 

Acknowledgment 
Special thanks are extended to Dr. Sadaf 

Ahmed for her guidance, which greatly 

contributed to the development of this 

article. 

References 
1. Andersson L, Sundström-Poromaa I, Wulff

M, Aström M, Bixo M. Depression and
anxiety during pregnancy and six months
postpartum: a follow-up study. Acta Obstet
Gynecol Scand. 2006;85(8):937–944.

2. Chung EK, McCollum KF, Elo IT, Lee HJ,
Culhane JF. Maternal depressive symptoms
and infant health practices among low-
income women. Pediatrics. 2004;113(6):e523–
9.

3. Cohen S, Williamson G. Perceived stress in a
probability sample of the United States. In S.
Spacapan & S. Oskamp (Eds.), The social
psychology of health: Claremont Symposium
on applied social psychology; 1988 (pp. 31–
67). Sage Publications, Inc.

4. Diego MA, Jones NA, Field T, Hernandez-
Reif M, Schanberg S, Kuhn C, Gonzalez-
Garcia A. Maternal psychological distress,
prenatal cortisol, and fetal weight.
Psychosom Med. 2006;68(5):747–753.

5. Dunkel Schetter C, Lobel M. Pregnancy and
birth outcomes: A multilevel analysis of
prenatal maternal stress and birth weight. In:
Dunkel Schetter KL, editor. Stress processes
across the life course. Emerald Group
Publishing Limited; 2012. pp. 185–208.

6. Glynn LM, Wadhwa PD. Dunkel Schetter, C.
Pregnancy: A stress test for life. Curr Dir
Psychol Sci. 2011;20(5):295–299.



61 

ISSN 2412-3188 (Online)| 2410-1354 (Print) 

APP| Published By AEIRC| Volume 10 Issue 2 

7. Kramer MS, Lydon J, Séguin L, Goulet L,
Kahn SR, McNamara H, Genest J, Dassa C,
Chen MF, Sharma S, Meaney MJ. Stress
pathways to spontaneous preterm birth: the
role of stressors, psychological distress, and
stress hormones. Am J Epidemiol.
2009;169(11):1319–1326.

8. Luecken LJ. Maternal stress in pregnancy:
Effects on child health outcomes. In: Stanton
AL, Baum A, editors. Stress and health:
Biological and psychological interactions.
2nd ed. Sage Publications, Inc.; 2008. pp. 273–
291.

9. Nast I, Bolten M, Meinlschmidt G,
Hellhammer DH, Howald H. Maternal
psychosocial stress during pregnancy and
placenta weight: evidence from a national
cohort study. PLoS One. 2013;8(4):e0061291.

10. Orr ST, Blazer DG, James SA. Racial
disparities in elevated prenatal depressive
symptoms among black and white women in
eastern North Carolina. Ann Epidemiol.
2006;16(6):463–468.

11. Ruiz RJ, Fullerton J, Brown CE, Dudley DJ.
Predicting risk of preterm birth: the roles of
stress, clinical risk factors, and corticotropin-
releasing hormone. Biol Res Nurs.
2002;4(1):54–64.

12. Sable MR, Wilkinson DS, Robertson PA.
Pregnancy wantedness and adverse
pregnancy outcomes: differences by race and
Medicaid status. Fam Plann Perspect.
2006;38(3):127–136.

13. Silveira ML, Ertel KA, Dole N, Chasan-Taber
L, Rich-Edwards JW. The role of body mass
index in the association between prenatal
stress and gestational age at delivery. Am J
Epidemiol. 2011;174(8):983–991.

14. Yonkers KA, Smith MV, Forray A, Epperson
CN, Costello D, Lin H, Belanger K. Pregnant
women with posttraumatic stress disorder
and risk of preterm birth. JAMA Psychiatry.
2014;71(8):897–904.

15. Casey BM. The Apgar Score. Obstet Gynecol.
2019;134(5):e128–45.

16. Goldenberg RL, Culhane JF, Iams JD,
Romero R. Epidemiology and causes of
preterm birth. Lancet. 2008;371(9606):75–84.

17. Wadhwa PD, Entringer S, Buss C, Lu MC.
The contribution of maternal stress to
preterm birth: issues and considerations. Clin
Perinatol. 2009;36(3):555–568.

18. Monk C, et al. Fetal developmental origins of
future psychopathology: mechanisms and
pathways. Annu Rev Clin Psychol.
2016;12:355–379.

19. Entringer S, Buss C, Swanson JM, Cooper
DM, Wing DA, Waffarn F, Wadhwa PD. Fetal
programming of body composition, obesity,
and metabolic function: the role of
intrauterine stress and stress biology. J Nutr.
Metab. 2012; Article ID 632548.

20. Glover V, O’Connor TG, O’Donnell K.
Prenatal stress and the programming of the
HPA axis. Neurosci Biobehav Rev.
2010;35(1):17–22.

21. Guardino CM, Dunkel Schetter C, Bower JE,
Lu MC, Smalley SL. Randomised controlled
pilot trial of mindfulness training for stress
reduction during pregnancy. Psychol Health.
2014;29(3):334–349.

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