Prenatal Stress Detection from Electrocardiography Using Self-Supervised Deep Learning: Development and External Validation

TL;DR

This study presents a deep learning approach for detecting prenatal stress from ECG signals, achieving high accuracy and external validation, offering a continuous, objective alternative to subjective questionnaires.

Contribution

The paper introduces a self-supervised deep learning model that accurately predicts prenatal stress from ECG data across different cohorts and devices, with robust external validation.

Findings

High accuracy in stress detection on training data (up to 99.8%)

Effective external validation with 77.3% accuracy on new cohort

Signal quality-based channel selection improves model performance by 12% R2

Abstract

Prenatal psychological stress affects 15-25% of pregnancies and increases risks of preterm birth, low birth weight, and adverse neurodevelopmental outcomes. Current screening relies on subjective questionnaires (PSS-10), limiting continuous monitoring. We developed deep learning models for stress detection from electrocardiography (ECG) using the FELICITy 1 cohort (151 pregnant women, 32-38 weeks gestation). A ResNet-34 encoder was pretrained via SimCLR contrastive learning on 40,692 ECG segments per subject. Multi-layer feature extraction enabled binary classification and continuous PSS prediction across maternal (mECG), fetal (fECG), and abdominal ECG (aECG). External validation used the FELICITy 2 RCT (28 subjects, different ECG device, yoga intervention vs. control). On FELICITy 1 (5-fold CV): mECG 98.6% accuracy (R2=0.88, MAE=1.90), fECG 99.8% (R2=0.95, MAE=1.19), aECG 95.5% (R2=0.75, MAE=2.80). External validation on FELICITy 2: mECG 77.3% accuracy (R2=0.62, MAE=3.54, AUC=0.826), aECG 63.6% (R2=0.29, AUC=0.705). Signal quality-based channel selection outperformed all-channel averaging (+12% R2 improvement). Mixed-effects models detected a significant intervention response (p=0.041). Self-supervised deep learning on pregnancy ECG enables accurate, objective stress assessment, with multi-layer feature extraction substantially outperforming single embedding approaches.