Effects of psychological stress on adverse pregnancy outcomes and nonpharmacologic approaches for reduction: an expert review

Abstract

Both acute and chronic stress can cause allostatic overload, or long-term imbalance in mediators of homeostasis, that results in disruptions in the maternal-placental-fetal endocrine and immune system responses. During pregnancy, disruptions in homeostasis may increase the likelihood of preterm birth and preeclampsia. Expectant mothers traditionally have high rates of anxiety and depressive disorders, and many are susceptible to a variety of stressors during pregnancy. These common life stressors include financial concerns and relationship challenges and may be exacerbated by the biological, social, and psychological changes occurring during pregnancy. In addition, external stressors such as major weather events (eg, hurricanes, tornados, floods) and other global phenomena (eg, the coronavirus disease 2019 pandemic) may contribute to stress during pregnancy.This review investigates recent literature published about the use of nonpharmacologic modalities for stress relief in pregnancy and examines the interplay between psychiatric diagnoses and stressors, with the purpose of evaluating the feasibility of implementing nonpharmacologic interventions as sole therapies or in conjunction with psychotherapy or psychiatric medication therapy. Further, the effectiveness of each nonpharmacologic therapy in reducing symptoms of maternal stress is reviewed. Mindfulness meditation and biofeedback have shown effectiveness in improving one's mental health, such as depressive symptoms and anxiety. Exercise, including yoga, may improve both depressive symptoms and birth outcomes. Expressive writing has successfully been applied postpartum and in response to pregnancy challenges. Although some of these nonpharmacologic interventions can be convenient and low cost, there is a trend toward inconsistent implementation of these modalities. Future investigations should focus on methods to increase ease of uptake, ensure each option is available at home, and provide a standardized way to evaluate whether combinations of different interventions may provide added benefit.

Adverse Perinatal Outcomes Predicted by Prenatal Maternal Stress Among U.S. Women at the COVID-19 Pandemic Onset

“…Access to a safe living environment and the provision of high-quality medical care, including mental health and prenatal care, are critical for all pregnant women. Additionally, measures to identify [ 68 ] and help those experiencing high levels of stress—such as Screening, Brief Intervention and Referral to Treatment (SBIRT), psychoeducation, and other forms of mental health promotion such as the Collaborative Care model—may reduce women’s risks [ 57 , 69 , 70 ]. During the COVID-19 pandemic, telehealth services for mental health treatment and prenatal care have expanded tremendously.…”

Data-Driven Modeling of Pregnancy-Related Complications

“…In addition toand perhaps as a consequence ofthis inherent complexity of pregnancy, the corresponding adverse outcomes are influenced by various interrelated factors, including genetic and immunological predisposition as well as medical history and social determinants (e.g., race/ethnicity, socioeconomic status, education) [7]. New diseases and environmental factorssuch as coronavirus disease 2019 (COVID- 19) and climate changecan affect pregnancy in many complex ways [6,8,9]. Disparities in outcomes often seem to be related to racial, socioeconomic, and geographic factors [10].…”

“…sPTB results from either PPROM or spontaneous preterm contractions/preterm labor (PTL). Although infection and inflammation have traditionally been thought to mediate a significant proportion of sPTBs, recent advances have also highlighted the role of pathological immune responses, maternal sociodemographic stressors (including bias and racism) [19,20], cervical Glossary Cardiotocography (CTG): recording of the fetal heartbeat and uterine contractions during pregnancy. Complex data: data that cannot be directly represented in tabular form, such as text, images, videos, time series, or networks.…”

Psychopathology associated with coronavirus disease 2019 among pregnant women

“…Despite the relatively short time after the COVID-19 outbreak, a multitude of studies have been published, aiming to better elucidate the effect of this disease on both the physical and psychological health of pregnant women. 2 , 3 , 4 , 5 …”

“…It is well known that life stressors might be exacerbated by the biological, social, and psychological changes occurring during pregnancy, and external stressors, such as a global pandemic, might even increase maternal stress during pregnancy. 3 …”