Asian Journal of Clinical Perinatology and Pediatric Biology

Volume 1 (2026)
Published : Feb 7, 2026

Hematological Adaptation in Term and Preterm Neonates Exposed to Antenatal Stress

San Thitsa Aung (1), Ruziah Ibrahim (2), Mahabuba Afrin (3)

(1) International Medical School, Management and Science University, Shah Alam, Selangor, Malaysia
(2) School of Medicine, Perdana University, Damansara Heights, Kuala Lumpur, Malaysia
(3) Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh
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Abstract

Antenatal stress exists as an important modifier of development of physiology in the neonate, yet the impact of this stress across gestational age on integrated components of hematological adaptation has yet to be fully described. Here, we applied a fully results-driven approach to assess the hematological components responsive to antenatal stress in term and preterm neonates, combining the components of erythroid, immune and platelets to composite metrics of adaptation. Interaction modeling confirmed the presence of non-linear stress-age dependencies for the outcome variables of neonates with antenatal stress. Most term neonates showed compensated adaptation, while most preterm neonates showed amplified sensitivity to, and transition of, the stress to dysregulated hematological states. Convergent Multidimensional state-space analysis distinguished positive coordination of adaptive responses from orbit patterns signifying destabilized responses characterized by the loss of erythropoiesis, inflammatory bias, and alteration of platelets. The results illustrate the importance of gestational age in defining the limits of hematological compensatory mechanisms in the presence of antenatal stress, and the insufficiency of a sole parameter analysis. We propose a loss of systems-thinking in the analysis of hematological components in the neonate, and the need for integrated measures as the basis for early identification of at-risk populations in neonates subjected to antenatal stress.

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