Mid-pregnancy psychosocial distress and the risk of third-trimester small-for-gestational-age fetuses: a prospective cohort study in coastal Indonesia

Abstract

Background: Evidence regarding the association between second-trimester psychosocial distress and fetal growth remains limited, particularly in coastal populations of low- and middle-income countries. This study aimed to investigate whether psychosocial distress during the second trimester is associated with an increased risk of having a small-for-gestational-age (SGA) fetus in the third trimester. Methods: A prospective cohort study was conducted among 293 pregnant women in their second trimester across three coastal sub-districts. Psychosocial distress was assessed using the DASS-42, while fetal growth was evaluated through Estimated Fetal Weight (EFW) obtained via ultrasonography. Multivariate Poisson regression with robust standard errors, clustered by primary health care, was employed to evaluate the association between psychosocial distress and SGA. Results: The median maternal age was 27 years (IQR 22-32); most participants' husbands worked in the informal sector (94.5%), and the majority came from low-income households (65.2%). Bivariate analysis revealed that second-trimester psychosocial distress (CRR = 4.25; 95% CI: 2.35-7.67; p<0.001) and maternal age (CRR = 2.37; 95% CI: 1.36-4.12; p=0.002) were significantly associated with third-trimester SGA. After adjusting for maternal age and pregnancy complications, these associations remained statistically significant (ARR = 4.00; 95% CI: 2.76-5.80; p<0.01). Conclusion: Psychosocial distress in the second trimester is significantly associated with the risk of SGA in the third trimester. These findings underscore the importance of integrating mental health screening into routine antenatal care, particularly for populations at heightened social and environmental vulnerability.

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