Overview

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 essentially 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 the adverse effects for both you and your baby and positively impact your mental health.

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Anxiety, Depression, and Seeking Help

The focus of this article is stress, specifically during pregnancy. Stress can grow over time to more severe conditions like anxiety and depression that 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.

Defining Stress

Stress is a state of mental or emotional strain or tension resulting from adverse or very 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.

Causes of Stress During Pregnancy

Pregnancy is a unique phase of your life where you are likely to 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 you preparing to be a new parent can be overwhelming at times. 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 potentially your baby, the evidence on stress during pregnancy, and some evidence-based practices to mitigate stress.

Stress Response

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 that 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. An easy way to remember these is 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 and breath rate increase, and your lungs increase their oxygen capacity. Senses, like sight and hearing become sharper. Your body is preparing for 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 has passed or the 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 a predator, 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. Your parasympathetic nervous system functions to turn off the stress response and downregulates all of the activated systems during the fight or flight response. The parasympathetic system essentially brings your body back to a relaxed state.

How Stress Affects You

Your stress response is not designed to be active for long periods. If you are constantly reacting to stress, you can be physically and emotionally exhausted. There is a lot of evidence that stress can affect your health both short and long term.

Hormones involved in your stress response have functions throughout every other system in your body. Over-activating your stress system for long periods can affect nearly every system in your body. Chronic stress ultimately impairs your immune system. Hormones released during periods of stress play a critical role in your immune system function.

Chronic stress can cause structural changes in your brain and lasting changes to your nervous 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.

In a period of 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 for 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, your 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

Everyone experiences events differently, and our perception of stress and how our body reacts is unique. Both physical and psychological mechanisms influence the complex stress response system. Your past experiences, environment, age, and even sex can affect how sensitive your stress response system is and your ability to recover after a stressful event.

Animal Studies

Some of the research on stress in pregnancy is in animal models. This is research that would be unethical to perform with humans. We should acknowledge that many people also object to animal studies. Most of these studies use rats and subject them to stress by methods like isolation with an unfamiliar rat. Researchers often use rats because they are genetically similar to humans and have complex social interactions. See this article for more information on why researchers use rats to study stress in pregnancy.

How Stress Affects Your Pregnancy

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. 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, and most are due to a chromosomal abnormality. Most women who experience a miscarriage will not know the underlying cause. Please do not feel responsible for the loss of a pregnancy due to the stress you are experiencing.

There is evidence that stress can increase your risk for preterm birth. One study found 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 may never know the underlying cause.

How Stress Affects 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 actually creates an increase in fetal exposure to maternal cortisol. However, there is also evidence that cortisol is probably not the sole mediator between perceived stress and outcomes.

We know that prenatal stress can have significant effects on maternal health, pregnancy, and the development of a baby. This is not one clear path that is well understood. There are many mechanisms through which stress can affect you and your baby. The research we reviewed shows how physiological changes can impact 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 on how stress can affect your baby during pregnancy, this article provides an in-depth summary of many research studies.

One study found 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. This study used hair samples from 78 pregnant women to measure cortisol in the previous three months. The babies underwent an MRI to look at the structure of the brain.

Research shows 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.

One study found a link between emotional stress during pregnancy and infant stress reactivity. This, in turn, influences mother-child interaction up to pre-school age.

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, and there are a few takeaways worth mentioning.

The ways and the extent to which a baby is affected depend on a wide range of factors.

Maternal stress involves numerous biological systems. There is growing evidence suggesting 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 for 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 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 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.

How stress impacts humans physically and emotionally from trying to conceive through development is a puzzle scientists are still trying to figure out. 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.

The Importance of Your Mental Health

Throughout the research reviewed for this article, a theme 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 resources to professionals, resources, and tools. 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.

Managing Stress

Let’s discuss some perspectives, strategies, and tools you can put into action. Everyone is different, and not all of these techniques will work. Take what applies to you and ignore what doesn’t.

Stoic Philosophy on Stress

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. Stoicism is 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. There are a lot of stressors we encounter that are out of our control, but we can control how we respond.

Putting Things into Perspective

If you are experiencing stress due to your pregnancy, remember this phase of your life is temporary. If you are dealing with physical discomforts, those will eventually go away. One great question to ask 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 this is easier said than done. It can still be helpful to realize that there will be a point in the future in which this issue goes away or that you will not be bothered by it.

Avoiding Stress

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 in your life. 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 simply 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 unknowns that may be ahead. The first step is to define what you are worried about and educate yourself. Next, acknowledge anything is possible and what you are concerned about may happen. Then you can prepare and develop a plan of how you will handle 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 some 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.

Coping Strategies

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 what works best for you.

In light of how your stress response system operates, the best tools to reduce stress quickly are those that have 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 allows your body to get rid of 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.

Social Connection

There is a large body of evidence to support 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 different stress indicators during pregnancy, including psychosocial, physical, and lifestyle. 66.8% of women were in the healthy group, 17.1% were in the psychologically stressed group who had clinically meaningful elevations in perceived stress, depression, and anxiety. 16% were in the physically stressed group with higher blood pressure and increased caloric intake. The researchers found social support contributed most to differentiating the three groups. They looked at three forms of social support; others with whom to talk, spend time, and on whom to rely for material help.

Starting or growing your family comes with 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 do not have a great 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.

COVID-19 has presented new challenges as many people are more isolated than ever. Research links isolation due to COVID-19 to stress, anxiety, emotional overload, poor sleep, and even physical health complications. If you feel less connected, you are not the only one. It may take more effort to try and connect with people right now. Building or deepening your social connections and a support system will benefit you and your baby, as well as the other people in your social circles.

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.

Mental Load

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 that you need to pick up something at the grocery store, you are overdue for a dentist appointment, next week is your best friend’s birthday, and you need to buy a gift. In many cases, if you are in a relationship, one person tends to take on more of the mental load. 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 should you get for your baby, planning for maternity leave, what you will do for childcare if you return to work. It is a never-ending list of things that you keep track of in your head that can easily contribute to stress.

One tip that may help with your mental load is to get everything written down and out of your head. You can make a note on your phone, on a pad of paper, or in a task management app. If you are remembering 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 somewhere other than your brain.

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 you 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 or friends, or family for assistance with small things can take a lot of your plate. If you can financially delegate some tasks to a third party, take advantage of it. Sign up for a meal delivery service, get your groceries delivered, 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 of household items you regularly need.

You may also be able to batch tasks. A perfect example of this is meal prepping. Even preparing 2-3 meals can minimize the amount of time you spend preparing food and reduce decision-making because you already know what you are eating that day.

Ultimately, lessening your mental load and all of the things you are keeping track of can lower your stress.

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 in turn 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 you are stressed out, you may be indulging 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 be prioritizing healthy whole foods. To fill any nutritional gaps, you should be taking a high-quality prenatal vitamin. You may also be interested in supporting and boosting your immune system, especially during particularly 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.

Exercise

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 exercise regularly. That could mean you join a gym, sign up for classes, or simply that you walk in your neighborhood every day. The key to incorporating exercise into your routine is finding something that works for you and being consistent. Sometimes consistency means that 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.

Journaling

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 are most looking 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. It also increases your interactions with your baby and increases the likelihood and length of breastfeeding. Breastfeeding 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.

Talking to Your Doctor or Midwife

While some stress is considered normal, other conditions like anxiety and depression may require intervention and assistance to get through. 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 challenging to try and deal with mental health issues on your own 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, and it is not easy. All you can do is try your best. Taking small steps now and consistently working on it will have a significant benefit on your life and for your child, both during pregnancy and in the long run. Like everything, it will get easier.

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