Infants whose mothers experienced high levels of stress while pregnant, particularly in the first trimester , show signs of more depression and irritability. In the womb, they also are slower to "habituate" or tune out repeated stimuli -- a skill that, in infants, is an important predictor of IQ. It has to So, how does a mom's stress get passed onto her fetus? Researchers aren't exactly sure which stress responses play the largest role, but it's clear that when a pregnant woman experiences anxiety , her body produces chemicals that affect the baby, too.
Her nervous system , for instance, stimulates the release of epinephrine and norepinephrine, stress hormones that constrict blood vessels and reduce oxygen to the uterus. Since a very significant decrease in blood flow is probably necessary to compromise development of the fetus, Dr.
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Wadhwa says that another stress response is more likely to affect fetal growth and pre-term labor. That is, when pregnant women experience stress, particularly in the first trimester, the placenta increases production of corticotropin-releasing hormone CRH , which regulates the duration of pregnancy and fetal maturation.
CRH is one of the most exciting recent scientific discoveries that could explain why women go into labor when they do.
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Called the "placental clock," CRH levels measured in the mother's blood early in pregnancy -- between 16 and 20 weeks -- can predict the onset of labor months later. Those with the highest levels will likely deliver prematurely, and those with lowest levels are apt to deliver past their due dates. And it appears that stressful events occurring during the first trimester are most critical in signaling early labor.
Indeed, our data suggests that women become psychologically stronger," says Dr. Curt Sandman, professor and vice chairman of the department of psychiatry at University of California, Irvine. Monitoring CRH levels and managing stress that early in pregnancy may have important implications in reducing pre-term delivery, says Dr. Dunkel-Schetter is working on two studies one with Drs.
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Wadhwa, Hobel and Sandman to determine who is at highest risk for pre-term birth and what types of stresses are the biggest contributors. But we're close, and very soon it will be appropriate for women to be asking their doctors if their level of stress should be assessed systematically.
Tiffanie Pomerance of Los Angeles remembers when she was admitted to the hospital during her first pregnancy after a sonogram found that her cervix had started to dilate at 19 weeks.
Doctors stitched her up but she started having severe contractions and was hospitalized. Everyone, including her husband and family, was worried. We all thought I was going to lose the pregnancy," says Pomerance, Her mother finally covered the monitor with a towel when Dr. Hobel explained that worries would exacerbate her condition.
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Sure enough, she started to notice that contractions got worse when she was more anxious. In hindsight, Pomerance says her hectic lifestyle as a speech therapist -- working hour days, dividing her time between three nursing homes and grabbing lunch while standing -- probably contributed to her problem in the first place.
She slowed down considerably with her second pregnancy. Fortunately, she carried both babies to 35 weeks. Like most women, Pomerance had no idea how much stress could put her over the edge. I thought that I would do it all, plus work out every day at the gym. Now I tell anyone who's pregnant to slow down a bit. That's what makes health providers so reluctant to emphasize the connection between stress and pregnancy problems.
They say a lot of the differences come down to women's personalities and how they cope with stress. Besides, who wants to lay even more guilt and anxiety on a woman who is already stressed? Dunkel-Schetter says she's hoping to nail down the biggest predictors of stress and devise a questionnaire that women could take, along with the blood test to measure CRH levels, to determine who's at highest risk. She says it appears that women who are constantly anxious or fearful may be most susceptible to problems during pregnancy.
Did you lose your job? What I see in our work that's leading to early delivery is being a generally anxious person But she says it's a continuum. Personality traits that might account for some women being better able to handle stress include optimism, self-esteem, a feeling of control over one's life, emotional suppression or expression, and hostility, says Dr.
Hobel worked in France with one of the first obstetricians to successfully reduce pre-term births. The program he devised included work leaves as early as 24 weeks into the pregnancy and nurse- midwife home visits to help women handle psychosocial stress. The big question, he says, is finding the right interventions.
He and Dr. Dunkel-Schetter believe some of those components include the usual methods to reduce stress , including biofeedback , guided imagery and yoga. But what may be equally important are a woman's support network and providing enough information about prenatal care and the pregnancy to ward off worries. And it's clearly a matter of teaching women how to relax, a foreign concept for many.
It might mean taking Wednesdays off and work Saturdays instead, just to break the fatigue of a week's work; or making sure to take time for breakfast and frequent meals.
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James McGregor, a professor of obstetrics at the University of Colorado Health Sciences Center, uses another type of test to predict pre-term labor. It's a saliva test that measures another hormone, estriol, which can give up to three-weeks notice of the onset of labor. He's even called employers when it indicates a patient needs to kick back a little. Sometimes, he says, it's hard to persuade pregnant women themselves that they may need to slow down if they're feeling stressed.
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First of all, your singing is garbage. I have to wonder how, with that kind of taste in music, you got a man to marry you. Or have friends. Or feel good about yourself. At least Dad busts out a Pink Floyd now and again. Not like it matters, though, because neither of you are getting any closer to putting me to bed by forcing your off-key warbling on me. You keep wrapping that blanket around me despite the fact that I keep kicking it off. Stop trying to make the swaddle happen. Ha, you are going to try getting in here with me?
Then you try to leave. Oh, Mom. I almost feel bad as I watch you tiptoe into the hallway, taking care to close my door as slowly and quietly as possible. That cup sucks worse than your singing. The biggest mistake you make is that you keep trying.
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