Pregnancy Anxiety, Anguish, and Stress: Effects on Mothers, Offspring, Research, and Practice View PDF

Being pregnant is one of women’s greatest psychological stress since psychologists have explained childbearing as an internal breakdown [1,2]. Pregnancy and societal parenthood are two connected important life transitions during which women and their partners go through major changes in their responsibilities as well as in their interpersonal interactions. Stress and anxiety, as well as positivity, might well be anticipated to accompany these shifts. It is accepted that firsttime pregnancies and motherhood are times of stronger emotional sensitivity. Women exhibit signs cause of worry, anxiety, and depression throughout pregnancy and in the months after giving birth. By drawing attention to try to promote these advancements, we research products and new possibilities as well as evidence-based screening and clinical procedures. Even though pregnancy is an estimation of a period of relatively good mental health, the significant hormonal changes that occur during this moment could alter the attentiveness to mental problems [1].
Depending on the criteria employed, projections of the incidence of depression during pregnancy range from 16% or more among the women who suffer symptoms to 5% of those with deep depression [2]. Low capital ability, difficult professional life situations, significant family and home duties, the strain in close relationships, and pregnancy issues are some of the stresses that consistently impact expectant mothers across the world (Table 1). If mothers are only examined once during pregnancy, it may be intimidating to diagnose prenatal depression. Variations in the levels of anxiety and depression throughout gestation may be revealed by numerous assessments. However, for some pregnant women, anxiety, and depression symptoms may linger and trigger biological, cognitive, and behavioral reactions. There seems to be nowadays a substantial corpus of research into the relationship between stress and emotional states during pregnancy as markers of specific pregnancy outcomes[3, 4].
Therefore, in longitudinal research involving 1073 first-time mothers, were examined the degree to which prenatal maternal mood variables, particularly symptoms of general anxiety, pregnancy-specific anxiety, and depression, were predictors of parental stress at 3 months postpartum. Despite their frequent correlation, general anxiety, pregnant anxiety, and depression may nonetheless have unique or independent effects on parental stress. Consequently, we looked at the independent prospective relationships between levels of general anxiety, anxiety specific to pregnancy, and depression during pregnancy, as well as the stress of parenting three months after the baby was born. Finally, we investigated the possibility that the rise in mood ratings from the first to the third trimester of pregnancy may predict parental stress [5,6].

Gestational Mental Anguish

Dunkel Schetter and Glynn have analyzed more than 80 scholarly studies on stress and preterm birth (PTB) [7]. The researchers had big samples, validated measurements, and prospective designs, but were mostly reasonably well-controlled for potential confounds including health risks, smoking, education, wealth, and parity. Significant impacts on gestational age at birth or PTB were also observed in the majority of a second, smaller set of research on catastrophic, neighborhoodwide events (such as earthquakes or terrorist strikes) [8-10]. A third small group of researchers found that persistent stresses like financial hardship or homelessness had a substantial impact on PTB. Especially over the past, most prior studies on neighborhood stressors including poverty and violence revealed substantial impacts on gestational age or PTB. Thus, plenty of (but not all) of the several distinct types of stress increase the risk of PTB.

Anxiety and Low Birth Weight

Dunkel Schetter and Lobel have studied the impact of stress on newborn birth weight and/or low birth weight (LBW) as a second area of growing convergence. This research can be categorized based on stress. However, long-term stresses have proved even better predictors of birth weight. For instance, one study found that unemployment and crowding predicted a 2.0 to 3.8 times greater risk of LBW among lowincome mothers [11]. A growing body of research has shown that racism and discrimination, especially among African American mothers, prospectively predict birth weight [12]. However, depression may play a significant role in how racial prejudice and chronic stress affect prenatal development and birth weight, most likely through physiological and behavioral pathways that are downstream from depression [11].

Effect of Anxiety and Depression during Pregnancy

In two subsections, recent research on the signs of anxiety and depression during pregnancy is similarly examined while separating results on PTB from those on LBW.

A) Associated with premature birth:

In seven of the 11 studies that were examined, state anxiety during pregnancy strongly predicted gestational age and/or PTB, but only when combined with other variables or in certain subgroups of the sample [13]. Maternity anxiety sometimes referred to as pregnancy-specific anxiety and comparable to pregnancy distress has been linked to more consistent outcomes. It stands for a specific emotional condition that is closely related to state anxiety but is more contextually driven, that is, attached especially to worries about a current pregnancy. Ratings of four descriptors have been incorporated into an index for the assessment of pregnant anxiety. experiencing pregnancy-related anxiety, worry, fear, or panic as well as a few reverse-coded items regarding assurance of a typical delivery [14]. Overall, the data from recent studies is surprisingly converging and shows that pregnant anxiety linearly predicts when a baby will be delivered. Furthermore, across studies, pregnant anxiety precisely predicts the probability of spontaneous PTB with effect sizes that are equivalent to or greater than those of recognized risk factors like smoking and medical risk. The consistency of these results opens the door to further research into the causes, correlates, mechanisms, and treatments of pregnancy anxiety.

B) Low birth weight and effect:

Recent research suggests that maternal depression symptoms play a more prominent role in the etiology of LBW than they do in the etiology of PTB [15]. A recent assessment of research indicated that mother depression symptoms had rather a substantial impact on newborn birth weight, with low-income or women of low social standing and women of race experiencing the highest effects [11]. Data shows that depressive symptoms or disorders may contribute more to LBW and slower fetal development than to delivery date or PTB, and these effects are more prominent for low-income mothers [13]. Contrarily, with a few notable exceptions, relatively few studies have shown any impact of anxiety on LBW [11].

Stress and Adverse States in Pregnancy and Outcomes for the Preborn Child

The growth and well-being of a mother’s unborn child may be significantly impacted by her stress levels and emotional states throughout pregnancy. Measures of pregnant anxiety capture both dispositional qualities, or attributes, and environmentally induced moods, which may be what gives it its potency. For instance, women who are more concerned about getting pregnant appear to have weaker psychosocial support systems, come from certain cultural backgrounds, have a history of infertility, be carrying unintended pregnancies, and have fewer psychosocial resources [16-19]. These findings imply that pre-existing vulnerabilities may interact with the social, family, cultural, societal, and environmental aspects of pregnancy to elevate pregnancy anxiety levels and have an impact on the maternal-fetal-placental systems, particularly during vulnerable times like the early stages of pregnancy. The gestational age at delivery and labor interventions, such as incisions, surgical evacuation of the placenta, artificial rupture of the membranes, labor induction in the hospital, and artificial stimulation of contractions, were also evaluated three months following the birth [21-24]. Labor interventions score = number of “yes” responses on these nine categories. A life event received a score of 1 if it happened, and a score of 0 if it didn’t. These two facts were not included because all women became pregnant and delivered birth. Evidence points to changes in the functioning of the maternal and fetal hypothalamus pituitary adrenal axis as well as impacts on the fetal nervous system’s development as possible mechanisms for this [24-26]. To prevent a variety of negative consequences for mother, child, and family, women should be the focus of early interventions such as evidence-based interventions for stress reduction, mood regulation treatments such as cognitive behavioral therapy, pharmaceutical treatments, and follow-up care throughout postpartum.

There is strong evidence that stress, anxiety, and depression during pregnancy increase the risk of negative outcomes for both mothers and their offspring. Furthermore, anxiety during pregnancy affects fetal neurodevelopment and the health of the unborn child, as well as is linked to shorter gestation times. Additionally, worry about a specific pregnancy appears to be particularly strong. However, it is notable that when all the mother mood components were concurrently modeled, pregnancy-specific anxiety and trait anxiety were independent and superior predictors of (nearly) all subscales of parenting stress compared to prenatal depression. When anxiety levels were considered, the depression subscale of the PSI was not connected to prenatal depression scores, however, a closer look at the items may help to understand why: Several the parental stress subscale’s depression-related questions center on guilt or loss of confidence, which isn’t necessarily symptoms of depression but may be related to anxiety. It is possible to hypothesize that significant life events or local disasters raise prenatal anxiety, and that long-term chronic stress increases the chance of depression. Moreover, the consequences of persistent stress on LBW via depression are not shown, although they need additional studies. The following are the main research topics for the upcoming wave: Examining the separate and combined impacts of stress, anxiety, and anxiety during pregnancy on mother and baby. The idea of pregnancy anxiety should be better understood, as should professional interventions for it. Additionally, it is important to continue researching the consequences of clinically significant emotional disturbances on maternal and fetal outcomes while taking into consideration the mother’s wider socio-environmental context. Many people think that this window of opportunity is our greatest shot if risk factors can be recognized before pregnancy and treatments can be created for preconception. However, to achieve these goals and lessen the burden of maternal stress, depression, and anxiety in the perinatal period, interdisciplinary research and collaboration will be essential.

1. Rubertsson C, Hellström J, Cross M, Sydsjö G (2014) Anxiety in early pregnancy: prevalence and contributing factors. Arch Womens Ment Health 17: 221-228. https:// doi.org/10.1007/s00737-013-0409-0
2. Ding XX, Wu YL, Xu SJ, Zhu RP, Jia XM, et al. (2014) Maternal anxiety during pregnancy and adverse birth outcomes: a systematic review and meta-analysis of prospective cohort studies. J Affect Dis 159: 103-110. https://doi.org/10.1016/j. jad.2014.02.027
3. Grant KA, Bautovich A, McMahon C, Reilly N, Leader L, et al. (2012) Parental care and control during childhood: associations with maternal perinatal mood disturbance and parenting stress. Arch Womens Ment Health 15: 297-305. https://doi.org/10.1007/ s00737-012-0292-0
4. Lederman RP (1990) Anxiety and stress in pregnancy: significance and nursing assessment. NAACOGS Clin Issu Perinat Womens Health Nurs 1(3): 279-288.
5. Oates M (1989) 6 Normal emotional changes in pregnancy and the puerperium. Baillieres Clin Obstet Gynaecol 3: 791-804. https://doi.org/10.1016/s0950-3552(89)80065-3
6. Austin MPV, Hadzi-Pavlovic D, Priest SR, Reilly N, Wilhelm K, et al. (2010) Depressive and anxiety disorders in the postpartum period: how prevalent are they and can we improve their detection? Arch Womens Ment Health 13: 395-401. https://doi. org/10.1007/s00737-010-0153-7
7. Morse CA, Buist A, Durkin S (2000) First-time parenthood: influences on pre-and postnatal adjustment in fathers and mothers. J Psychosom Obstet Gynecol 21: 109-120. https://doi.org/10.3109/01674820009075616
8. Leight KL, Fitelson EM, Weston CA, Wisner KL (2010) Childbirth and mental disorders. Int Rev Psychiatry 22: 453-471. https://doi.org/10.3109/09540261.2010.51 4600
9. Beydoun H, Saftlas AF (2008) Physical and mental health outcomes of prenatal maternal stress in human and animal studies: a review of recent evidence. Paediatr Perinat Epidemiol 22: 438-466. https://doi.org/10.1111/j.1365-3016.2008.00951.x
10. Behrman RE, Butler AS (2007). Preterm birth: causes, consequences, and prevention. National Academies Press, United States 
11. Schetter CD (2009) Stress processes in pregnancy and preterm birth. Curr Dir Psychol Sci 18: 205-209. https://doi.org/10.1111/j.1467-8721.2009.01637.x
12. Borders AEB, Grobman WA, Amsden LB, Holl JL (2007) Chronic stress and low birth weight neonates in a low-income population of women. Obstet Gynecol 109: 331-338. https://doi.org/10.1097/01.AOG.0000250535.97920.b5
13. Giscombé CL, Lobel M (2005) Explaining disproportionately high rates of adverse birth outcomes among African Americans: the impact of stress, racism, and related factors in pregnancy. Psychol Bull 131: 662-683. https://doi.org/10.1037/0033-2909.131.5.662
14. Dominguez TP, Dunkel-Schetter C, Glynn LM, Hobel C, Sandman CA (2008) Racial differences in birth outcomes: the role of general, pregnancy, and racism stress. Health Psychol 27: 194. https://doi.org/10.1037/0278-6133.27.2.194
15. Love C, David RJ, Rankin KM, Collins Jr JW (2010) Exploring weathering: effects of lifelong economic environment and maternal age on low birth weight, small for gestational age, and preterm birth in African-American and white women. Am J Epidemiol 172: 127-134. https://doi.org/10.1093/aje/kwq109
16. Schetter CD, Glynn LM (2011) Stress in pregnancy: empirical evidence and theoretical issues to guide interdisciplinary research. In Contrada RJ Baum A (eds) The handbook of stress science: biology, psychology, and health. Springer Publishing Company, pp 321–347.
17. Roesch SC, Schetter CD, Woo G, Hobel CJ (2004) Modeling the types and timing of stress in pregnancy. Anxiety Stress Coping 17: 87-102. https://doi.org/10.1080/10615 80031000123667
18. Goedhart G, Snijders AC, Hesselink AE, van Poppel MN, Bonsel GJ, et al. (2010). Maternal depressive symptoms in relation to perinatal mortality and morbidity: results from a large multiethnic cohort study. Psychosom Med 72: 769-776. https://doi. org/10.1097/PSY.0b013e3181ee4a62
19. Schetter CD, Lobel M (2012) Pregnancy and birth outcomes: a multilevel analysis of prenatal maternal stress and birth weight. In Baum A, Revenson TA, Singer J (eds) Handbook of health psychology. Psychology Press, pp 431-463.
20. Alder J, Fink N, Bitzer J, Hösli I, Holzgreve W (2007) Depression and anxiety during pregnancy: a risk factor for obstetric, fetal and neonatal outcome? a critical review of the literature. J Matern Fetal Neonatal Med 20: 189-209. https://doi. org/10.1080/14767050701209560
21. Conde A, Figueiredo B, Tendais I, Teixeira C, Costa R, et al. (2010) Mother’s anxiety and depression and associated risk factors during early pregnancy: effects on fetal growth and activity at 20–22 weeks of gestation. J Psychosom Obstet Gynecol 31: 70- 82. https://doi.org/10.3109/01674821003681464
22. Schneider ML, Moore CF (2000) Effect of prenatal stress on development: a nonhuman primate model. In Nelson CA (ed) The Minnesota symposia on child psychology, Vol. 31. The effects of early adversity on neurobehavioral development. Lawrence Erlbaum Associates Publishers, pp 201-244.
23. Coe CL, Lubach GR (2008). Fetal programming: prenatal origins of health and illness. Curr Dir Psychol Sci 17: 36-41. https://doi.org/10.1111/j.1467-8721.2008.00544.x
24. O’Connor TG, Ben-Shlomo Y, Heron J, Golding J, Adams D, et al. (2005) Prenatal anxiety predicts individual differences in cortisol in pre-adolescent children. Biol Psychiatry 58: 211-217. https://doi.org/10.1016/j.biopsych.2005.03.032
25. Schetter CD (2011) Stress and anxiety in human pregnancy: powerful and still puzzling. In Presentation at the Annual Meeting of the Academy of Behavioral Medicine, Park City, UT.
26. 26. Lu MC, Kotelchuck M, Culhane JF, Hobel CJ, Klerman LV, et al. (2006) Preconception care between pregnancies: the content of internatal care. Matern Child Health J 10: 107-122. https://doi.org/10.1007/s10995-006-0118-7