Anxiety, Depression, and Salivary Cortisol Levels in Pregnant Women

A Comprehensive Review


  • Jahan Sahb Jawid Obstetrics & Gynecology, Iraqi Ministry of Health, Karbala Health Directorate, Imam Al-Hassan Al-Mujtaba Teaching Hospital, Karbala, Iraq
  • Kawther Salih Mehdi Obstetrics & Gynecology, Iraqi Ministry of Health, Karbala Health Directorate, Karbala Maternity Teaching Hospital, Karbala, Iraq
  • Shatha Abd Al-Ameer Hussein Obstetrics & Gynecology, Iraqi Ministry of Health, Karbala Health Directorate, Karbala Maternity Teaching Hospital, Karbala, Iraq
  • Tareq Jawad Kadem Al-Rubayee Diploma General Surgery, Ministry of Higher Education and Scientific Research, AL-Rasheed University College, Department of Pharmacy, Baghdad, Iraq


anxiety, depression, salivary cortisol levels, pregnant women, complications, quality of life


Pregnancy is an extraordinarily dynamic period of growth and development, which poses significant physical and psychological challenges to pregnant women and their partners. Stress, anxiety, and/or depression are emotional states that reign today, and their effective management is becoming increasingly necessary due to the public health problems they pose. This study assessed and analyzed outcomes associated with anxiety, depression, and salivary cortisol levels in pregnant women. 88 samples of pregnant women whose ages ranged between 25-40 years were recruited. Mood symptoms were measured, which included anxiety, trait anxiety, and depression. This study identified that cortisol levels were classified as low (≤ 17.66 µg/L) and high (>17.66 μg/L). Measurements of salivary cortisol levels in pregnant women were also performed, which included Ehlers-Danlos syndrome, PHQ-2, and TPDS. Demographic rates showed that pregnant women aged 30-35 years had the highest percentage, which included 50%, the percentage of smokers was 20.45%, and the percentage of non-smokers was 79.55%. Comorbidities included high blood pressure in 20 women, and HIV in 5 Pregnant women, diabetes in 15 pregnant women, kidney disease in 6 pregnant women, rate of pregnant women with cortisol levels where low cortisol (≤ 17.66 µg/L) included 22 pregnant women and high cortisol (> 17.66 µg/L) included 66 pregnant women. The Ehlers-Danlos Syndrome score was 10.24 ± 3.78, the PHQ-2 was 9.81 ± 6.47, the TPDS was 18.23 ± 6.89, the mood for anxiety was 36.71 ± 8.53, trait anxiety was 40.66 ± 7.84, depression was 20.43 ± 9.22, and perceived stress was 27.68. ± 4.83. Our current study indicates that anxiety, depression, and salivary cortisol levels have a negative impact on the quality of life and mental and physical health of pregnant women.


M. Galbally, A. J. Lewis, M. van IJzendoorn, and ..., “The role of oxytocin in mother-infant relations: a systematic review of human studies,” Harvard review of …, 2011, [Online]. Available:

L. S. Bleker, S. R. de Rooij, R. C. Painter, A. C. J. Ravelli, and ..., “Cohort profile: the Dutch famine birth cohort (DFBC)—a prospective birth cohort study in the Netherlands,” BMJ Open, 2021, [Online]. Available:

M. Lobel, D. L. Cannella, J. E. Graham, C. DeVincent, and ..., “Pregnancy-specific stress, prenatal health behaviors, and birth outcomes.,” Health …, 2008, [Online]. Available:

M. E. Coussons-Read, “Effects of prenatal stress on pregnancy and human development: mechanisms and pathways,” Obstet Med, 2013, doi: 10.1177/1753495x12473751.

S. Madigan, H. Oatley, N. Racine, R. M. P. Fearon, and ..., “A meta-analysis of maternal prenatal depression and anxiety on child socioemotional development,” Journal of the American …, 2018, [Online]. Available:

C. D. Schetter, “Psychological science on pregnancy: stress processes, biopsychosocial models, and emerging research issues,” Annu Rev Psychol, 2011, doi: 10.1146/annurev.psych.031809.130727.

S. Seth, A. J. Lewis, and M. Galbally, “Perinatal maternal depression and cortisol function in pregnancy and the postpartum period: a systematic literature review,” BMC Pregnancy Childbirth, 2016, doi: 10.1186/s12884-016-0915-y.

A. J. Lewis, E. Austin, and M. Galbally, “Prenatal maternal mental health and fetal growth restriction: a systematic review,” Journal of developmental origins of …, 2016, [Online]. Available:

L. Murray, A. Arteche, P. Fearon, S. Halligan, and ..., “Maternal postnatal depression and the development of depression in offspring up to 16 years of age,” Journal of the American …, 2011, [Online]. Available:

A. L. Sutter-Dallay, V. Giaconne-Marcesche, and ..., “Women with anxiety disorders during pregnancy are at increased risk of intense postnatal depressive symptoms: a prospective survey of the MATQUID cohort,” European …, 2004, [Online]. Available:

C. D. Schetter and L. Tanner, “Anxiety, depression and stress in pregnancy: implications for mothers, children, research, and practice,” Curr Opin Psychiatry, 2012, [Online]. Available:,_depression_and_stress_in_pregnancy_.13.aspx

V. Glover, “Maternal depression, anxiety and stress during pregnancy and child outcome; what needs to be done,” Best practice &research Clinical obstetrics & …, 2014, [Online]. Available:

R. Graignic-Philippe, J. Dayan, S. Chokron, and ..., “Effects of prenatal stress on fetal and child development: a critical literature review,” … & biobehavioral reviews, 2014, [Online]. Available:

K. Z. LeWinn, L. R. Stroud, B. E. Molnar, and ..., “Elevated maternal cortisol levels during pregnancy are associated with reduced childhood IQ,” International journal …, 2009, [Online]. Available:

E. P. Davis and C. A. Sandman, “The timing of prenatal exposure to maternal cortisol and psychosocial stress is associated with human infant cognitive development,” Child Dev, 2010, doi: 10.1111/j.1467-8624.2009.01385.x.

L. Duthie and R. M. Reynolds, “Changes in the maternal hypothalamic-pituitary-adrenal axis in pregnancy and postpartum: influences on maternal and fetal outcomes,” Neuroendocrinology, 2013, [Online]. Available:

E. C. Braithwaite, J. Hill, A. Pickles, V. Glover, and ..., “Associations between maternal prenatal cortisol and fetal growth are specific to infant sex: findings from the Wirral Child Health and Development Study,” … origins of health and …, 2018, [Online]. Available:

E. W. Harville, D. A. Savitz, N. Dole, A. H. Herring, and ..., “Stress questionnaires and stress biomarkers during pregnancy,” Journal of women’s …, 2009, doi: 10.1089/jwh.2008.1102.

G. R. Babu, G. V. S. Murthy, R. Deepa, Yamuna, and ..., “Maternal antecedents of adiposity and studying the transgenerational role of hyperglycemia and insulin (MAASTHI): a prospective cohort study: Protocol of …,” BMC pregnancy and …, 2016, doi: 10.1186/s12884-016-1088-4.

A. Zaveri, P. Paul, J. Saha, B. Barman, and P. Chouhan, “Maternal determinants of low birth weight among Indian children: Evidence from the National Family Health Survey-4, 2015-16,” PLoS One, 2020, [Online]. Available:

M. Malda, F. J. R. Van De Vijver, and ..., “Adapting a cognitive test for a different culture: An illustration of qualitative procedures,” Psychology …, 2008, [Online]. Available:

S. J. Cherak, G. F. Giesbrecht, A. Metcalfe, and ..., “The effect of gestational period on the association between maternal prenatal salivary cortisol and birth weight: A systematic review and meta-analysis,” …, 2018, [Online]. Available:

C. P. Stewart, B. M. Oaks, K. D. Laugero, U. Ashorn, and ..., “Maternal cortisol and stress are associated with birth outcomes, but are not affected by lipid-based nutrient supplements during pregnancy: an analysis of data …,” BMC pregnancy and …, 2015, doi: 10.1186/s12884-015-0793-8.

M. I. Bolten, H. Wurmser, A. Buske-Kirschbaum, and ..., “Cortisol levels in pregnancy as a psychobiological predictor for birth weight,” Archives of women’s …, 2011, doi: 10.1007/s00737-010-0183-1.

M. Wilson and Z. Thayer, “Maternal salivary cortisone to cortisol ratio in late pregnancy: an improved method for predicting offspring birth weight,” Psychoneuroendocrinology, 2017, [Online]. Available:

G. Goedhart, Perinatal health epidemiology in multi-ethnic Amsterdam: Psychobiological processes. University of Amsterdam., 2010. [Online]. Available:

A. K. Peterson, C. M. Toledo-Corral, T. A. Chavez, and ..., “Prenatal maternal cortisol levels and infant birth weight in a predominately low-income Hispanic cohort,” International journal of …, 2020, [Online]. Available:

B. F. P. Broekman, Y. H. Chan, Y. S. Chong, and ..., “The influence of anxiety and depressive symptoms during pregnancy on birth size,” Paediatric and …, 2014, doi: 10.1111/ppe.12096.

G. R. Babu, G. V. S. Murthy, Y. Reddy, R. Deepa, and ..., “Small for gestational age babies and depressive symptoms of mothers during pregnancy: Results from a birth cohort in India,” Wellcome open …, 2018, [Online]. Available:

B. R. Mueller and T. L. Bale, “Early prenatal stress impact on coping strategies and learning performance is sex dependent,” Physiology &behavior, 2007, [Online]. Available:




How to Cite

Jawid, J. S. ., Mehdi, K. S. ., Hussein, S. A. A.-A. ., & Al-Rubayee, T. J. K. . (2024). Anxiety, Depression, and Salivary Cortisol Levels in Pregnant Women: A Comprehensive Review. World of Science: Journal on Modern Research Methodologies, 3(2), 58–67. Retrieved from




Most read articles by the same author(s)