Stress and Pregnancy

Pregnancy is a special time for a woman and her family. It is a time of many changes – in a pregnant woman’s body, in her emotions and in the life of her family. As welcome as they may be, these changes often add new stresses to the lives of busy pregnant women who already face many demands at home and at work.

Stress, however, does not have to be all bad. When managed properly, stress can provide us with the drive to meet new challenges. A pregnant woman (or anyone else) who feels she is coping well with stress – taking good care of herself, feeling energized, rather than drained, and functioning well at home and work – probably does not face health risks from stress.

However, when physical or emotional stress builds up to uncomfortable levels, it can be harmful for pregnant women. In the short term, a high level of stress can cause fatigue, sleeplessness, anxiety, poor appetite or overeating, headaches and backaches. When a high level of stress continues for a long period, it may contribute to potentially serious health problems, such as lowered resistance to infectious diseases, high blood pressure and heart disease. Studies also suggest that high levels of stress may pose special risks during pregnancy.

The good news is that stress is unlikely to cause problems in pregnancy for most women. Pregnant women who are concerned about the level of stress in their lives, and their ability to cope with it, should talk with their health care provider. A health care provider may be abele to point a woman to resources in her community and show her simple, effective steps to help her reduce and cope with physical and emotional stress.

What Special Stresses do Pregnant Women Face?

Pregnancy-related discomforts (such as nausea, fatigue, frequent urination, swelling and backache) can be stressful, especially if a pregnant woman attempts to accomplish everything she did prior to pregnancy. A pregnant woman can help reduce her stress by recognizing that these symptoms are temporary, and her health care provider can recommend ways to cope with them. She also can consider cutting back on unnecessary activities when she is uncomfortable.

Hormonal changes may be partly responsible for the mood swings experienced during pregnancy. These mood swings are common and normal, so a pregnant woman should not be overly concerned about them. However, she should keep in mind that mood swings may make it more difficult for her to cope with stress.

In addition, many pregnant women and their partners worry about the health of their unborn baby, their ability to cope with labor and delivery and their ability to become good parents. Added financial responsibilities are another common source of stress, especially if the parents anticipate a reduction in income – whether brief or long-term – after the baby is born. All of these worries can be magnified if the pregnancy is high-risk, in which the pregnant woman must significantly reduce her activity and, possibly, leave her job early.

A number of studies have suggested that very high levels of stress may increase the risk of preterm labor and low birth-weight. A 1999 study at the University of California Los Angeles School of Medicine found that women who reported high levels of stress at 18 to 20 weeks of pregnancy were more likely to have high levels of a hormone called corticotropin-releasing hormone (CRH) in their blood. This and other studies have found a potential link between high levels of CRH and preterm labor.

CRH, which is produced by the brain and the placenta, is closely tied to labor. It prompts the body to release chemicals called prostaglandins, which trigger uterine contractions. CRH also is the first hormone our brains secrete when we are under stress. Researchers continue to explore the possibility that women who experience high levels of stress early in pregnancy have elevated levels of CRH that set their placental clock for early delivery.

Another recent study suggests that the timing of stress during pregnancy may influence pregnancy outcomes. Researchers at the University of California at Irvine found that the earlier in pregnancy a woman experienced a very stressful event (in this study an earthquake), the earlier she was likely to deliver. The researchers speculate that women become less sensitive to stress as pregnancy progresses, possibly helping protect the baby from adverse effects of stress.

Babies who are born prematurely are often low birthweight. However, studies suggest that babies of women who suffer from high levels of stress and anxiety are more likely to be born low birthweight even when born at full term. Some stress-related hormones (such as norepinephrine) may constrict blood flow to the placenta, so the baby may not receive the nutrients and oxygen it needs for optimal growth.

Stress also may exert potential adverse effects indirectly by affecting the pregnant woman’s behavior. For example, women who experience high levels of stress may not follow good health habits. They may skip meals or not choose nutritious foods, or they may react to stress by reaching for cigarettes, alcohol or illicit drugs, all of which have been linked to low birthweight. Use of alcohol and certain illicit drugs also increases the risk of birth defects.

Studies also suggest that high levels of stress may contribute to other pregnancy complications. A few studies suggest that women with stressful jobs may be slightly more likely than women with low-stress jobs to develop preeclampsia (a pregnancy-related disorder that includes high blood pressure and can results in poor fetal growth and other problems). There also is a concern that high levels of stress may increase the risk of miscarriage. Studies to date suggest that these risks – if they exist at all – are likely to be small for most women.

Do Individuals Respond Differently to Stress?

Each of us finds different tasks or situations stressful. A task that one person finds enjoyable can be highly stressful to another. Each individual also reacts differently to an event perceived as stressful. There appear to be distinct differences in how our bodies respond to stress, and some of these differences may have an impact on pregnancy.

James McCubbin, PhD, and other researchers at the University of Kentucky College of Medicine measured pregnant women’s blood pressure following a stressful arithmetic task. All of the women had normal blood pressure readings prior to the task. This 1996 study reported that women with larger diastolic blood pressure increases (a blood pressure reading is given as the systolic over the diastolic pressure; for example, 110/80) were more likely to have smaller-than-average or low-birth-weight babies and premature babies. The researchers speculate that increased levels of stress-related hormones may affect both maternal blood pressure and fetal growth and development. Studies like this one suggest that it may eventually be possible to identify a group of women who are at risk of preterm labor and of having a low-birthweight baby, and provide stress-reduction techniques to help reduce their risk.

How Can a Pregnant Woman Reduce Stress?

Each pregnant woman needs to identify the personal and work-related sources of stress in her life and develop effective ways to deal with them. Any woman, whether pregnant or not, can cope better with the stresses in her life if she is healthy and fit.

A pregnant woman should eat a healthy diet, get plenty of sleep, avoid alcohol, cigarettes and drugs and exercise regularly (with her healthcare provider’s consent). It is important that a pregnant woman not skip meals because the fetus needs constant nutrition, and long fasts put stress on a woman’s body. She should eat three meals plus at least two healthy snacks, or five to six small meals a day. Exercise keeps pregnant women fit, helps prevent some common discomforts of pregnancy (such as backache, fatigue and constipation) and relieves stress.

Having a good support network – which can include the pregnant woman’s partner, extended family, friends and others – also helps a pregnant woman relieve stress. These individuals may provide information, emotional support or help with tasks around the home. Some studies suggest that having good support actually may reduce the risk of preterm labor and low birthweight, especially for poor, high-risk women or women who are feeling stressed.

A number of stress reduction techniques have been used successfully in pregnancy. These include biofeedback, meditation, guided mental imagery and yoga (specifically for pregnant women). Unless a pregnant woman has practiced these techniques previously, she may need instruction from an expert. Child-birth education classes teach relaxation techniques and help reduce anxiety by educating parents-to-be about what to expect during labor and delivery.

Dr. McCubbin has developed a simple relaxation plan that any pregnant woman can use:

1. Relax for the health of your baby and yourself. Maternal stress can affect your developing baby.
2. Allow sufficient time to relax each day. Relaxation is important for you and your baby.
3. Get comfortable. A quiet room with no phone works best. Lying down or reclining is good. Lie slightly tilted to one side with your belly (and baby) partially supported by a pillow.
4. Prepare mentally. Clear your mind of distractions and focus on your relaxation.
5. Take control. You control the relaxation you give to your body and your baby.
6. Focus on your breathing. Use slow, steady, deep breaths from your belly, not your chest.
7. Monitor your muscles. Learn to recognize tension in your body’s major muscle groups.
8. Release the tension in each muscle group. Become familiar with the feel of tension dissolving.
9. Imagine yourself in your favorite restful place – maybe on the beach, by a stream or on a mountain top.
10. Practice and enjoy the pleasant feelings that you have given to yourself and your baby. Do it at least once a day for 20 to 30 minutes. Relax throughout pregnancy.

Fortunately, most women adjust well to the physical and psychological changes of pregnancy. However, if a pregnant woman feels overwhelmed by stress, she always should consult her maternity healthcare provider who may recommend that she see a mental health professional.

Does the March of Dimes Support Research on Stress in Pregnancy?

Several March of Dimes grantees are studying the connection between stress reactions and preterm birth. Prematurity is a leading cause of infant death and disability. These researchers are seeking to determine how stress-related factors in a pregnant  woman’s environment – including home and neighborhood conditions, occupation, income and major life events – may contribute to her risk of preterm labor. They also are examining how the body physically responds to stress, including increases in blood pressure, heart rate and levels of various stress-related hormones (including CRH) to better understand how stress may trigger preterm labor. One researcher is exploring the possibility that stress resulting from racism may help explain why African-American mothers are twice as likely as white women to deliver prematurely. A better understanding of the causes of preterm labor may lead to new ways to prevent and treat it.

References:

Glynn, L., et al. When stress happens matters: effects of earthquake timing on stress responsivity in pregnancy. American Journal of Obstetrics and Gynecology, volume 184, number 4, March 2001, pages 637-642.

Hobel, C.J., et al. Maternal plasma corticotropin-releasing hormone associated with stress at 20 weeks’ gestation in pregnancies ending in preterm delivery. American Journal of Obstetrics and Gynecology, volume 180, number 1, part 3, January 1999, pages S257-S263.

McCubbin, James A., et al. Prenatal maternal blood pressure response to stress predicts birthweight and gestational age: a preliminary study, American Journal of Obstetrics and Gynecology, volume 175, number 3, September 1996, page 706-712.

Walker, S.P., et al. Blood pressure in late pregnancy and work outside the home. Obstetrics and Gynecology, volume 97, number 3, March 2001, pages 361-365.

All materials provided by the March of Dimes are for information purposes only and do not constitute medical advice.

Source: www.MarchofDimes.org
Stress and Pregnancy, item #09-405-00 6/04
© March of Dimes Birth Defects Foundation, 2003