Objectives: The purpose of this study was to characterize the stress experienced by pregnant women in Kenya and assess the relationship between perceived stress and stress-related biomarkers of cortisol and cortisone.

Background: Kenyan women are exposed to multiple stressors that may result in chronic stress. However, antenatal stress has not been examined and characterized in Kenya; nor has the relationship between pregnant women’s self-reported stress and stress biomarkers been established.

Methods: One hundred and fifty women were recruited between 22 and 28 weeks gestation. Participants completed the Perceived Stress Scale (PSS) and a sociodemographic questionnaire. Hair samples were obtained for analysis of cortisol and cortisone. Factor analysis was used to extract unique clusters of stress symptoms from items in the PSS. Regression models were computed to examine relationships of stress to cortisone and cortisol, controlling for obstetric risk.

Results: Mean age of the women was 25 years (SD = 5, ±16–41). Their degree of perceived stress and cortisol/cortisone concentrations both indicated moderate levels of stress. There was no association between general perceived stress and either hair cortisol or cortisone. However, factor analysis of the PSS identified three clusters of stress symptoms and one cluster - a woman’s negative frame of mind regarding life and inefficacy in handling its problems - was associated with higher levels of cortisone (β= −.231, p = 0.011).

Conclusions: Specific stress symptoms may have unique relationships to specific biomarkers and be more useful in assessment than general perceived stress. Assays of both hair cortisol and cortisone might enable a more comprehensive assessment of glucocorticoid activity and better prediction of health risks from stress.

• Lay summary

• Understanding stress among rural pregnant Kenyan women may help in addressing risks during pregnancy that lead to adverse birth outcomes. Findings suggest that a woman’s tendency to think negatively about life and to doubt her ability to handle life’s problems are symptoms of stress that may contribute to higher levels of stress hormones. Assessing women’s specific symptoms of stress and different stress hormones during pregnancy may more effectively identify women who need intervention to reduce their health risk.

目的：本研究的目的是表征肯尼亚孕妇遭受的压力，并评估感知到的压力与皮质醇和可的松与压力相关的生物标志物之间的关系。

背景：肯尼亚妇女面临多种压力，可能导致慢性压力。但是，肯尼亚尚未检查和表征产前压力。孕妇自我报告的压力与压力生物标志物之间的关系也未建立。

方法：在妊娠22至28周之间招募了150名妇女。参与者完成了感知压力量表（PSS）和社会人口统计学调查表。获得头发样品用于分析皮质醇和可的松。因子分析用于从PSS中的项目中提取独特的压力症状群集。计算回归模型以检查压力与可的松和皮质醇的关系，以控制产科风险。

结果：妇女的平均年龄为25岁（SD = 5，±16-41）。他们的感觉压力程度和皮质醇/可的松浓度均表明中等水平的压力。一般感觉到的压力与头发皮质醇或可的松之间没有关联。但是，对PSS进行的因素分析确定了三类压力症状，而一类是女性对生活和处理问题效率低下的消极心态，与可的松水平较高相关（β= -.231，p  = 0.011） 。

结论：特定的压力症状可能与特定的生物标志物具有独特的关系，并且比一般感知的压力在评估中更有用。头发中的皮质醇和可的松的含量测定可能有助于更全面地评估糖皮质激素的活性，并更好地预测压力对健康的危害。

• 放置摘要

• 了解肯尼亚农村孕妇的压力可能有助于解决怀孕期间导致不良分娩结果的风险。研究结果表明，女性对生活持消极态度并怀疑自己处理生活问题的能力的倾向是压力的症状，可能会导致压力激素水平升高。评估妇女在怀孕期间的特定压力症状和不同的压力荷尔蒙，可能会更有效地确定需要干预以降低健康风险的女性。