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Every person has experienced stress at some point in their lives. Stress is normal. In fact, it can be argued that if we’re not experiencing any type of stress, it means we’re no longer living.

Stress is something researchers have been trying to define for decades, but they’ve run into challenges because stress is subjective (1). Pregnancy is a great example of a situation where although it is an exciting time, stress levels can be high. That’s because the idea of being responsible for growing, carrying, and nurturing a human being can feel overwhelming and uncertain, contributing to feelings of stress.

However, normal levels of stress may be important for fetal development. Low levels of cortisol do reach the fetus and may help with development of the fetuses own stress response system. While normal levels of stress may not necessarily be problematic and may in fact be beneficial for development, high levels of maternal stress have the potential to negatively impact fetal growth and development (2, 3). Because of this, it’s important to be aware and informed about high levels of stress during pregnancy.

WHAT IS STRESS DURING PREGNANCY?

Stress often gets a bad reputation, but what is stress exactly? Simply put, stress occurs when we perceive some type of threat (4). Because it is a unique time, stress during pregnancy may look different during this time than any other. Oftentimes, we associate stress with other negative experiences, and research suggests stress is linked to anxiety and depression, as well as poorer physical health and social relationships (5). Fortunately, there are a handful of relatively simple, scientifically-backed strategies to manage stress during pregnancy. But, it’s important to first be informed about the causes of stress and how stress affects the body and the developing fetus during pregnancy in order to understand why stress management during pregnancy and beyond is vital in the first place.

WHAT CAN CAUSE STRESS DURING PREGNANCY AND BEYOND?

Every day stress can come from a huge variety of sources, including interpersonal (e.g. relationships), interpersonal (e.g. job, financial, injury), academic, and environmental (e.g. living conditions) (6). During pregnancy, you may worry about whether you need to move to accommodate your growing family, or about caring for a child financially. Additionally, you may worry about who will care for your child if you and your partner are working. However, it is a common misconception that positive life events, such as getting married, retirement, buying a home, or going on vacation are not stressful. In fact, all of these can contribute to stress-related illnesses (7). Similar to pregnancy, all of these life events cause some sort of change in our routine, which can be stressful. So, how is it that something that we so often think of as external has such an effect on our bodies?

WHAT TYPES OF STRESS CAN IMPACT MY FETUS DURING PREGNANCY?

The effects of the stress response system occur throughout the body and there is evidence that fetuses can pick up on maternal stress levels in the womb. Research by Dr. Catherine Monk and colleagues have found evidence that fetal heart rate is altered when mothers are exposed to stressful tasks. Among pregnant women with high levels of anxiety who underwent a stressful task, research shows their fetuses had a significantly higher heart rate than women whose anxiety level was below average in response to the task (8). This suggests that fetuses are able to sense and respond to their mother’s elevated stress level.

On a larger scale, evidence suggests that maternal exposure to stressors during pregnancy ranging from daily hassles to anxiety and depression to major environmental stressors (e.g. hurricanes) can have a negative impact on children’s mental health and behaviors across the early lifespan (9). There is a hypothesis referred to as the Barker hypothesis that experiencing adverse events in early development, notably prior to birth, contributes to a higher risk of developing a variety of diseases later in life. For example, low birth weight has been linked to diseases such as hypertension, diabetes, impaired neurodevelopment, and coronary artery disease (10).

HOW DOES STRESS AFFECT MY BODY?

Although stress can be sometimes visible to others, the majority of the stress response occurs within the body. In fact, stress affects nearly every bodily system. The “fight or flight” response, is the system that kicks into high gear when we have to slam on our brakes suddenly to avoid a crash or jump out of the way of a bicyclist (11). Hormones as well as nerve signals which take place throughout the body are the primary drivers of this response. When this system kicks into high gear, suddenly the heart speeds up, muscles become tense, pupils dilate, breathing becomes more shallow, blood pressure increases, glucose is secreted by the liver, and a whole other slew of things happen below the surface (11,12).

Once the stressor subsides, it is the job of the parasympathetic nervous system to calm the body and restore it to its ideal level of functioning. The parasympathetic nervous system is responsible for constricting the pupils, decreasing the heart rate, and relaxing the muscles, and resuming gastrointestinal function, among other things (1).

HOW DOES STRESS AFFECT MY FETUS DURING PREGNANCY?

There are several ways in which stress can affect a woman’s body and her developing fetus. It is thought that the placenta is primarily responsible for maternal stress impacting the fetus (13). During pregnancy, there is an enzyme in the placenta which functions to protect the developing fetus from maternal cortisol. When maternal stress levels are high, there is some evidence that greater levels of cortisol are transmitted to the fetus, disrupting the growth of their endocrine system, the same system that will help them to manage stress later in life (9). Because the placenta is also responsible for supplying the fetus with nutrients, it is also thought that poor maternal mental health and diet quality may negatively impact blood and nutrient supply to the uterus, thus negatively impacting the fetus (9, 10, 13). So, how is it the biological mechanisms have the ability to alter fetal development?

During pregnancy, there is a tremendous amount of growth and change that is occurring for the fetus. Through signaling, the fetus receives messages from the maternal environment about their future world, for example, whether it is safe or dangerous and whether there will be abundant food or scarcity (12). This is referred to as fetal programming, and it is thought that fetal programming can be dramatically changed as a result of significant problems during this time, mainly through poor fetal nutrition and excess hormonal influence. There is some evidence that this contributes to changes in gene expression, referred to as epigenetics (10). This information contributes to our understanding of how maternal stress levels can impact their children in utero.

HOW CAN I MANAGE MY STRESS DURING PREGNANCY AND BEYOND?

Fortunately, there are a variety of evidence-based techniques that are supported by scientific literature that you can do to help reduce stress during pregnancy. It’s likely that you’ve already relied on parts of these techniques and may not have been even aware. Deep breathing is when the breath is directed into the abdomen (4). Although you may feel some relief after taking just a single deep breath, it is recommended to practice several minutes, several times daily and consult a trained professional to learn more about how deep breathing may help manage your particular level of stress. Another recommended technique for managing stress is progressive muscle relaxation (14). This technique involves tensing and release muscle groups throughout the body with the primary focus being on differentiating feelings of tension and relaxation. Further, Mindfulness-Based Stress Reduction, a structured program which focuses on mindfulness meditation, and Cognitive Behavioral Therapy, a specific type of psychotherapy focused on cognitive and behavioral techniques, have both been shown to be associated with stress reduction (4).

One area in the research literature that has received significant attention is the impact of mindfulness and meditation on stress. Meditation, has been shown to reduce blood pressure, stress, and a host of mood-related disorders. Further, the practice of meditation has been shown to be associated with greater immunity, and lower pain sensitivity and intensity, and better sleep quality (15,16,17,18).

WHAT ARE THE BENEFITS OF MEDITATION DURING PREGNANCY?

During pregnancy, there are numerous benefits to practicing meditation and mindfulness. Mindfulness practices during and after pregnancy have been linked with reduced depression, stress and anxiety levels (19,20,21). Further, meditation has been shown to reduce the likelihood of preterm birth. More specifically, it has been found that among women who engaged in meditation practice during pregnancy, only 6% of women gave birth prematurely, compared with 16% of women with no mindfulness education. Together, this evidence suggests that practicing mindfulness and meditation practices during pregnancy is related to positive benefits for both mother and infant.

WHAT’S NORMAL STRESS DURING PREGNANCY AND HOW WILL I KNOW IF MY STRESS LEVELS ARE TOO HIGH?

It’s so important that it’s worth mentioning more than once: stress is normal, especially during pregnancy. More often than not, you are the best judge of whether or not you’re experiencing too much stress. However, it’s important that you check in with your healthcare provider or a trained professional if you feel your stress level is too high, as the health of you and your baby are of highest importance. They may recommend trying some of the strategies discussed above or meeting with a therapist to focus on more tailored stress management treatment.

Knowledge is power when it comes to stress management. Staying well informed and routinely assessing your stress levels may help you to better manage your stress and contribute to a healthier, happier pregnancy.

References
  1. Porges, S.W. (1992). Vagal Tone: A Physiologic Marker of Stress Vulnerability. Pediatrics, 90(3), 498-504.

  2. Kinsella, M.T., & Monk, C. (2009). Impact of maternal stress, depression and anxiety on fetal neurobehavioral development. Clinical Obstetrics and Gynecology, 52(3), 425-440.

  3. Schoof, E., Girstl, M., Frobenius, W., Kirschbaum, M., Repp, R., Knerr, I., … Dötsch, J. (2001). Course of placental 11b-hydroxysteroid dehydrogenase type 2 and 15-hydroxyprostaglandin dehydrogenase mRNA expression during human gestation. European Journal of Endocrinology, 145, 187-192.

  4. Varvogli, L., & Darviri, C. (2011). Stress management techniques: Evidence-based procedures that reduce stress and promote health. Health Science Journal, 5(2), 74-89.

  5. Rusli, B.N., Edimansyah, B.A., & Naing, L. (2008). Working conditions, self-perceived stress, anxiety, depression and quality of life: A structural equation modelling approach. BMC Public Health, 8(1), 48-59.

  6. Ross, S.E., Niegling, B.C., & Heckert, T.M. (1999). Sources of stress among college students. College Student Journal, 33(2), 312-317.

  7. Holmes, T.H., & Rahe, R.H. (1967). The social readjustment rating scale. Journal of Psychosomatic Research, 11(2), 213-218.

  8. Monk, C., Fifer, W.P., Myers, M.M., Sloan, R.P., Trien, L., & Hurtado, A. (2000). Maternal stress responses and anxiety during pregnancy: Effects on fetal heart rate. Developmental Psychobiology, 36(1), 67-77.

  9. O’Donnell, K., O’Connor, T. G., & Glover, V. (2009). Prenatal stress and neurodevelopment of the child: focus on the HPA axis and role of the placenta. Developmental neuroscience, 31(4), 285-292.

  10. De Boo, H.A., & Harding, J.E. (2006). The developmental origins of adult disease (Barker) hypothesis. Australian and New Zealand Journal of Obstetrics and Gynaecology, 46, 4-14.

  11. Salleh, M.R. (2008). Live event, stress and illness. Malaysian Journal of Medical Sciences, 15(4), 9-18.

  12. Tsigos, C., & Chrousis, G.P. (2002). Hypothalamic-pituitary-adrenal axis, neuroendocrine factors and stress. Journal of Psychosomatic Research, 53, 865-871.

  13. Monk, C., Spicer, J., & Champagne, F.A. (2012). Linking prenatal maternal adversity to developmental outcomes in infants: The role of epigenetic pathways. Developmental Psychopathology, 24(4), 1361-1376.

  14. Jacobson, E. (1938). Progressive relaxation.

  15. Davidson, R.J., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M., Muller, D., Santorelli, S.F., … Sheridan, J.F. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine, 65, 564–570.

  16. Grant, J., Courtemanche, J., Duerden, E.G., Duncan, G.H., & Rainville, P. (2010). Cortical thickness and pain sensitivity in zen meditators. Emotion, 10(1), 43–53.

  17. Nagendra, R. P., Maruthai, N., & Kutty, B. M. (2012). Meditation and its regulatory role on sleep. Frontiers in Neurology, 3(54), 1-4.

  18. Zeidan, F., Martucci, K.T., Kraft, R.A., Gordon, N.S., McHaffie, J.G., & Coghill, R.C. (2011). Brain mechanisms supporting modulation of pain by mindfulness meditation. Journal of Neuroscience, 31(14), 5540-5548.

  19. Dimidjian, S., Goodman, S.H., Felder, J.N., Gallop, R., Brown, A.P., & Beck, A. (2015). An open trial of mindfulness-based cognitive therapy for the prevention of perinatal depressive relapse/recurrence. Archives of Women’s Mental Health, 18(1), 85-94.

  20. Sriboonpimsuay W., Promthet S., Thinkhamrop J., & Krisanaprakornkit, T. (2011). Meditation for preterm birth prevention: A randomized controlled trial in Udonthani, Thailand.. International Journal of Public Health Research, 1(1), 31-39.

  21. Vieten C, Astin J. (2008). Effects of a mindfulness-based intervention during pregnancy on prenatal stress and mood: Results of a pilot study. Archive of Women’s Mental Health, 11, 67-74.

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