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Poster Session 2

Category: Perinatal Mental Health

Poster Session 2

(658) Third trimester perceived stress is associated with adverse birth outcomes in rural Ethiopia

Wednesday, February 11, 2026

3:30 PM - 5:00 PM

Submitting Author and Presenting Author(s)

Sarah KG Jensen, BA, MSc, PhD (she/her/hers)

Staff Scientist
Boston Children's Hospital
Boston, Massachusetts, United States

Coauthor(s)

FW

Firehiwot Workneh, BA

Assistant Professor of Public Health
Addis Continental Institute of Public Health
Addis Ababa, Adis Abeba, Ethiopia
KY

Kalkidan Yibeltal, MBBS

Assistant Professor
Addis Continental Institute of Public Health
Addis Ababa, Adis Abeba, Ethiopia
TC

Theresa Chin, BA, PhD

Postdoctoral Fellow
Warren Alpert Medical School
Providence, Rhode Island, United States
KN

Krysten North, MD

Instructor
Brigham and Women's Hospital
Boston, Massachusetts, United States
NF

Nebiyou Fasil

Assistant professor of Public Health
Addis Continental Institute of Public Health
Addis Ababa, Adis Abeba, Ethiopia
Blair J. Wylie, MD, MPH

Chair, Department of Obstetrics and Gynecology
Beth Israel Deaconess Medical Center
Boston, Massachusetts, United States
SC

Sara Cherkerzian, PhD

Instructor
Brigham and Women's Hospital
Boston, Massachusetts, United States
YB

Yemane Berhane, MD, PhD

Professor
Addis Continental Institute of Public Health
Addis Ababa, Adis Abeba, Ethiopia
AL

Anne CC Lee, MD, MPH

Associate Professor
Warren Alpert Medical School
Providence, Rhode Island, United States

Objective:
Low birthweight affects 1 in 7 babies globally, with Ethiopia experiencing 300,000-600,000 annual cases. While maternal psychological stress may represent an added risk factor for adverse birth outcomes in vulnerable populations, most studies of the effects of maternal prenatal stress have been conducted in high-income countries. We examined the associations of prenatal perceived stress with birth weight-for-age, birth length-for-age, preterm birth, and stillbirth in the 'Enhancing Nutrition and Antenatal Infection Treatment for Maternal and Child Health' (ENAT) cohort in rural Ethiopia.

Study Design:
The ENAT study is a registered cluster randomized trial (ISRCTN15116516) that enrolled pregnant women (< 24 weeks gestation) from August 2020 to December 2021. Socio-demographic, nutritional, and antenatal history data were collected at enrollment. Perceived stress data were collected at ANC visits using the Cohen’s Perceived Stress Scale (PSS), a tool previously validated in pregnant women in Ethiopia. We used regression models with cluster-robust standard errors and adjusted for potential confounders and women’s intervention status.

Results:
Of N=2,399 women enrolled in ENAT, n=1,103 provided stress data for both second and third trimesters. Second-trimester stress was not associated with birth outcomes. Third-trimester stress was not associated with birth weight-for-age or preterm birth. However, higher third-trimester stress predicted lower birth length-for-age (coef. = -0.024, 95% CI = -0.038, -0.009, p=0.007) and was associated with a 14% increased stillbirth risk per one-unit increase in the stress score (OR = 1.14, 95% CI = 1.01, 1.29, p<0.001).

Conclusion:
Prenatal perceived stress was associated with lower birth length-for-age and increased stillbirth risk in our cohort of socioeconomically vulnerable women in rural Ethiopia. These findings suggest that stress screening may help identify women at risk for poor birth outcomes. Future work will examine if these associations differ by nutrition intervention status.