STRIVE: How the stress response during pregnancy affects the health of the mother - a new study is launched

Stress during pregnancy is not only linked to outcomes for the baby, it also has consequences for the mother herself, from cardiometabolic risks to anxiety and depressive symptoms. However, most studies measure stress “once” in the clinic and rarely record how the pregnant woman’s body reacts to stressors on a day-to-day basis. The STRIVE (Stress Reactivity and Maternal Health) study protocol, published in BMJ Open, aims to fill this gap: the authors want to understand how psychological and physiological reactivity to everyday stressors is associated with short-term and long-term maternal health.

Research methods

STRIVE is a prospective longitudinal study with repeated measurements during pregnancy and after birth. The key feature is ecological momentary assessments (EMA): participants regularly fill out short surveys on their smartphone, which record current stressors, mood, and context (work, home, sleep, etc.). This allows us to “catch” stress in real life, not just in the lab.

In parallel, objective data on maternal health (clinical visits, standard tests, and mental health scales) and demographics/lifestyle (physical activity, nutrition, sleep) will be collected. The researchers will then compare the dynamics of stress reactivity with clinical outcomes in the perinatal and postpartum periods.

What exactly will be measured (plan)

• Exposure to everyday stressors and emotional responses - via smartphone EMAs several times a week.
• Maternal mental health - validated anxiety/depression and stress scales (e.g. end-of-trimester and postpartum).
• Somatic and cardiometabolic parameters are standard clinical data from the pregnancy chart and postpartum observation (blood pressure, weight gain/retention, gestational complications, etc.).

The result is a “multi-signal” profile of stress reactivity (psychological load + reaction) and its relationship with the mother’s health.

How will they analyze it?

The plan is to use longitudinal data models (repeated EMA measurements), assess time windows of sensitivity (by trimester), and test whether sleep, physical activity, etc. “mediate” this relationship. This design allows us to distinguish the effect of stress itself from individual differences in reactivity —that is, the body’s tendency to respond with a stronger psychological and/or physiological response.

Why is it necessary (interpretation and possible clinical conclusions)

If STRIVE shows that certain patterns of daily stress reactivity predict adverse maternal outcomes, it will provide the clinician with practical tools:

• early risk stratification (based on EMA dynamics, not on a one-time questionnaire);
• targeted interventions during “sensitive windows” of pregnancy (sleep hygiene, behavioral stress management techniques, mental health support);
• personalization of postpartum monitoring for women with high reactivity.

Authors' comments

The authors emphasize that STRIVE fundamentally shifts the focus from one-off surveys to repeated “slices” of real life via smartphone, which should more accurately capture the connection between stress and maternal health than classic, disparate measurements. The researchers also note that reactivity (how strongly a person responds to stress) can be no less important than the level of stressors themselves — and it is precisely this that has often been underestimated in previous studies.

Conclusion: STRIVE is a protocol, not published results. But the approach itself — “stress as a process” with EMA — gives a chance to finally understand when and for whom stress during pregnancy is most dangerous for a woman’s health, and how to turn this into precise, personalized prevention.