The relationship between stress, depression, cortisol, and preterm birth in women residing in Karachi, Pakistan

Date of Award


Document Type


Degree Name

Master of Science in Nursing (MScN)


School of Nursing and Midwifery, Pakistan


Objective: To determine the relationship between maternal stress, depression, cortisol levels, and preterm birth in women residing in Karachi, Pakistan. Methods: A prospective longitudinal cohort study design in which pregnant women were recruited at 28 to 30 weeks of gestation from the Aga Khan Hospital for Women and Children, Kharadar and Karimabad, and followed till delivery. Data sources included: the demographic questionnaire, A-Z stress tool, CES-D, cortisol levels, and delivery outcomes (e.g., term or preterm birth). The Spearman's correlation coefficient was used to examine the relationship between two ordinal level variables (hypothesis la, lb). The Wilcoxon rank sum test was used to examine the difference in medians between two independent samples when assumptions for parametric test were violated (hypothesis 2, 3a, 3b). Pearson's correlation coefficient was used to examine the relationship between two variables measured on the interval scale (hypothesis 4). Results: 19.7% of the pregnant women experienced a high level of stress and 33% experienced depressive symptoms. The median and mode of cortisol level was 27.40 ug/dl and 27.10 ug/dl, respectively. The frequency of preterm birth was 11.4%. A significant positive relationship was identified only between maternal depression and stress. A statistically significant difference was observed in age, family system, parity, number of children, sex of children at home and nature of present pregnancy between pregnant women in the not high stress and high stress groups. Discussion: The high percentage of stress and depression in pregnant women suggests that pregnant women's psychological health is an important consideration. A longitudinal cohort study, with a large sample size and multiple measures of stress, depression, and cortisol levels, as well as a measure of anxiety and other stress hormone biomarkers may add new knowledge and enhance our understanding about the relationship between stress, depression, anxiety, cortisol levels and preterm birth.

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