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.
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.
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.
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.
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.