COSMIN database

How to Measure Prenatal Stress? A Systematic Review of Psychometric Instruments to Assess Psychosocial Stress during Pregnancy

Nast, I., Bolten, M., Meinlschmidt, G., and Hellhammer, D. H.
BACKGROUND: A growing body of literature documents associations of maternal psychosocial stress during pregnancy with fetal, infant and child behaviour and development. However, findings across studies are often inconsistent, which may in part be due to differences in stress definitions and assessments.

METHODS: We systematically reviewed methods applied to assess maternal psychosocial stress during pregnancy in studies looking at associations with biobehavioural outcomes in the offspring. A systematic literature search was performed on Web of Science and PubMed for the time period between January 1999 and October 2009. Psychometric instruments assessing maternal psychosocial stress during pregnancy were identified and described if data on psychometric properties were available.

RESULTS: We identified 115 publications that assessed psychosocial stress during pregnancy with validated methods. These publications applied overall 43 different instruments assessing constructs falling under seven categories, ordered according to their frequency of use: anxiety, depression, daily hassles, aspects of psychological symptomatology (not reduced to anxiety or depression), life events, specific socio-environmental stressors and stress related to pregnancy and parenting. If available, we provide information on validity and reliability of the instruments for samples of pregnant women.

CONCLUSIONS: Within the 'prenatal stress' research, a broad range of instruments is applied to assess psychosocial stress during pregnancy. Prenatal stress research should take into consideration that the variety of methods in use might hamper the comparability of stress research results. In each category of stress constructs, one instrument with good psychometric properties in pregnant women is highlighted as the best currently available measure
Publication year:
Symptom status:
Cognitive/mental state
Emotional state
Adults (18-65)
Certain conditions originating in the perinatal period and related symptoms
Pregnancy, childbirth and puerperium and related symptom
PRO / non-PRO:
Non-patient Reported Outcome
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
2 - Interviews
6 - Clinical rating scales
Abbreviated Scale for the Assessment of Psychosocial Status in Pregnancy
Abuse Assessment Screen
Affect Intensity Measure
BAI - Beck Anxiety Inventory
BDI - Beck Depression Inventory   
BSI - Brief Symptom Inventory
CES-D - Centre for Epidemiologic Studies-Depression Scale   
Conflict Tactics Scale
Crown-Crips Index
Daily Stress Inventory
DAS - Dyadic Adjustment Scale
Delusions Symptoms-States Inventory
DHS - Daily Hassles Scale
DIS - Diagnostic Interview Schedule
EPDS - Edinburgh Postnatal Depression Scale   
Everyday Problem List
GHQ - General Health Questionnaire
Index of Spouse Abuse
Intimate Partner Violence
JCQ - Job Content Questionnaire   
LES - Life Experience Survey
NEO-PI - NEO-Personality Inventory
PAS - Pregnancy Anxiety Scale
PDQ - Prenatal Distress Questionnaire
Perceived Racism Scale
PES - Pregnancy Experience Scale
POMS-B - Profile of Mood States – Brief
Pregnancy Related Anxieties Questionnaire
Prenatal Life Events Scale
Prenatal Psychosocial Profile, Hassles Scale
PSEI - Prenatal Social Environment Inventory
PSS - Perceived Stress Scale (versions: PSS-10 items)
Revised Life Events Questionnaire
SCL-90-R - Symptom Checklist 90-Revised
SRRS - Social Readjustment Rating Scale
STAI - State-Trait Anxiety Inventory
STAXI - State-Trait Anger Expression Inventory
Structured Clinical Interview for DSM-IV – Axis I – disorders
Taylor Manifest Anxiety Scale
Work Experience Appreciation Questionnaire (Dutch modification of Job Content Questionnaire)