by Dr. Michele Brown OB/GYN
The season of joy can indeed be joyous, but for most people it also means cramming enormous amounts of activity into a tiny amount of time. While Holiday gift shopping and business and social celebrations may be fun, they arrive with the need to prepare large meals, deal with relatives and in-laws, worry about the cost of new clothes and extra food, end of year taxes, finances in general, bonus anxiety and even job security. This kind of pressure can bring on enormous amounts of stress and will drive you nuts (not the warm chestnut kind) very quickly if you let it.
For mothers-to-be, how does all of this stress affect her pregnancy? Can maternal psychiatric conditions such as depression, anxiety, and stress adversely affect the baby when pregnant during the holiday season? This particular area of concern has always been debatable but review of recent scientific literature has shown some surprising results regarding the relationship between psychiatric conditions and the possibility of affecting the uteroplacental environment… and consequently the fetus.
Do Psychiatric Conditions Effect Pregnancy Outcome?
A recent article from the Journal of Affective Disorders, in 2010 by Nicole Paz found that the risk of placental abruption is increased in pregnant women with mood or anxiety disorders. Placental abruption is an obstetrical emergency when the placenta prematurely separates from the wall of the uterus. This occurs in about 1 to 2% of all pregnancies. It is often associated with an "ischemia of the placenta" or a lack of perfusion to the placenta causing parts of the placenta to be infarcted (deadened) and consequently separate from the wall of the uterus. The placenta is the lifeline to the baby and having substantial areas that no longer function can dramatically effect the safety and well-being of the baby. Many other medical situations can be associated with this event such as hypertension, uterine infections, trauma to the uterus, premature rupture of membranes, maternal smoking, and maternal clotting disorders. Now there might be evidence that psychiatric conditions can also effect the placenta.
Previous studies by Qiu in 2009 have shown that there is a higher risk of preeclampsia (hypertension, protein in the urine , and marked swelling) and preterm delivery with maternal depressive, anxiety and stress symptoms. The authors -- Alder in 2007, and Halbreich in 2005 confirmed that anxiety during pregnancy and psychological distress have been reported to be associated with preterm delivery, low birth weight, and obstetrical complications. Another scientist Cohen in 1989 described placental abruption associated with panic attacks.
How Does This Occur?
Activation of the sympathetic nervous system with elevated chemicals in the body such as cortisol, corticotrophin releasing hormone, and serotonin levels, associated with anxiety and stress is believed to cause some of these observations. Stress causes increased hypothalamic—pituitary-adrenal activity. These elevated chemicals can result in systemic inflammation and damage to vessel lining (endothelial dysfunction) which can lead to abruption of the placenta.
Other investigators have found changes in clotting and platelet activity in women with major depression which can then affect coagulation pathways resulting in preeclampsia and abruption. Much evidence has mounted to show a relationship between depression and cardiovascular disease later in life through similar mechanisms.
More studies need to be done to investigate all the hormonal, vascular, and hemodynamic effects of maternal mood and anxiety on pregnancy and its outcome.
Does the Effect Continue After Delivery?
Research has shown that anxiety, depression, and prenatal stress is also associated with maternal mental disorders after birth. There is a higher incidence of postpartum depression in women that have prenatal anxiety.
Are the Children Affected After Birth?
Behavioral and emotional problems in children such as attention deficit disorders, hyperactivity, oppositional defiant disorder and childhood anxiety are more prevalent in mothers that have anxiety and psychological distress during their pregnancies.
Maternal anxiety and stress can negatively affect both mom and baby both during the pregnancy and afterward. Screening women that have some of these disorders, and providing treatment, could be found to alter some of the adverse pregnancy outcomes associated with some of these well known psychiatric illnesses.
In the meantime, try to chill out during THIS holiday season. Allow yourself to sit back, and let everyone else worry about the seasonal details. No gift, meal, or gathering should ever be allowed to get under your skin because you don't want stress to get the better of your baby's health.
Get some relaxation tapes, try a little yoga and/or meditation and treat yourself to a massage --DOCTORS ORDERS!
Dr. Brown, founder of Beauté de Maman, is a board-certified member of the American College of Obstetrics and Gynecology, a member of the American Medical Association, the Fairfield County Medical Association, Yale Obstetrical and Gynecological Society and the Women's Medical Association of Fairfield County. She is a magna cum laude graduate of Tufts University, completed her medical training at George Washington University Medical Center and completed her internship and residency in obstetrics and gynecology at Yale-New Haven Hospital. Dr. Brown has a busy obstetrical practice in Stamford, Connecticut and, as a clinical attending, actively teaches residents from Stamford Hospital and medical students from Columbia Presbyterian Hospital in New York.
Copyright © Michele Brown. Permission to republish granted to Pregnancy.org, LLC.