Stress during pregnancy: what you need to know
Medically reviewed on April 21, 2023 by Jillian Foglesong Stabile, MD, FAAFP. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.
Table of contents
- Effects of post-traumatic stress disorder (PTSD) and pregnancy
- Effects of maternal anxiety disorders and pregnancy
- How to ease stress and anxiety (and their effects) during pregnancy
- Speak to an Everlywell licensed clinician to mitigate pregnancy risks
- Related content
During pregnancy, women and people assigned female at birth (AFAB) experience physical, hormonal, and emotional changes that can disrupt the body’s natural equilibrium. In addition to bodily changes, lifestyle adjustments and the demands of parenthood can make pregnant women and other people more susceptible to the effects of stress. [1]
It’s important to understand that while some stress is normal during pregnancy, excessive stress can have negative effects on both the mother and the developing fetus. Therefore, it is crucial to take steps to manage stress during pregnancy. [1]
To alleviate any concerns you may have, we’re discussing the typical impact of stress on pregnancy and its various effects to equip you with valuable knowledge that can assist you in making informed choices about your own health as well as that of your baby.
Effects of post-traumatic stress disorder (PTSD) and pregnancy
If you’ve been diagnosed with post-traumatic stress disorder (PTSD) and are currently pregnant, you may be at an increased risk of preterm birth and low birth rate.1 In fact, pregnant women and individuals diagnosed with PTSD or depression are four times more likely to experience a preterm birth, which occurs when babies are born before the completion of the term. [2]
Preterm birth is the cause of about two-thirds of infant deaths. [2] Several types of preterm birth exist, based on the gestational age of the infant: [3]
- Extremely preterm: Less than 28 weeks
- Very preterm: 28 to 32 weeks
- Preterm: 32 to 36 weeks
- Late Preterm: 36-38 weeks
PTSD is a type of disorder that develops after experiencing a traumatic or shocking event. Unfortunately, psychological distress can often lead to preterm delivery since it can activate the hypothalamic-pituitary axis—a system of neuroendocrine pathways that help maintain physiological homeostasis. In effect, this may induce birth. [2]
This stress response may occur for one of two reasons: [4]
- Neuroendocrine factors – Maternal stress may activate the maternal-placental-fetal endocrine systems that induce birth, thus leading to preterm labor.
- Immune or inflammatory factors – Maternal stress may affect the specialized immune system that protects the fetus during pregnancy, which can make the fetus more susceptible to infectious-inflammatory processes and prompt early delivery.
Additionally, the medication that’s prescribed to treat PTSD may also impact the fetus and increase the risk of a preterm delivery. [5] This is particularly true for pregnant people who began the medications in the second or third term of pregnancy. [5]
See related: Low Energy Levels in Females
Effects of maternal anxiety disorders and pregnancy
Pregnant people who experience anxiety during pregnancy may experience adverse effects on their health, as well as the health of their infant(s). [6]
Women and people AFAB are more predisposed to mood and anxiety disorders, particularly during their childbearing years. Oftentimes, these disorders can emerge or worsen during pregnancy: At least 10.8% of pregnant individuals have an anxiety disorder. And many pregnant people who experience anxiety also experience symptoms of depression. [6]
Typically, anxiety disorders are characterized by: [6]
- Excessive worrying
- Irritability
- Headaches
- Nausea
- Tension
- Catastrophizing
That said, general anxiety disorders (GAD) can often evolve into pregnancy-related anxiety (PrA). Those with PrA typically experience worries in relation to: [6]
- Labor
- Delivery
- The well-being of themselves and their infant(s)
They may also worry about the effectiveness of certain medical equipment and the skills of their healthcare provider. Post-delivery, these feelings may manifest as anxiety related to their ability to parent or their physical appearance after pregnancy. [6]
At low levels, stress during pregnancy can help equip the parent for the role of parenting. However, high stress levels can negatively affect the behavior of the parent and may lead to a high-risk pregnancy. [6]
About 15 to 20% of pregnancies are classified as high-risk, and they often occur in individuals who are over the age of 35. Unfortunately, women and people AFAB of this age are also more predisposed to anxiety. [6]
As a result, both the mother and the fetus are at higher risk of medical complications, such as:
- Gestational hypertension
- Gestational diabetes
- Preeclampsia
- Placenta previa
- Placenta abruption
- Fetal growth restriction
- Cervical incompetence
- Congenital anomalies
- Bleeding disorders
Sadly, these diagnoses can further exacerbate maternal anxiety levels. [6]
Gestational hypertension
This occurs when a pregnant person experiences high blood pressure (140/90 mmHg or higher) during pregnancy and is often coupled with: [7]
- A lack of protein in the urine
- Heart problems
- Kidney issues
Typically, it’s diagnosed around 20 weeks of pregnancy, but symptoms will go away following the birth of the baby. However, it may predispose women and people AFAB to hypertension or other health problems later in life. And it may also negatively impact the fetus, inhibiting its growth and safety within the placenta. [7]
Gestational diabetes
Gestational diabetes is a type of insulin resistance that can develop during pregnancy. [8] It affects about 2 to 10% of pregnancies. So why, and how, does this occur?
During pregnancy, the body releases many hormones that cause weight gain, to support the growth of the fetus. As a result, the body is unable to utilize insulin as efficiently as before to deliver glucose to its cells, thus fueling the body. [8]
This is called insulin resistance. [8]
Fortunately, gestational diabetes doesn’t have many symptoms in the mother, but it can increase their blood pressure and the chance of having a cesarean section (c-section) during delivery. That said, it can impact the fetus. Babies born to parents with gestational diabetes may: [8]
- Weigh nine pounds or more upon delivery
- Be born early
- Have low blood sugar
- Develop type 2 diabetes later in life
Preeclampsia
When a woman or person AFAB experiences a spike in blood pressure during pregnancy they may experience preeclampsia. Unlike gestational hypertension, preeclampsia occurs in individuals with high levels of protein in the urine. [7]
About 1 in 25 pregnancies in the United States involve preeclampsia. During their pregnancy, those diagnosed with the condition can experience: [7]
- Chronic headaches
- Blurry vision
- Stomach pain
- Face and hand swelling
- Weight gain
- Trouble breathing
The condition may also develop into eclampsia, which is characterized by maternal seizures and considered a medical emergency. [7]
Placenta previa
During pregnancy, the placenta—which provides oxygen and nutrients to the baby—may lie very low within the uterus, covering the opening of the cervix completely or partially.
In effect, a pregnant person with this condition may experience bleeding during and after pregnancy. [9]
Placenta abruption
In some pregnancies, the placenta may detach partially or completely from the uterus. For the infant, this may result in: [10]
- Premature birth
- Low birth weight
- Growth problems
- Brain injury
- Stillborn birth
Alternatively, those carrying the baby may experience: [10]
- Blood loss
- Blood clotting
- Hemorrhage
- Kidney failure
Fetal growth restriction (FGR)
Stress during pregnancy can affect the growth of the fetus. More specifically, fetal growth restriction (FGR) can occur. As a result, infants will weigh less than the 10th percentile in their gestational age category. [11]
Unfortunately, FGR can lead to several short and long-term complications that may impact the child’s quality of life. These include but are not limited to: [11]
- Hearing loss
- Low-set ears
- Cleft palate
- Clenched fist with overlapping fingers
Cervical incompetence
Also called cervical insufficiency, cervical incompetence can lead to premature birth or the loss of a pregnancy, due to weak cervical tissue. More specifically, the cervix may begin to open too soon over the course of each trimester. [12]
While it’s difficult to diagnose this condition before it occurs, people who are pregnant can look for some signs of the condition, which include: [12]
- Pelvic pressure
- Backaches
- Abdominal cramps
- Change in vaginal discharge
- Light vaginal bleeding
How to ease stress and anxiety (and their effects) during pregnancy
Although it can be challenging to cope with negative moods and anxiety while pregnant, it is crucial for the well-being of both you and your baby to address and manage these emotions. Oftentimes, this involves multidisciplinary approaches to care for maternal anxiety and its related conditions: [12]
- Prenatal care – Attending regular prenatal appointments with your healthcare provider can help monitor your physical and emotional health throughout pregnancy.
- Mental health screenings – Your healthcare provider may recommend mental health screenings to identify any underlying mood or anxiety disorders and provide appropriate treatment.
- Practice mindfulness – Engaging in relaxation techniques like deep breathing exercises, yoga, or meditation can help reduce stress levels and promote emotional well-being.
- Eat a healthy diet – Eating a balanced and nutritious diet can help support both physical and emotional health during pregnancy.
- Exercise, if possible – Regular physical activity can help boost mood and reduce stress, but it's important to talk to your healthcare provider before starting any new exercise routine during pregnancy.
- Avoid risky medications or substances – Certain medications and substances can be harmful to the developing fetus, so it's important to talk to your healthcare provider before taking any medications or supplements during pregnancy to ensure you take the prenatal vitamins your baby needs.
Speak to a licensed clinician via Everlywell to mitigate pregnancy risks
Stress experienced by pregnant individuals can have a significant impact on their well-being, as well as the well-being of their developing baby. As such, it’s critical that pregnant people regularly monitor their physical and emotional health to ease feelings of anxiety during pregnancy.
At Everlywell, we offer women’s telehealth services with one goal in mind: to provide exceptional healthcare. When you join the virtual meeting, you and your healthcare provider can discuss your symptoms and they’ll provide you with guidance to reduce your stress levels and continue to care for yourself and your growing baby.
Book an appointment today.
Related content
PCOS weight gain: what you need to know
Understanding the intersection of stress and heart disease
Can stress cause ovarian cysts?
References:
- Will stress during pregnancy affect my baby? NIH. URL. Published March 3, 2023. Accessed April 18, 2023.
- Yonkers K. Pregnant Women With Posttraumatic Stress Disorder and Risk of Preterm Birth. JAMA Psychiatry. URL. doi: 10.1001/jamapsychiatry.2014.558. Accessed April 18, 2023.
- Preterm birth. WHO. URL. Published November 14, 2022. Accessed April 18, 2023.
- Wadhwa P. Stress, infection and preterm birth: a biobehavioural perspective. URL. doi: 10.1046/j.1365-3016.2001.00005.x. Accessed April 18, 2023.
- Calderon-Margalit R. Risk of Preterm Delivery and Other Adverse Perinatal Outcomes in Relation to Maternal use of Psychotropic Medications during Pregnancy. URL. doi: 10.1016/j.ajog.2009.06.061. Accessed April 18, 2023.
- Araji S. An Overview of Maternal Anxiety During Pregnancy and the Post-Partum Period. Journal of Mental Health & Clinical Psychology. URL. Published November 30, 2020. Accessed April 18, 2023.
- High Blood Pressure During Pregnancy. CDC. URL. Published February 15, 2023. Accessed April 18, 2023.
- Gestational Diabetes. CDC. URL. Published December 30, 2022. Accessed April 18, 2023.
- Placenta previa. Mayo Clinic. URL. Accessed April 18, 2023.
- Placental Abruption. Cleveland Clinic. URL. Published July 7, 2021. Accessed April 18, 2023.
- Chew L, Verma R. Fetal Growth Restriction. StatPearls. URL. Published March 18, 2023. Accessed April 18, 2023.
- Incompetent cervix. Mayo Clinic. URL. Accessed April 18, 2023.