Impact of prenatal depression, anxiety and stress on low birth weight: a retrospective case-control study in Karachi, Pakistan.

INTRODUCTION

Maternal psychological distress is common in Pakistan, yet it remains underaddressed in antenatal care. This study aimed to examine whether prenatal depression, anxiety and stress are associated with low birth weight (LBW) and whether perceived social support mitigates risk among mothers delivering at two tertiary care hospitals in Karachi, Pakistan.

METHODS

This was a retrospective case-control study conducted at Dr Ruth K.M. Pfau Civil Hospital and Jinnah Postgraduate Medical Centre. Mothers were enrolled within 48 hours of singleton live birth. Cases were mothers of infants <2500 g (n=196); controls were mothers of infants ≥2500 g (n=196). A precoded structured questionnaire was used to gather information on maternal sociodemographic factors, obstetric factors and psychological factors. Determinants were estimated using multivariable binary logistic regression; adjusted ORs (AORs) and 95% CIs were reported.

RESULTS

Multivariable logistic regression revealed a dose-response association of psychological distress with LBW; mild-to-moderate prenatal depression (AOR 4.62; 95% CI 2.09 to 10.62), severe-to-extremely severe prenatal depression (AOR 9.30; 95% CI 3.73 to 24.38), mild-to-moderate prenatal anxiety (AOR 3.51; 95% CI 1.57 to 8.11), severe-to-extremely severe prenatal anxiety (AOR 6.57; 95% CI 2.85 to 15.85), severe-to-extremely severe prenatal stress (AOR 2.23; 95% CI 2.09 to 2.55). Meanwhile, 'moderate' perceived social support (AOR 0.17; 95% CI 0.06 to 0.45) and 'high' perceived social support (AOR 0.09; 95% CI 0.03 to 0.23) had a protective effect.

CONCLUSION

This study underscores that maternal psychological distress during pregnancy is linked to higher odds of LBW in a dose-response manner, while social support is protective. This highlights the importance of mental health screening with stepped care and strengthened family support in antenatal care.