A child's future cognitive development, their motor development and their mental health can be associated with the stress their mother experienced, and how they coped with it, even years before becoming pregnant, researchers say.
As a result, researchers are taking a closer look at what can be done to help people develop coping strategies and support systems for their mental health early on in their pregnancy and in their preconception years.
"It is now widely accepted that stress in pregnancy is related to adverse birth outcomes," Chris Dunkel Schetter, Ph.D., professor of psychology and psychiatry at the University of California Los Angeles (UCLA) told "Good Morning America." "The more women feel out of control and overwhelmed and unable to cope, the shorter the length of their pregnancy."
Research done at Dunkel Schetter's Stress Processes in Pregnancy Lab at UCLA found that a woman’s stress level not just during pregnancy but up to four years before conception was a risk factor for the length of her pregnancy.
Women who experienced the highest levels of stress gave birth to infants whose time in utero was shorter by one week or more, according to the research, published last year in the Annals of Behavioral Medicine, a medical journal.
"As a researcher, it makes sense to me that what’s happening to your body when you’re pregnant is going to affect the child that’s growing inside you," said Nicole E. Mahrer, Ph.D., co-author of the study and assistant professor of psychology at the University of La Verne in California. "What was surprising to me, though, was the fact that it can start so much earlier, before the pregnancy even happens."
Mahrer, who was pregnant with twins while conducting the research, said the study looked at environmental stressors -- like financial difficulties, job loss, interpersonal violence and discrimination -- as well as people's difficulty coping with stress in their lives.
"The way that stress is understood and the way we measure it is really differentiating the experience of stress in terms of how much stress you perceive, how overwhelmed you feel, your inability to cope, from the actual stressors that are happening in your environment," she said. "The stress that someone is feeling in terms of them feeling overwhelmed or unable to cope, the more stress somebody has, the shorter their pregnancy was."
Dunkel Schetter and Mahrer's research is getting a fresh look amid the coronavirus pandemic, which has led to a rise in stress, anxiety and depression, particularly among pregnant people and people in their childbearing years.
Data released last summer by the Harvard T.H. Chan School of Public Health found that over 70% of pregnant and postpartum women surveyed reported "clinically significant depression or anxiety," and over 40% "screened positive for post-traumatic stress disorder.”
In the United States, among all people, one in five will experience a mental illness in a given year, according to the U.S. Centers for Disease Control and Prevention.
Also in the U.S., around 380,000 babies are born prematurely -- before the 37th week of pregnancy -- each year, one of the worst preterm birth rates among high-resource nations, according to the March of Dimes, a nonprofit organization focused on improving maternal and infant health.
The effect that stress, which can lead to health complications like high blood pressure and heart disease, can have on a pregnancy can go beyond just a preterm delivery, research shows.
Stress can also increase the chances of having a low-birthweight baby, defined as weighing less than 5 pounds, 8 ounces. Later in life, studies show that high levels of stress in pregnancy may impact things like a child's attention span, brain development or immune system, according to the March of Dimes.
"We study often the neuroendocrine system and the ways in which stress hormones can activate and dysregulate a person’s body," said Dunkel Schetter. "If you enter pregnancy with a dysregulated physiology in the stress systems, then that’s poison for the mom to have that continue and affect her baby."
Dunkel Schetter said it is important for people to remember that stress is just one of the risk factors for adverse birth outcomes, saying, "Like any risk factor, it’s not certain that if you’re having stress you’re going to have problems."
She said she wants to see people asked about stress and taught about coping skills and healthy pregnancies all the way from high school through OBGYN appointments.
"I personally want to see curriculum in high school because if you’re going to teach about sex and contraception, you can also teach what a healthy pregnancy is and how [men and women] can both play a role," said Dunkel Schetter. "That leads to this concept of preconception care that would be talking about healthy women and healthy young women and encouraging women from the time they are teenagers to engage in healthy practices that set the stage for healthy pregnancies."
"In pregnancy, it would be ideal if women were assessed at their first prenatal visit not just for depression but for broader-based stress concepts," she said. "Early in pregnancy you can refer women to social services, to therapy, to mindfulness-based education, to prenatal education and health behaviors and you're able to do more."
In Canada, Dr. Darine El-Chaar, a maternal fetal medicine specialist and assistant professor at the University of Ottawa, said she routinely screens for stress early on in pregnancy, putting the research into practice.
"We know that the in-utero exposure to nutrients and stress is so important long term," she said. "Part of our prenatal screening intake is asking about things like relationship stressors, financial concerns, whether it was a planned pregnancy or something they’re excited about and I try to pick up on those elements and talk about them and see what resources they can access."
"The other thing I do is literally prescribe them help, like, ‘I prescribe for you to ask for help, to get some time for yourself,'" said El-Chaar.
Things like a mindfulness practice and relaxation techniques can help women, as can more clinical services like counseling, cognitive behavioral therapy (CBT) and medication, some of which can be safe for women to take during pregnancy, according to experts.
"Screening always needs to be paired with resources or recommendations for support or for intervention," said Mahrer. "Start these conversations when they first come in or when they’re thinking about starting to try for a baby."
If you or someone you know is in crisis, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text HELLO to the Crisis Text Line at 741741. You can also call the NAMI Helpline at 800-950-6264, available Monday to Friday from 10 a.m. to 8 p.m. EST, or text "NAMI" to 741741 for 24/7, confidential, free crisis counseling. People looking for help for themselves or a loved one can also email NAMI at email@example.com.