Relax! Your Baby Will Thank You!

Part 2 of a 2-part series.

From the WebMD Archives

Part 1: The Effects of Stress on Fertility

Cell phones ringing. Beepers going off. Traffic jams, work deadlines, and laundry piled sky high. These are just a few of the stresses that are routinely a part of most women's lives.

Add pregnancy into the mix -- including some fears and anxieties -- and a woman's body can really begin to feel the effects.

"What many women don't realize is that, in and of itself, pregnancy is a stressful event. Your heart rate increases, your blood volume increases, your weight increases, there is additional stress on ligaments and bones. So just the physical aspects of pregnancy can add to your load," says Calvin Hobel, MD, vice chairman of the department of obstetrics and gynecology at the Cedars Sinai Medical Center in Los Angeles.

And the recognition of that stress load is important, say experts, particularly in terms of your baby's health.

Different types of stress can increase the risk of low birth weight as well as premature birth.

The Nutrition Dos and Don'ts of Pregnancy

According to the March of Dimes, socioeconomic factors such as low income and lack of education are associated with increased risk of having a low-birth-weight baby. Yet they add that the reasons for the link still remain unclear and are not well understood.

Chronic tension, especially in early pregnancy, may "imprint" similar stressful tendencies onto baby's developing brain.

Effects of Traumatic Events

For example, in a study published in the journal Child Development in 2004, a group of Belgian researchers found an association between women who experienced high anxiety during the early stages of pregnancy and children who exhibited signs of hyperactivity -- including attention deficit hyperactivity disorder -- 8 to 9 years after birth.

Their theory: traumatic events occurring in early pregnancy program certain biological systems in the unborn child, making the child more susceptible to emotional disorders later in life.

These findings mimic earlier studies, including one conducted at the Imperial College in London. Here, women who reported severe anxiety attacks during pregnancy were twice as likely to give birth to a hyperactive child.

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Yet another study published in the journal Developmental and Behavioral Pediatrics in 2003 found that anxiety-related increases in the mother's heart rate had a direct impact on the fetal heart rate. More specifically, researchers from Columbia University linked changes in fetal heart rate to the mother's cardiovascular activity after experiencing psychological stress as well as anxiety. This, they say, indicates that emotional ups and downs may affect the baby's biology and could hold a key to fetal development. Still, many doctors say this is not quite enough evidence to draw a clear correlation for all women.

"These studies can be difficult to interpret because too many factors can influence the outcome. Right now it's an association we need to pay attention to, but not a cause," says Bruce Young, MD, a professor of obstetrics and gynecology at NYU Medical Center in New York City.

High-risk pregnancy expert Andrei Rebarber, MD, agrees. "It's an interesting phenomenon, but admittedly, we don't have great markers from what we know thus far," says Rebarber, an associate professor at the Mt. Sinai School of Medicine in New York City.

That said, when stress does a play a role, Rebarber believes it's most likely long-term chronic anxiety and tension that is of most concern.

"The basic idea here is that the maternal response to chronic stress compromises various hormones during pregnancy, including causing higher levels of CRH [corticotropin releasing hormone], in conjunction with cortisol and other stress hormones, to cross the placenta," says Rebarber.

It is this cascade of events, he says, that appears to affect premature labor and birth, possibly affecting the growth rate of the baby.

Pregnancy and Acute Stress: Important Links

While most experts agree that any truly detrimental effects of stress are likely to be the result of long-term or chronic stress, what about those life-changing events that happen suddenly?

Hobel says it's not something most women have to worry about.

"No matter how severe, if it's just one episode, most women can handle it, particularly if they have a good support system, with family members, spouses, and friends helping them through the trying event," says Hobel.

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And that's precisely what doctors in New York City learned in the days and weeks following the events of Sept. 11. While they fully expected the stress of that day to increase rates of premature birth, surprisingly, says Young, this was not the case.

Rebarber says that some of the Sept. 11 data showed an increase in women starting labor early, but that early delivery had not necessarily increased.

Hobel believes that may be because the effects of a sudden episode of a stressful event are far more likely to cause problems when experienced early rather than late in the pregnancy.

That is precisely what researchers at the University of California at Irvine documented following the 1994 northern California earthquake. In this instance, women who were in their first three months of pregnancy when the quake hit were far more likely to deliver prematurely than women who were in their third trimester when the disaster occurred.

"The definition of major stressors includes things like loss of another child or a parent -- something personally profound and traumatic," says Hobel.

Pregnant and Stressed? How to Tell

While studies are teaching us some of the deleterious effects of stress, they're also helping to validate that stress reduction can offer both mother and baby important benefits.

The stumbling block, say doctors, is that many women are not aware of just how stressed they are or the simple ways they can control it.

"When we think of stress we tend to think of the big, easy-to-identify events, or even the annoying factors we encounter every day. What we don't realize is that how we care for ourselves on a daily basis holds the real key to stress control," says Hobel.

Among the most important decisions, he says, is to pay attention to good nutrition.

"Not eating well during pregnancy is a primary way to increase your stress load and whatever effects that may have on your baby," says Hobel.

Not only is it important to eat nutritiously, he says, but also to eat frequent, small meals.

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"If you skip breakfast, for example, you can develop accelerated ketosis [a fat burning process seen in starvation] which can be very stressful on your baby. So something as simple as eating breakfast is a great way to reduce some of the risks related to stress," says Hobel.

He says smoking can also place undue stress on both mother and baby.

"The body has a very potent stress reaction to even a single cigarette. So by not smoking during pregnancy you automatically reduce the risk of many stress-related effects on your baby," says Hobel.

Likewise, he says, avoiding excessive travel -- with risks that include fatigue, dehydration, and missing meals -- is another way to protect your baby, particularly during the first trimester.

"You don't have to avoid travel, but you should pay a little extra attention to things like getting more rest, making sure to drink enough fluids if you are flying, and carrying nutritious snacks for sustenance during the trip," he says.

Also important, he says, is to tend to any infections that occur during pregnancy, including gum disease or UTIs (urinary tract infections), both of which can add more stress to your load.

Pregnancy Stress Protection: What to Do

While a little bit of precaution goes a long way, as the saying goes, "life happens." And that means that no matter how we try to avoid it, some stress is bound to creep into our lives.

When it does, most women can diffuse the effects if they have a good support system in place.

"It can be a spouse, your mother, your best friend, your clergyman -- anyone that you can talk to and seek comfort in, is going to help alleviate your stress," says Young.

He says studies show that just voicing your stressful feelings is a tremendous source of relief, particularly if your stress is linked to worries about your pregnancy.

"Every pregnant woman has some stressful thoughts and fears during pregnancy. But if you talk it out, voice your concerns, tell someone how you feel, you release that stress and both you and your baby can benefit," says Bruce.

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Rebarber agrees and adds that learning to delegate and to embrace the changes that pregnancy brings are two more important ways to reduce stress.

"You have to slow down just a little bit and find a small window of opportunity within each day to take a deep breath, relax, and do something comforting for yourself -- all of which can help keep tension from building," says Rebarber.

Most important: All our experts tell WebMD that women should not fret or worry that their "fretting or worrying" is going to harm their baby.

Says Rebarber: "Remember, it's normal to be concerned -- it's not going to harm you or your baby. And even if you experience a major stressful event, a good support system, good nutrition, and time for relaxation every day is usually enough to counter the effects, protecting you and your baby from harm."

WebMD Feature Reviewed by Brunilda Nazario, MD on July 11, 2005

Sources

Published July 11, 2005.

SOURCES: Calvin Hobel, MD, vice chairman of obstetrics and gynecology, Cedars Sinai Medical Center, Los Angeles; Miriam Jacobs Chair in maternal fetal medicine, Cedars-Sinai Medical Center. Bruce Young, MD, Silverman Professor of obstetrics and gynecology, NYU School of Medicine, New York. Andrei Rebarber, MD, associate clinical professor of maternal fetal medicine, Mt. Sinai School of Medicine, New York. Van den Bergh, B. Child Development, July 2004; vol 75: p 1085. Glover, V. British Journal of Psychiatry, 1997; vol 171: pp 105-106. Monk, C., Journal of Developmental and Behavioral Pediatrics, February 2003; vol 24: pp 32-38. American Psychological Society annual meeting, Miami Beach, June 9, 2000. Society for Neuroscience annual meeting, San Diego, 2002.

© 2005 WebMD, Inc. All rights reserved.

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