Date of Award


Document Type


Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Joseph Wangira Musana

Second Supervisor/Advisor

Professor Marleen Temmerman

Third Supervisor/Advisor

James Orwa


Obstetrics and Gynaecology (East Africa)


Introduction: Antenatal stress has been linked to maternal morbidity and preterm birth (PTB). One of the pathophysiological processes leading to PTB is thought to be via activation of the hypothalamus-pituitary-adrenal axis resulting in cortisol production. Hair cortisol has recently been shown to be a stress marker in the pregnant and non-pregnant population. Some determinants of hair cortisol have also been studied but more research is needed in this area, especially in pregnancy. Understanding the risk factors of antenatal stress may guide institution of preventative or screening measures to reduce the risk of adverse birth outcomes. As the effect of stress may be dependent on an individual’s perception, coping strategies and resources, using a biomarker alone may not reflect the true mental stress perceived by the victim, thereby necessitating psychological measures of stress.

Objectives: To determine the effect of selected maternal sociodemographic factors on psychological and biological stress levels in pregnancy

Methods: A retrospective analysis of data collected from a hundred and fifty pregnant women attending the antenatal care services at Migori County Hospital for another study. They all completed a sociodemographic and clinical questionnaire, the Cohen’s Perceived Stress Scale (PSS) and gave a sample of hair for analysis. The association between predictors (age, parity, marital status, maternal education, household income, polygyny, and intimate partner violence) and outcomes (hair cortisol, hair cortisone and PSS score) was examined using bivariate and multivariate models

Results: Negative association between perceived stress scores and household income (β = -2.40, p = 0.016, 95% CI = -4.36 to -0.45). Positive association of ratio of hair cortisone to cortisol with Adolescent age group (β = 0.64, p = 0.031, 95% CI = 0.06 to 1.22), and Cohabitation (β = -1.21, p = 0.009, 95% CI = -2.11 to -0.31). No association between any of the other predictors and outcomes

Conclusion: Low income may be a risk factor for increased stress. Exploring this in pre-conception and antenatal care facilities may guide appropriate psychological support to at-risk mothers. The influence of some sociodemographic factors on stress measures should be considered when evaluating other desired variables in relation to stress

Recommendation: Further studies on stress measures in pregnant adolescent mothers could yield a biological explanation of stress vulnerability in adolescent mothers hence special interventions for this group. Research is required in Sub-Saharan Africa to determine use of hair cortisol and cortisone as biomarkers of chronic stress and presence of resilience factors.