Editor's Choice| Volume 30, ISSUE 6, P409-415, November 2020

Stress and Anxiety are Associated with Lower Gestational Weight Gain in Hispanic Women

Published:September 26, 2020DOI:



      Prior studies indicate that inadequate and excessive gestational weight gain (GWG) are associated with poor maternal and infant outcomes, and that stress and anxiety may contribute to GWG. However, these studies often failed to use validated measures of stress and anxiety, measured only total GWG, and were limited to largely non-Hispanic White populations. We explored the association between stress and anxiety and GWG.


      We used data from 1,308 participants in Proyecto Buena Salud, a prospective cohort of predominantly Puerto Rican women 18–40 years of age (2006–2012). We measured stress with the Perceived Stress Scale and anxiety with the State-Trait Anxiety Scale, and abstracted GWG from medical records.


      The average GWG was 31.0 ± 16.1 pounds. More than one-half of participants (51.8%) exceeded Institute of Medicine guidelines for GWG. After adjusting for age and pre-pregnancy body mass index, women in the highest quartiles of stress and anxiety in early pregnancy had approximately 4 lbs lower GWG (β = −3.89; SE = 1.54; p = .012 and β = −4.37; SE = 1.54; p = .005, respectively) as compared with those in the lowest quartiles. Similarly, women in the highest quartiles of mid/late pregnancy stress and anxiety had lower GWG (β = −3.84 lbs; SE = 1.39; p = .006, and β = −3.51 lbs; SE = 1.38; p = .011, respectively) and a lower rate of GWG in the second and third trimesters (β = −0.117 lbs/week; SE = 0.044; p = .008 and β = −0.116 lbs/week; SE = 0.043; p = .007, respectively), compared with those in the lowest quartiles.


      High stress and anxiety were associated with lower GWG. Interventions to decrease stress and anxiety during pregnancy should include counseling on maintaining healthy GWG.
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      Megan Ward Harvey, PhD, is an Assistant Professor of Health Science at Springfield College. Her research focuses on maternal health, weight related health, and stress, particularly among vulnerable populations.


      Barry Braun, PhD, is a Professor of Health and Exercise Science at Colorado State University. His research interests include using exercise and pharmacology to prevent and manage type-2 diabetes, to prevent recurrence of breast cancer, and in hormonal regulation of appetite.


      Karen A. Ertel, ScD, is a social epidemiologist who studies maternal mental health and children's health. Her current research focuses on maternal depression and its relation to overweight in children.


      Penelope S. Pekow, PhD, is a Research Assistant Professor in the School of Public Health and Health Sciences at the University of Massachusetts-Amherst. Her research interests include analytic methods for use with large observational databases with multi-level hierarchical data.


      Glenn Markenson, MD, is an obstetrician and gynecologist and faculty in the Boston University School of Medicine. His research interests include preterm birth predication and gestational diabetes.


      Lisa Chasan-Taber, ScD, is a Professor of Epidemiology and Chair of the Department of Biostatistics and Epidemiology in the School of Public Health and Health Sciences at the University of Massachusetts-Amherst. Her research interests include reproductive epidemiology, women's health, and applied research in physical activity and pregnancy.