Mahbobeh Faramarzi - Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
Parvin Hassanjanzadeh - psychology Department, Ayatollah Amoli Branch, Islamic Azad University, Amol, Iran.
Soraya Khafri - Infertility and Health Reproductive Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.

Background: There is lack of information about the effect of general distress and pregnancy-specific distress in mid- and late-pregnancy separately on neonatal outcome.Objective: The aim of this study was to assess the effects of mid-maternal distress on late-maternal distress and birth outcomes with a causal model of relationships amonggeneral distress and pregnancy-specific distress. Materials and Methods: In this longitudinal descriptive study, 100 low-risk pregnant women participated. Participants completed three questionnaires at mid-pregnancy (13–26 wk) and at late pregnancy (27–40 wk). Pregnancy-general distress was assessed by the Perceived Stress Scale and the Hospital Anxiety Depression Scale. Pregnancyspecific distress was evaluated by the Prenatal Distress Questionnaire. The pregnant women were followed to after birth and neonatal outcome were assessed. Results: All total effect pathways were significant as predictors of birth outcomes (height, weight, and head circumference). Mid-pregnancy-specific distress had a significant relationship with late pregnancy-specific distress. However, mid-maternal distress was not related directly to birth outcomes. The effect of mid-maternal distress on birth outcomes was related indirectly to late-maternal distress. Both late general distress and late pregnancy-specific distress had direct negative effects on three indexes of birth outcome. The negative effect of late general-pregnancy distress and mid-pregnancyspecific distress on birth outcome was mediated through late pregnancy-specific distress. Conclusion: Both late pregnancy-general distress and pregnancy-specific distress have negative effects on birth outcomes. These findings support a role for negative effect as mediating the relationship between late pregnancy-specific distress and birth outcomes.

Birth outcomes, Pregnancy, Distress, Anxiety, Depression