The Importance of Reducing Stress During Pregnancy

Part I

Ann Diamond Weinstein, Ph.D.

Finding healthy ways to reduce stress is an essential part of optimizing the health of mothers-to-be and the development of their babies from conception through the postnatal period. Stress is often perceived as a discrepancy between environmental demands and an individual’s psychological, social and biological resources.  A wealth of knowledge and research now suggests that maternal prenatal stress plays an important role in the health, growth and development of a woman’s offspring during gestation and over their life span (1)(2)(3).  Exposure to maternal prenatal high levels of psychosocial stress have been associated with dysregulation of metabolic, immune, endocrine and cognitive function in offspring.

Parents-to-be can become aware of when and how stress is affecting them by noticing the feelings in their body, their emotions and their behaviors.  They can learn to use simple stress reduction skills before and during pregnancy (4)(5)(6). These skills can expand their stress coping resources as they face day-to-day challenges and difficult events that may arise during their babies’ development in the womb and after birth and may also be used to help them regulate their stress response system as they encounter the challenges of parenting.

There is increasing evidence that suggests that the intentional use of stress reduction skills during the preconception, prenatal and early parenting periods lessens the negative impacts of stress on mothers-to-be and their developing babies (7). Many mothers-to-be report experiencing high levels of stress, as well as little time and limited resources to fulfill their own needs in healthy ways. They may experience multiple sources of stress currently in their lives, the effects of which are cumulative over time. Past experiences of stress and trauma also impact how they cope with stress in the present, and may increase the reactivity of their stress response system in the preconception, prenatal and early parenting periods.

Our perceptions of our environment shape our experiences and contribute to feelings of stress or comfort.  We have all noticed that people are stressed by different experiences, just as people find comfort and ease in different environments. Recent studies show that, “subjective measures of stress perception and appraisals are more strongly associated with adverse outcomes than measures of exposure to potentially stressful events or conditions” (8). This highlights the need to gain a deep understanding of women’s and girls’ perceptions of their experiences before and during the prenatal development of their offspring, rather than just asking whether they have experienced specific events commonly identified as stressors.

A mother-to-be’s perception of her internal environment (inside her body) and external environment (surrounding her body) affect her state of mind and her physiology, which are inextricably interconnected. Her past experiences and beliefs shape her perceptions in the present.  Her perceptions and beliefs influence her experience of conception, pregnancy, birth and early parenting. Her experience of these crucial events impacts her psychophysiology and in turn, that of her developing baby.

Stephen Porges coined the term “neuroception” which describes the relationship between our perceptions and our psychophysiology (9). Neuroception is the way our nervous system continuously evaluates our environment for safety, danger or life threat.  It is through our senses that we perceive our environment and our nervous system uses the information we take in to make these assessments. This process occurs very rapidly, beneath the level of our conscious awareness. If a woman’s neuroception of her environment is that of danger or life threat, her stress response system will be activated. A neuroception of life threat may trigger symptoms of traumatic stress (10).  A neuroception of danger or life threat regarding the health and safety of one’s baby before, during or after birth may also trigger a parent’s stress response system (11).

Stress and traumatic stress may be also be associated with difficult events that occur during reproductive experiences and reproductive health care in the preconception, prenatal and early parenting periods. These experiences may include: attempts to conceive; treatment for infertility; pregnancy losses; pregnancy terminations; pregnancy and birth complications, pain and treatment; health issues that are experienced as dangerous or life threatening to mother and/or baby in the prenatal and/or postnatal periods; neonatal losses; difficulties with infant feeding; premature birth; neonatal complications resulting from premature birth; and parenting an infant who is receiving care in the neonatal intensive care unit (NICU).

Recent studies suggest that the adverse outcomes of stress on mothers-to-be and their developing babies during pregnancy are not related to any single effect of stress, but to multiple factors and the interactions between them (12). The systems and tissues of the mother, the placenta and the fetus may all react to the mother’s experience of stress, each affecting the other.  Stress evokes changes in the unique physiology of each pregnant woman or girl, which triggers physiological reactions in her placenta and her developing baby. It is has now been shown that a “bi-directional physiological relationship” exists between the mother, the placenta and her developing baby (12).

Repeated or chronic activation of a mother-to-be’s stress response system may negatively impact her nervous, endocrine, immune and cardiovascular systems during the preconception through early parenting periods. These complex and interrelated bodily systems play numerous crucial roles in conceiving a child, sustaining a pregnancy to term, giving birth, infant feeding and early parent-child interactions. Stress reduction practices have been shown to positively impact these systems in both mothers-to-be and their developing babies.

Stress reduction skills offered to parents-to-be are most helpful if they are simple practices that can be employed quickly and spontaneously, even in difficult circumstances, and have been shown to have beneficial effects on a parent’s stress response system. If stress reduction skills are easy to learn and use, they can offer parents-to-be a valuable resource that will contribute to their lifelong well-being and that of their child.

In Part II, I will discuss some of the stress reduction practices that have been shown to reduce reactivity in an individual’s stress response system and can be helpful to parents during the preconception, prenatal and early parenting periods.

References

(1) Entringer, S., Buss, C., & Wadhwa, P. D. (2010). Prenatal stress and developmental programming of human health and disease risk: Concepts and integration of empirical findings. Current Opinion in Endocrinology, Diabetes, and Obesity, 17(6), 507-516.

(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. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3710585/

(3) Staneva, A., Bogossian, F., Pritchard, M. & Wittkowski, A. (2015). The effects of maternal depression, anxiety, and perceived stress during pregnancy on preterm birth: A systematic review. Women and Birth. http://dx.doi.org/10.1016/j.wombi.2015.02.003.http://dx.doi.org/10.1016/j.wombi.2015.02.003.

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The Importance of Reducing Stress During Pregnancy

Research highlights the impacts of prenatal maternal stress on developing babies