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

Martin G. Frasch; Marlene J. E. Mayer; Clara Becker; Peter Zimmermann; Camilla Zelgert; Marta C. Antonelli; Silvia M. Lobmaier

arXiv · 2602.03886

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

Martin G. Frasch·Marlene J. E. Mayer·Clara Becker·Peter Zimmermann·Camilla Zelgert·Marta C. Antonelli·Silvia M. Lobmaier

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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.

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Martin G. Frasch, Marlene J. E. Mayer, Clara Becker, Peter Zimmermann, Camilla Zelgert, Marta C. Antonelli, Silvia M. Lobmaier. 2026-02-03. Prenatal Stress Detection from Electrocardiography Using Self-Supervised Deep Learning: Development and External Validation. https://arxiv.org/abs/2602.03886

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