Stress in pregnancy can lead to low-birth-weight and preterm babies and to psychological consequences such as anxiety and depression during pregnancy and the puerperium. Previous scales to measure stress contain items that overlap with the symptoms of pregnancy. A stress scale was developed based on in-depth interviews with pregnant women in Pakistan. Construct validity, test-retest reliability and inter-rater reliability were carried out. Cronbach alpha was 0.82 for the 30 short-listed items, with item-total correlations of 0.2-0.8. Multidimensional scaling determined 2 dimensions: socioenvironmental hassles and chronic illnesses. This was the first scale developed for pregnant women based on stressors in a developing country in South Asia.