Assessment of Maternal Stress, Anxiety, Well-Being, and Sleep Quality during Different Stages of Gestation

Open Access

Abstract

Background: Maternal stress, anxiety, overall well-being, and sleep quality are important determinants of both maternal and fetal health outcomes. Elevated stress and anxiety, poor well-being, and disrupted sleep during pregnancy have been associated with adverse outcomes including preterm birth, low birth weight, hypertensive disorders, impaired maternal functioning, and long-term neurodevelopmental effects in offspring. Despite their clinical importance, the temporal patterns of these psychological and behavioral measures across different stages of gestation remain underexplored, particularly in low-resource settings such as Bangladesh. Aim of the study: This study aimed to evaluate the levels and changes of maternal stress, anxiety, well-being, and sleep quality across the first, second, and third trimesters of pregnancy, identify associated risk factors, and determine critical gestational periods of vulnerability. Methods & Materials: A cross-sectional observational study was conducted involving 300 pregnant women attending the Department of Obstetrics and Gynaecology, Bangladesh Medical University, Dhaka, Bangladesh, stratified equally by trimester (n = 100 per trimester). Validated instruments, including the 10-item Perceived Stress Scale (PSS-10), State-Trait Anxiety Inventory (STAI), WHO-5 Well-Being Index, and Pittsburgh Sleep Quality Index (PSQI), were used to assess maternal psychological and behavioral outcomes. Data were analyzed using ANOVA with post-hoc Bonferroni comparisons, chi-square tests, Pearson correlations, and multiple linear regression to determine predictors of sleep quality. Results: Maternal stress, state anxiety, and poor sleep quality significantly increased across gestation, while overall well-being significantly declined (p<0.001 for all). The third trimester demonstrated the highest prevalence of high stress (41%), clinical anxiety (35%), and poor sleep quality (78%). Strong correlations were observed among stress, anxiety, well-being, and sleep quality measures. Regression analyses identified stress and anxiety as independent and significant predictors of impaired maternal sleep quality. Conclusion: Late pregnancy represents a critical period for psychological and behavioral disturbances. Systematic assessment and timely interventions targeting maternal stress and anxiety may improve sleep quality, overall well-being, and potentially maternal and fetal health outcomes.