I’ve mentioned before that I’m a huge fan of the Headspace meditation app. I find it to be very well-designed, and makes it much easier and fun for me to meditate on a daily basis. They have sessions on various topics such as stress, sleep, relationships, even creativity. I was very excited that they recently introduced a new session on pregnancy- worked out perfectly for me, timewise. The sessions evolve during the course of 30 days, and involve visualizations for yourself as well as focusing on the baby.
Per the narrations, the basis of the sessions is that it’s beneficial for you and the baby to have a more calm, positive mindset and that stress is bad for you and the baby. While I don’t disagree with that, it did get me wondering- how much do we really know about how bad stress is for the pregnancy?
Like most things in pregnancy, I figure it’s hard to study. You can’t exactly split a group of pregnant women, subject half to significant stress and half not and see what happens. I’m not one to go searching through all the evidence, so I went to two of my go-to sources. One is UpToDate, a website many of us clinicians subscribe to that gives us current evidence and recommendations from experts. It’s generally reliable, and most of us use it as a higher-level Google. The other resource is ACOG, the organization that oversees us OB/Gyn docs in the US and gives us practice guidelines (how to manage patients based on the current evidence).
According to UpToDate, there is evidence that stress is associated with preterm birth. They say that major maternal physical and psychological stressors, including anxiety and depression, can activate the HPA axis (involved in the stress response), and it’s been associated with a slightly higher rate of preterm birth. One study showed that women who had depression early in pregnancy had a higher rate of preterm birth, and there was a “dose-response” effect, meaning that the worse the depression, the more it was correlated with preterm birth. They talk about the various mechanisms thought to be related to this, and even have the graphic below.
Pathogenesis of preterm birth
Don’t ask me to explain it in detail, as I’m certainly no expert in it. Bottom line is, stress apparently causes certain factors to be released, which are then thought to cause physiologic changes that lead to preterm labor and preterm birth.
ACOG doesn’t specifically have any articles on stress and pregnancy that I found. When I looked at their practice bulletin on preterm birth, they didn’t mention stress as a risk factor. Unfortunately, there is a lot that we still don’t know about preterm birth, or we’d be better at preventing it. The biggest risk factor is if one has had a prior preterm birth. There are other things, like underlying infection that have been correlated with preterm birth, but then again treatment hasn’t been shown to prevent preterm births. Some cervical procedures, like conization of the cervix which is performed to remove cervical dysplasia (advanced precancerous changes), were traditionally thought to increase risks of preterm birth, but they also wonder if there are other factors that contributed to the dysplasia in the first place that also put one at risk for preterm birth. There are some behavioral factors like smoking and substance abuse that increase risks.
So how do I approach the topic in real life? July was a brutal month work-wise, working nearly 60 hours a week consistently the whole month. I can’t say my mindset was exactly Zen as I’d be finishing yet another long work day. But am I worried that this is going to significantly affect my pregnancy? No.
My patients often worry about the stress in their lives affecting their pregnancies, and I think it’s generally unnecessary. While I wouldn’t advise volunteering for combat and voluntarily going to a war zone, most of us experience normal life stressors throughout the pregnancy, and that’s fine. That’s life. I can’t imagine that from the caveman days to now, that women have ever been able to get through 9 months of pregnancy without normal life stressors. And sometimes my patients have more significant stressors- some of them have lost family members during their pregnancy. Do they all go into preterm labor? Nope, their babies do just fine.
As a doctor, my goal is to make sure that my patients don’t need a higher level of care for what’s going on. If they are significantly depressed or anxious, then they may need to see a therapist or psychiatrist. I certainly wouldn’t want their underlying condition to affect their behaviors, such as eating or substance use, which would then affect the pregnancy.
I do agree that there is potential benefit in working on handling stress levels, such as meditating and exercising. But rather than doing that, many of my patients worry that their stressful work situation is going to affect their pregnancy, and then they come to me asking for notes for work. While work modifications are reasonable for patients who have physical pains and limitations, I do think some women are misguided when they think they need to modify because of “stress.” One extreme example is a patient who works as a school bus driver, driving 2 hours in the morning, and 2 hours in the afternoon. She felt like this was too much, and asked to reduce her hours. This is the kind of behavior that will make your doctor roll her eyes and complain about you behind closed doors.
My thoughts are to do what you can to handle your normal life stresses while you’re pregnant. Meditation is a good use of your time if you are so inclined, but it’s not for everyone. If there are significant issues going on, they need to be taken care of. But worrying about how much your normal life stressors are affecting your pregnancy is unnecessary and just increasing your stress. You have enough to worry about in pregnancy; make this one less thing.