Prenatal Maternal Stress, Socioeconomic and Cultural Determinants, and Early Childhood Physical and Neurodevelopmental Outcomes: Evidence from a Prospective Cohort Study in Georgia

Abstract

Background: Prenatal maternal stress is increasingly recognized as a critical determinant of fetal programming, with potential consequences for early physical growth and neurodevelopment. Although a growing body of evidence links maternal psychological stress to adverse perinatal and developmental outcomes, most studies originate from high-income Western settings, rely predominantly on self-reported stress measures, and rarely incorporate biological stress markers. Evidence from post-Soviet regional contexts remains limited. Methods: A two-phase study was conducted in Tbilisi, Georgia. Phase I employed a cross-sectional observational design involving 398 pregnant women recruited from maternity homes and women’s consultations. Maternal psycho-emotional stress was assessed using a study-specific pregnancy stress questionnaire, and salivary cortisol was measured in a subsample of women reporting chronic stress (N = 95). Phase II used a prospective cohort design to follow infants born to stress-exposed mothers (N = 95) and non-stressed controls (N = 95) from birth to 12 months. Infant outcomes included anthropometric measurements evaluated using World Health Organization Child Growth Standards and neurodevelopmental screening using the Ages & Stages Questionnaires, Third Edition (ASQ-3), at 1–3, 5–7, and 11–13 months. Statistical analyses were made by SPSS 23.0. Results: Salivary cortisol assessment in the stress-exposed subsample provided supportive biological evidence of elevated stress levels but was not used for direct comparison with the control group. Children born to stress-exposed mothers showed significantly poorer physical growth and lower ASQ-3 scores across all developmental domains during the first year of life (all p < 0.05). Conclusions: This study provides novel evidence from an underrepresented regional context and supports early developmental surveillance and preventive strategies to improve maternal and child health outcomes.