Stress and Pregnancy

Pregnancy is a special time for a woman and her family. It is a time of many changes in a pregnant womanís
 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 feeling
energized, rather than drained, and functioning well at home and work probably does not face health risks
 from stress.

However, when stress builds up to uncomfortable levels, it can be harmful for pregnant women or anyone else.
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 can 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.

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 that there are
 ways to cope with them that her health care provider can recommend. 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 they sometimes 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 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 there is a high-risk pregnancy, in which the
 pregnant woman must leave her job early and, possibly, significantly reduce her activity or stay in bed for
an extended period of time.

A number of studies have suggested that high levels of stress may increase the risk of preterm labor and
 low birthweight. Recently, researchers have begun to clarify how stress may contribute to these pregnancy
outcomes.

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 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.

Babies who are born prematurely are often of low birthweight. However, studies also suggest that babies of
women who suffer from high levels of stress and anxiety are more likely to be born with low birthweight even
when born at full term. It appears that CRH or other stress-related hormones may constrict blood flow to
the placenta, so the fetus may not receive the nutrients and oxygen it needs for optimal growth.

Stress also may exert its adverse effects indirectly by affecting the pregnant womanís behavior. For example,
women who are experiencing high levels of stress may not follow good health habits. They may not eat
properly, or they may react to stress by withdrawing into bad habits.

Studies also suggest that high levels of stress may contribute to other pregnancy complications. A recent
 study in Finland found that women who experienced high levels of anxiety early in pregnancy were
three times as likely as less anxious women to develop preeclampsia, a pregnancy-related form of high
blood pressure that can result in poor fetal growth and other problems. A 1995 study by the California
Department of Health Services found that the risk of miscarriage was increased two- to three-fold for
certain women who reported high levels of job stress.

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 of us also reacts differently to an event we perceive 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 womenís blood pressure following a stressful arithmetic task. All of the women had normal blood
pressure readings prior to the task. This new 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-birthweight 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. While this study is preliminary, it may lead to a new approach
 to identifying a group of women who are at risk of preterm labor and of having a low- birthweight baby, and
who may possibly be able to reduce their risk by practicing stress-reduction techniques.

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 an effective way of dealing 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 be sure she eats a healthy diet, gets plenty of sleep, and (with her health
care providerís go-ahead) exercises regularly. Exercise keeps pregnant women fit, helps prevent some
 of the common discomforts of pregnancy (such as backache, fatigue and constipation), and relieves stress.
Having a good support network which can include the pregnant womanís spouse, extended family, friends
and othersĺ 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.

There are a number of stress reduction techniques that have been used successfully in pregnancy.
These include biofeedback, meditation and guided mental imagery. Unless a pregnant woman has
 practiced these techniques previously, she may need instruction from an expert. Relaxation techniques
also are taught in childbirth education classes. These classes also help reduce anxiety by educating
parents-to-be about what to expect from labor and delivery.

Here is a simple relaxation plan that any pregnant woman can use:
Relax for the health of your baby and yourself. Maternal stress can affect your developing baby.
Be sure you allow sufficient time to relax each day. Itís important for you and your baby.
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.
Prepare mentally. Clear your mind of distractions and focus on your relaxation with calm resolve.
Take control. The relaxation that you give to your body and your baby is under your control.
Focus on your breathing. Use slow, steady, deep breaths from your belly, not your chest.
Monitor your muscles. Learn to recognize tension in the major muscle groups of your body.
Release the tension in each muscle group. Become familiar with the feel of tension dissolving.
Imagine yourself in your favorite restful place. You can be on the beach, by a stream, or on a
mountain top.

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 health care provider who may recommend that she see a mental health professional.