We all deal with some level of stress daily. Pregnancy can be a time of additional stress as you are experiencing many physical changes and preparing for birth and a new baby. In a sense, everything you expose yourself to during pregnancy also can affect your baby, and stress is not an exception.
Stress during pregnancy can affect your baby in many ways. Physiological changes can impact your developing baby. Stress that puts you at a higher risk for some complications can affect the health and development of your baby. How you and your baby are affected by stress, both in the short and long term, is a function of your stress response and your ability to turn it off. The good news is that understanding your stress response and learning about evidence-based tools to manage stress will minimize your and your baby’s adverse effects and positively impact your mental health.
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Stress is a state of mental or emotional strain or tension resulting from adverse or demanding circumstances. Stressors can be psychological or physical. We tend to think of stress as a negative response. How our stress response works and how it affects our body is more nuanced than simply being positive or negative.
Anxiety, Depression, and Seeking Help
This article will help you understand your stress response and give you some powerful tools to mitigate the impacts of stress on you and your baby. Stress can grow over time to more severe conditions like anxiety and depression, which can be devastating. If you are struggling with your mental health, please do not struggle alone. Talk to your doctor or midwife about how you feel and work on a plan to access resources that can help.
Causes of Stress During Pregnancy
Pregnancy is a unique phase where you will likely encounter additional stress. Your body may be under physical stress from common symptoms like morning sickness, heartburn, constipation, or aches and pains. You will go through many emotional changes due to increased levels of hormones. You are also embarking on a new journey where you are responsible for the health and well-being of a new human.
Thankfully, you have nine months to prepare and plan. Although nine months may seem like a long time, all the learning, planning, and work that goes into preparing to be a new parent can sometimes be overwhelming. It could be nine months of worrying that your baby will be healthy. You may have anxiety about your birth going as planned or that you will be a good parent. The last thing you need to stress out about is stress. Let’s examine how stress affects you and your baby, the evidence on stress during pregnancy, and some evidence-based practices to mitigate stress.
Your nervous system includes your brain, spinal cord, and nerves throughout your body. This complex system controls everything you do, from breathing and moving to feeling emotions. Part of your nervous system is your autonomic nervous system which controls your actions and bodily functions without thinking about them, including how you respond to stress. Your autonomic nervous system includes your sympathetic and parasympathetic systems. Your sympathetic is your fight or flight system, and your parasympathetic is the rest and digest system. These systems work together to regulate all of your body’s functions.
Your sympathetic nervous system triggers your stress response. When you encounter a physical or emotional stressor, your brain communicates with a chain of neurons in the middle of your body that activates and releases a chemical called acetylcholine. Other neurons throughout your body respond to acetylcholine and release epinephrine, also known as adrenaline. Epinephrine activates some systems in your body and shuts down or down-regulates others. Your heart rate increases. Your breath rate increases, and your lungs increase their oxygen capacity. Your senses, like sight and hearing, become sharper. Your body prepares you to act quickly to the stressor. As your body prioritizes energy to systems that may help you escape the threat, functions not needed for immediate survival, like digestion, are halted. Your brain also triggers hormones that lead to the release of cortisol. Your cortisol levels remain elevated until the threat or stressor disappears. This is the flight or fight response.
Duration of Stress Matters
Not all stress is bad. Humans would not be around today if we did not have a stress response. We may have developed this mechanism to prevent us from being eaten by predators, but other forms of stress are not simply a modern problem. For all of human history, people have had to deal with stressors from strained relationships, loss, lack of resources, and a myriad of reasons other than avoiding a hungry predator.
Short-term stress may be beneficial. Acute stress can trigger your immune system to fight off illness. The immediate chain reaction to a stressor can instantly make you move out of physical danger. The stress of a work deadline can motivate you to finish a project. When you experience short-term stress, your parasympathetic nervous system activates to turn off the stress response, bringing your body back to a relaxed state. The issue is that your stress response is not designed to be active for long periods. When you experience constant, prolonged, or chronic stress, the effects are more significant than short-term or acute stress.
How Stress Affects You
There is a lot of evidence that stress can affect your health in the short and long term. You can be physically and emotionally exhausted if you constantly react to stress. Hormones involved in your stress response also serve other functions. As a result, over-activating your stress system for long periods can affect nearly every system in your body.
Hormones released during periods of stress play a critical role in your immune system function. Chronic stress ultimately impairs your immune system.
Your brain is responsible for initiating your stress response. When stress happens too often and for long periods, it can cause structural changes to your brain that alter your response to stress, cognition, and memory.
During acute stress, your muscles tense up, then release once the stress passes. Chronic stress causes your muscles to be tense for long periods, which can have a lasting impact on your musculoskeletal system.
Short-term stress increases your heart rate. Over time, chronic stress affects your cardiovascular system by increasing inflammation, the risk of hypertension (high blood pressure), heart attack, or stroke.
In a fight or flight scenario, functions not needed for immediate survival, like digestion, are halted. Long-term stress can harm your gastrointestinal tract. Processes like nutrient absorption, GI tract movement, intestinal permeability, mucus, and stomach acid secretion, microbiome, and inflammation are all affected by stress.
Long-term stress can have negative impacts on your nutrition through loss of appetite. Your quality and quantity of sleep can be affected. Not only is it difficult to enjoy your life if you are under constant stress, but it can also be challenging to cope daily.
Stress is Subjective
The research on stress in pregnancy is generalized and cannot account for everyone experiencing stress differently. Your perception of stress and how your body reacts is unique. Physical and psychological mechanisms, including past experiences, environment, and age, influence the complex stress response system. Even your sex can affect how sensitive your stress response system is and your ability to recover after a stressful event.
Research on animals allows us to study stress during pregnancy at a level that would not be possible with human subjects. Most animal studies use rats and subject them to stress by isolation with an unfamiliar rat. While rats and humans differ, we are genetically similar, and both species have complex social interactions. Animal studies have provided a wealth of information we would not otherwise have, and we have learned a lot that we can apply to humans. See this article for more details on why researchers use rats to study stress in pregnancy.
Stress and Miscarriage
One of the biggest concerns of stress in pregnancy is a possible link to miscarriage. Miscarriage describes pregnancy loss before 20 weeks. The most widely accepted statistic is that 10-15% of clinically recognized pregnancies result in a loss. One study showed this number might be even higher for pregnancies that miscarry before being clinically recognized, and it could be as high as one in three. The possibility of miscarrying can be terrifying. For a mother who experiences a miscarriage, it could be devastating to blame herself and stress in her life for her loss.
A systematic review and meta-analysis investigated whether maternal psychological stress is associated with an increased risk of miscarriage. The risk of miscarriage was significantly higher in women with a history of exposure to psychological stress, by 42%. The study authors note that doctors and other health care professionals often dismiss a link between stress and miscarriage. That may be due to doctors not wanting patients to feel responsible for pregnancy loss.
There are many possible causes of miscarriage, most due to a chromosomal abnormality. Most women who experience a miscarriage will not know the underlying cause. Please do not feel responsible for losing a pregnancy due to the stress you are experiencing.
Stress and Preterm Birth
There is evidence that stress can increase your risk for preterm birth. One study found that approximately 20% of the participants’ preterm births were estimated to be due to maternal stress exposure during pregnancy as an attributable risk factor. In addition to stress, other factors can increase your risk for preterm birth. Like miscarriage, if your baby is born early, you likely never know the underlying cause.
Physiological Impact of Stress on Your Baby
There are thousands of studies on the potential impact of maternal stress on a developing baby. By examining some of this research, you will better understand the mechanisms of how your stress can impact your baby during pregnancy.
Research shows that stress in a pregnant mother can impact the stress hormones secreted by the placenta and circulate in the amniotic fluid. In one study, scientists measured hormone levels in the amniotic fluid from amniocentesis. This created an acutely stressful event since amniocentesis involves inserting a needle through your belly into the amniotic sac and comes with risks to both you and your baby. Mothers recorded long-term stress with questionnaires. They found no connection between short-term stress and stress hormones in the amniotic fluid, but there was an increase in stress hormones in the amniotic fluid when the mother reported long-term stress.
The key pathway through which maternal stress transfers to a baby is thought to be through the maternal-fetal transfer of cortisol. An enzyme regulates this transfer through the placenta by converting about 80–90% of maternal cortisol to the inactive form, cortisone. Animal studies have shown that increased levels of maternal cortisol down-regulate the activity of this enzyme and stimulate the synthesis of corticotrophin-releasing hormone (CRH) production. This creates an increase in fetal exposure to maternal cortisol. We know cortisol will transfer from a mother to her baby. However, there is also evidence that cortisol is probably not the sole mediator between perceived stress and outcomes.
Stress and Your Baby’s Brain Development
Some research shows that stress can impact the development of your baby’s brain. A study used hair samples from 78 pregnant women to measure cortisol in the previous three months. The brain structures of their babies were examined with MRI scans. This study found that cortisol levels in a mother are linked to the development of the baby’s amygdala, an area of the brain involved in emotional and social development in childhood. Cortisol was also linked to differences in brain connections.
The Impact of Stress on Your Child’s Behavior and Mental Health
In addition to affecting a baby physically, stress in pregnancy can impact a child’s behavior and mental health. One study found a link between emotional stress during pregnancy and infant stress reactivity. This, in turn, influences mother-child interaction up to preschool age. Some research shows that maternal stress during pregnancy is associated with the development of ADHD. One study used siblings to control confounding factors such as parenting style, home environment, parental mood disorders, or parental ADHD. Researchers found that maternal stress during pregnancy increases the risk of ADHD diagnosis later in life.
There is an extensive review breaking down all of the evidence that prenatal exposure to maternal stress can have long-lasting effects on the behavior and mental health of the offspring. This review is very in-depth, with a few takeaways worth mentioning.
The ways and the extent to which a baby is affected depend on various factors. Prenatal stress and outcomes in babies are complex. It is not a simple cause-and-effect system.
Maternal stress involves numerous biological systems. Growing evidence suggests an association between a baby’s autonomic nervous system function and prenatal exposure to maternal stress, depression, and anxiety.
Several studies have found critical periods in gestation that are vulnerable to the effects of prenatal stress. We cannot identify one pregnancy period as the most susceptible period to stress. Your baby is developing different structures and functions of the brain throughout its development. This means your entire pregnancy is a series of critical periods vulnerable to one or more offspring outcomes.
Multiple studies found that male and female babies responded differently to stress. This differed based on prenatal stress when it occurred, and measured outcomes. Overall, one sex was not more susceptible to stress, but some studies found that males and females differed depending on the outcomes measured.
Many of the studies reviewed looked at longer-term outcomes. There is even evidence that maternal stress can impact the telomere length of babies. The length of telomeres is a biomarker for aging. As we age, stress hormones, oxidation, and inflammation affect the length of telomeres.
We know that prenatal stress can significantly affect maternal health, pregnancy, and baby development. This is not one clear path that is well understood. There are many mechanisms through which stress can affect you and your baby. Stress can impact you and your baby by impacting your mental health, affecting how you interact with your baby. If stress impacts your pregnancy and birth, that can have lasting changes on your baby’s health and development. If you want to dig into more of the science of how stress can affect your baby during pregnancy, this article provides an in-depth summary of many research studies.
Prioritizing Maternal Mental Health
A recurring theme throughout the research reviewed for this article is that we need better solutions for maternal mental health. Some of the proposed solutions are to screen expecting mothers for stress, anxiety, depression, and other issues at the beginning of their pregnancy. Many studies suggest that care providers should offer expecting mothers access to professionals, resources, and tools. Maternal mental health starts in pregnancy, and the earlier you prioritize your mental health, the better.
Unfortunately, our society, especially in the United States, does not prioritize mental health. If there is one thing you can do for yourself and your baby that will have the most significant impact on your family, it would be to take care of your mental health. That starts with learning how to manage stress. Some sources of stress in your life are out of your control. However, you have a lot of control over how you react to mitigate stress and its impact on you and your baby. Let’s discuss some perspectives, strategies, and tools you can implement. Everyone is different, and not all of these techniques will work. Take what applies to you and ignore what doesn’t.
It would be wonderful to avoid stress in the first place. Of course, this is not a realistic solution for everything, but there are scenarios in which you may avoid some stress. To avoid stress, you need to identify the source. If people, online or in-person, stress you out, you can limit your interaction with them. This may be more challenging with a co-worker or family member than with someone you can unfollow online. If your source of stress is something you can avoid while still fulfilling your obligations, start there.
Worry, Fear, and Anxiety
Worry, fear, or anxiety about the future is something every parent will experience. You can take steps to overcome these issues and get more comfortable with the unknowns that may be ahead. The first step is to define what you are worried about and educate yourself. Next, acknowledge that anything is possible and what you are concerned about may happen. Then you can prepare and develop a plan for handling that situation.
If you are worried about your birth, there is so much you can do to educate yourself and prepare. Preparing a plan B is an excellent way to alleviate anxiety about what to do if your birth does not go as planned. There are also great tools on the podcast to help you get a head start on parenting. If you have anxiety about maternity leave or what you will do with your baby once you return to work, take steps to explore your options and start working on a plan. Taking action is almost always better than doing nothing. All you can do is control what is in your control.
Everyone varies in their response to stress, and there is no one-size-fits-all solution for everyone. You may need to try several strategies and find the best for you.
In light of how your stress response system operates, the best tools to reduce stress quickly are those with a direct line to the autonomic nervous system. You can control this by controlling your breath. Making your exhales longer or more vigorous than your inhales will slow your heart rate down. This is a function of how your diaphragm moves with your breath and the space created for your heart. This exhale-emphasized breathing is known as the physiological sigh. This is a double inhale followed by a long exhale. This lets your body eliminate extra carbon dioxide and immediately calm you down. Performing this breathing technique one to three times can quickly diminish your stress response in real time. Heart rate will take 20-30 seconds or more to reduce.
This is a technique I learned about from Andrew Huberman, a neuroscientist and a fantastic resource. If you want to know more about tools for managing stress, I encourage you to watch this video. The Huberman Lab podcast is terrific for neuroscience and science-based tools for everyday life.
A large body of evidence supports a connection between social connection and physical and mental health. Humans are social creatures that are wired to connect to others. A study examined 27 stress indicators during pregnancy, including psychosocial, physical, and lifestyle. 66.8% of women were in the healthy group, and 17.1% were in the psychologically stressed group and had clinically meaningful elevations in perceived stress, depression, and anxiety. 16% were physically stressed with higher blood pressure and increased caloric intake. The researchers found that social support contributed most to differentiating the three groups. They looked at three forms of social support; others with whom to talk and spend time and on whom to rely for material help.
Starting or growing your family involves significant life changes that can significantly impact your lifestyle and the people you connect with. Going through pregnancy and parenting in isolation or with little support from a larger community of friends and family will make everything more difficult. If you feel like you need a better support system right now, that is something you have the power to change. There will always be people going through pregnancy and having babies in your community or area. You have the opportunity to meet other expecting or new parents through an in-person birth class, a local Facebook or Meetup group, or even at your neighborhood park. Pregnancy or having children around the same age is an instant common ground to connect with others.
Talking to Your Partner
If you are feeling stressed, please share your feelings with your partner. If you do not have a partner, try talking to a friend or family member. Sometimes even sharing what you are feeling can make you feel better. Having another person’s point of view can also help you work through solutions or put your experiences in a different perspective.
A significant contributor to stress can be mental load. The term mental load describes everything you keep track of in your brain. The invisible labor you do every day often goes unnoticed by others. This could include picking up something at the grocery store, being overdue for a dentist appointment, next week is your best friend’s birthday, and buying a gift. In many cases, one person tends to take on more of the mental load if you are in a relationship. Stereotypically, this is something that women do more than men.
Your mental load will exponentially grow as you become a mother. You may be experiencing it now, thinking about prenatal appointments, prenatal testing, ultrasounds, baby showers, what kind of crib you should get for your baby, planning for maternity leave, and what you will do for childcare if you return to work. It is a never-ending list of things you track in your head that can easily contribute to stress.
Make a Brain Dump
One tip that may help with your mental load is to get everything written down and out of your head. I like to call this a brain dump. You can make a note on your phone, paper, or task management app. If you remember that you need to take your car in for an oil change, schedule it so you don’t have to think about it. Get those items out of your head and record them somewhere other than your brain.
Delegate, Automate, and Batch
If you are carrying the bulk of the mental load in your household, you are the project manager of your home. If you can, delegate, automate, or batch tasks. Delegating tasks seems like a great solution, but for delegation to be successful means that someone else should complete the task without you having to follow up. If you ask your partner to tackle a project before the family visits but feel like you have to remind your partner to do it or follow up, you have not removed the task from your mental load. Even asking your partner, friends, or family for assistance with small things can take a lot off your plate. If you have the financial means to delegate tasks to a paid service, take advantage of it. Sign up for a meal delivery service, get your groceries delivered, and hire a service to clean your house.
If there are tasks that you can automate, that can also ease the list of things to do in your head. You can sign up for recurring subscriptions to household items you regularly need. You can set up some bills on autopay so you don’t have to think about them every month when they are due and need to pay them. You may also be able to batch tasks. A perfect example of this is meal prepping. Preparing 2-3 meals can minimize your time preparing food and reduce decision-making because you already know what you will eat that day.
Anything you do to lessen your mental load and everything you are keeping track of can lower your stress. Make a brain dump and get everything off your brain and on paper or your phone. If you can, delegate, automate, and batch tasks.
Diet, Sleep, and Health
During periods of stress, your health can be affected by stress impacts on your diet, sleep, and overall health. You can buffer some of the adverse effects by paying extra attention to taking care of these areas of health, which may improve your ability to manage stress.
Pregnancy can present some challenges to sleeping well, but you can also do a lot to prioritize and improve your sleep. Stress and diet can affect each other. When stressed out, you may indulge in less healthy food. Eating unhealthy food can also affect your energy and health, increasing stress. Your diet does not need to be perfect, but you should prioritize healthy whole foods. You should take a high-quality prenatal vitamin to fill any nutritional gaps. You may also be interested in supporting and boosting your immune system, especially during stressful periods. The healthier you are overall, the better you will manage your stress, and the more you can mitigate stress’s adverse short and long-term effects.
It may seem counterintuitive that exercise can help you manage stress when the act of exercise puts physical stress on your body. Exercise can cause changes to many hormones, including those involved in your stress response. It can also help with many symptoms resulting from chronic stress, like cardiovascular issues and impaired immune function.
One of the challenges is that stress can impair your efforts to be physically active. The more stress you experience, the less motivated you may be to work out. One way to combat this feedback loop is to make exercise a habit. One of the most beneficial things you can do for your health is to exercise regularly. That could mean you join a gym, sign up for classes, or walk in your neighborhood daily. The key to incorporating exercise into your routine is finding something that works for you and being consistent. Sometimes consistency means you do it even when you are stressed and don’t feel like it. In the long run, you will experience less stress and better manage your stress.
Nearly every form of exercise can be modified to be safe during pregnancy. For more information, there are episodes of the Pregnancy Podcast on exercise during pregnancy, yoga, strength training, and cardio.
Journaling or writing about your experiences and emotions may be a helpful tool in managing stress. Evidence shows that expressive writing has both short and long-term beneficial effects, especially concerning stress. If you are new to journaling, it may feel awkward to pick up a pen and stare at a blank page, wondering what you should write. You can start by simply writing about what you did that day or what you plan to do. You can write about how you feel, what you are grateful for, or what you look forward to after your baby is born. Like any tool, the more you practice journaling, the easier it will become. Other than taking a few minutes of your time, there is no downside to trying out journaling.
Managing Your Stress as a New Parent
Your newborn baby has limited methods to regulate their stress, and they rely on caregivers to help them regulate. Skin-to-skin contact is a fantastic tool to use for this. Being skin-to-skin stabilizes your baby’s heart rate, breathing, and temperature and reduces stress in both you and your baby. These benefits are not just for mothers. Dads and partners can and should get skin-to-skin with their babies.
One benefit of skin-to-skin contact is that it increases your interactions with your baby and increases the likelihood and length of breastfeeding. You want to take advantage of anything you can do to get breastfeeding off to a good start. Breastfeeding itself can be a source of stress if it is not going well. There are a lot of resources on the Pregnancy Podcast website for breastfeeding.
Managing stress is a skill that you will not master overnight. The more you practice and find effective techniques, the easier it gets. Applying techniques to manage stress during pregnancy will enable you to better deal with stress as you encounter it in your parenting journey.
Putting Things into Perspective
As long as humans have been around, we have been dealing with stress and working on ways to manage it. Stoicism is a Greek philosophy dating back to 300 BC. Based on the idea that we don’t control and cannot rely on external events, only ourselves and our responses. Marcus Aurelius wrote, “Today I escaped anxiety. Or no, I discarded it because it was within me, in my perceptions—not outside.” To be human means you will endure stressful situations. We can train ourselves to look at things from another perspective or respond differently. Over time and with consistency, you can train yourself to be more resilient to stress and mitigate the adverse effects.
If you want to explore more stoicism, Ryan Holiday is a great resource. I look forward to his Daily Dad email every morning with fantastic advice, not just for dads but all parents. Many stressors we encounter are out of our control, but we can control how we respond.
Most Stress is Temporary
If you are experiencing stress due to pregnancy, remember that this phase of your life is temporary. If you are dealing with physical discomforts, those will eventually go away. One great question is, Will this matter in a week, month, or year? If the answer is no, it may not be worth thinking about now. I acknowledge that this is easier said than done. It can still be helpful to realize that there will be a point when this issue goes away, or you will not be bothered by it.
Talking to Your Doctor or Midwife
While some stress is normal, other conditions like anxiety and depression may require intervention and assistance. If there is something causing stress concerning your pregnancy or birth planning, your doctor or midwife may help. If you are experiencing deeper feelings, you could benefit from seeing a therapist or other specialist. It can be challenging to admit that you have a tough time and ask for help. It will be far more difficult to try and deal with mental health issues alone in the long run. Please discuss how you are feeling with your doctor or midwife.
The Big Takeaway
Pregnancy is a complex process that even the most intelligent scientists do not fully understand. Please do not blame yourself for conditions you may encounter or outcomes you do not have direct control over. The biggest takeaway I want you to have from this article is that learning to manage your stress is a lifelong process that takes work. All you can do is try your best. Taking small steps now and consistently working on them will significantly benefit your life and your child, both during pregnancy and in the long run. Like everything, it will get easier.
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