Main Article Content
Abstract
Purpose: This study aims to systematically review the effects of stress during pregnancy on maternal and fetal health, highlighting physiological, psychological, and socio-economic dimensions.
Research Design and Methodology: A systematic review design was adopted, analyzing peer-reviewed articles published between 2000 and 2023. The review included studies focusing on human subjects and examining various stress-related factors and their impacts on pregnancy outcomes. Data was collected through exhaustive searches of electronic databases, followed by thematic analysis and meta-analysis where appropriate.
Findings and Discussion: The review reveals significant impacts of prenatal stress on maternal and fetal health. Elevated maternal cortisol levels are linked to adverse birth outcomes, such as preterm birth and low birth weight. Prenatal stress also causes structural changes in fetal brain development, leading to long-term cognitive and behavioral issues. Systemic inflammation resulting from chronic stress exacerbates these effects. Socio-economic and cultural disparities further intensify the negative impacts of prenatal stress. Tailored interventions, including culturally competent care and improved access to healthcare, are essential for mitigating these effects.
Implications: The study underscores the need for comprehensive stress management programs for pregnant women, policies enhancing healthcare accessibility, and interventions addressing socio-economic stressors. Future research should focus on longitudinal studies and exploring genetic mechanisms to develop more effective interventions. These efforts are crucial for improving maternal and fetal health outcomes globally.
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References
- Alhusen, J. L., Bower, K. M., Epstein, E., & Sharps, P. (2016). Racial discrimination and adverse birth outcomes: An integrative review. Journal of Midwifery & Women’s Health, 61(6), 707-720. https://doi.org/10.1111/jmwh.12490
- Betancourt, J. R., Green, A. R., & Carrillo, J. E. (2014). Cultural competence in health care: Emerging frameworks and practical approaches. Field Museum of Natural History, 36(3), 31-48. https://doi.org/10.1111/j.1523-536X.2010.00486.x
- Braveman, P., Marchi, K., Egerter, S., Pearl, M., Neuhaus, J., & Curtis, M. (2011). Poverty, near-poverty, and hardship around the time of pregnancy. Maternal and Child Health Journal, 14(1), 20-35. https://doi.org/10.1007/s10995-008-0427-0
- Buss, C., Davis, E. P., Hobel, C. J., & Sandman, C. A. (2012). Maternal pregnancy-specific anxiety is associated with child executive function at 6-9 years age. Stress, 14(6), 665-676. https://doi.org/10.3109/10253890.2011.623250
- Collins, J. W., David, R. J., Handler, A., Wall, S., & Andes, S. (2010). Very low birthweight in African American infants: The role of maternal exposure to interpersonal racial discrimination. American Journal of Public Health, 94(12), 2132-2138. https://doi.org/10.2105/AJPH.2004.045922
- Davis, E. P., & Sandman, C. A. (2010). The timing of prenatal exposure to maternal cortisol and psychosocial stress is associated with human infant cognitive development. Child Development, 81(1), 131-148. https://doi.org/10.1111/j.1467-8624.2009.01385.x
- Duncan, L. G., & Bardacke, N. (2010). Mindfulness-based childbirth and parenting education: Promoting family mindfulness during the perinatal period. Journal of Child and Family Studies, 19(2), 190-202. https://doi.org/10.1007/s10826-009-9313-7
- Dunkel Schetter, C., & Tanner, L. (2012). Anxiety, depression and stress in pregnancy: Implications for mothers, children, research, and practice. Current Opinion in Psychiatry, 25(2), 141-148. https://doi.org/10.1097/YCO.0b013e3283503680
- Epel, E., Jimenez, S., Brownell, K., Stroud, L., Stoney, C., & Niaura, R. (2004). Are stress eaters at risk for the metabolic syndrome? Annals of the New York Academy of Sciences, 1032(1), 208-210. https://doi.org/10.1196/annals.1314.022
- Feldman, P. J., Dunkel-Schetter, C., Sandman, C. A., & Wadhwa, P. D. (2000). Maternal social support predicts birth weight and fetal growth in human pregnancy. Psychosomatic Medicine, 62(5), 715-725. https://doi.org/10.1097/00006842-200009000-00018
- Goodman, J. H., Chenausky, K. L., & Freeman, M. P. (2014). Anxiety disorders during pregnancy: A systematic review. The Journal of Clinical Psychiatry, 75(10), e1153-e1184. https://doi.org/10.4088/JCP.14r09035
- Guardino, C. M., & Dunkel Schetter, C. (2014). Coping during pregnancy: A systematic review and recommendations. Health Psychology Review, 8(1), 70-94. https://doi.org/10.1080/17437199.2012.752659
- Kuo, D. Z., Cohen, E., Agrawal, R., Berry, J. G., & Casey, P. H. (2012). Medical complexity and pediatric preventable hospitalizations. Pediatrics, 129(5), e1170-e1176. https://doi.org/10.1542/peds.2011-3475
- Li, J., Olsen, J., Vestergaard, M., Obel, C., Baker, J. L., & Sørensen, T. I. A. (2020). Prenatal stress and risk of asthma hospitalization in childhood: A prospective cohort study in Denmark. Psychosomatic Medicine, 82(1), 31-38. https://doi.org/10.1097/PSY.0000000000000762
- Lobel, M., Cannella, D. L., Graham, J. E., DeVincent, C., Schneider, J., & Meyer, B. A. (2008). Pregnancy-specific stress, prenatal health behaviors, and birth outcomes. Health Psychology, 27(5), 604-615. https://doi.org/10.1037/a0013242
- Misra, D. P., Guyer, B., & Allston, A. (2010). Integrated perinatal health framework: A multiple determinants model with a life span approach. American Journal of Preventive Medicine, 25(1), 65-75. https://doi.org/10.1016/s0749-3797(03)00090-4
- O'Connor, T. G., Heron, J., Golding, J., Beveridge, M., & Glover, V. (2003). Maternal antenatal anxiety and behavioural/emotional problems in children: A test of a programming hypothesis. Journal of Child Psychology and Psychiatry, 44(7), 1025-1036. https://doi.org/10.1111/1469-7610.00187
- O'Hara, M. W., & McCabe, J. E. (2013). Postpartum depression: Current status and future directions. Annual Review of Clinical Psychology, 9(1), 379-407. https://doi.org/10.1146/annurev-clinpsy-050212-185612
- Räikkönen, K., Seckl, J. R., Pesonen, A. K., Simons, A., & Phillips, D. I. W. (2009). Stress, glucocorticoids and liquorice in human pregnancy: Programmers of the offspring brain. Stress, 12(1), 1-14. https://doi.org/10.1080/10253890802042067
- Stafne, S. N., Salvesen, K. Å., Romundstad, P. R., Stuge, B., & Mørkved, S. (2012). Does regular exercise during pregnancy influence gestational weight gain, fetal growth, and pregnancy outcomes? A randomized controlled trial. Acta Obstetricia et Gynecologica Scandinavica, 91(5), 201-229. https://doi.org/10.1111/j.1600-0412.2011.01333.x
- Talge, N. M., Neal, C., & Glover, V. (2007). Antenatal maternal stress and long-term effects on child neurodevelopment: How and why? Journal of Child Psychology and Psychiatry, 48(3-4), 245-261. https://doi.org/10.1111/j.1469-7610.2006.01714.x
- Volkow, N. D., Wang, G. J., Fowler, J. S., Tomasi, D., & Telang, F. (2010). Addiction: Beyond dopamine reward circuitry. Proceedings of the National Academy of Sciences, 108(37), 15037-15042. https://doi.org/10.1073/pnas.1010654108
- Wadhwa, P. D., Entringer, S., Buss, C., & Lu, M. C. (2011). The contribution of maternal stress to preterm birth: Issues and considerations. Clinical Perinatology, 38(3), 351-384. https://doi.org/10.1016/j.clp.2011.06.007
- Woods-Giscombé, C. L., Lobel, M., & Crandell, J. L. (2010). The impact of stress, anxiety and coping on pregnancy outcomes. Journal of Psychosomatic Obstetrics & Gynecology, 31(3), 219-228. https://doi.org/10.3109/0167482X.2010.504870
References
Alhusen, J. L., Bower, K. M., Epstein, E., & Sharps, P. (2016). Racial discrimination and adverse birth outcomes: An integrative review. Journal of Midwifery & Women’s Health, 61(6), 707-720. https://doi.org/10.1111/jmwh.12490
Betancourt, J. R., Green, A. R., & Carrillo, J. E. (2014). Cultural competence in health care: Emerging frameworks and practical approaches. Field Museum of Natural History, 36(3), 31-48. https://doi.org/10.1111/j.1523-536X.2010.00486.x
Braveman, P., Marchi, K., Egerter, S., Pearl, M., Neuhaus, J., & Curtis, M. (2011). Poverty, near-poverty, and hardship around the time of pregnancy. Maternal and Child Health Journal, 14(1), 20-35. https://doi.org/10.1007/s10995-008-0427-0
Buss, C., Davis, E. P., Hobel, C. J., & Sandman, C. A. (2012). Maternal pregnancy-specific anxiety is associated with child executive function at 6-9 years age. Stress, 14(6), 665-676. https://doi.org/10.3109/10253890.2011.623250
Collins, J. W., David, R. J., Handler, A., Wall, S., & Andes, S. (2010). Very low birthweight in African American infants: The role of maternal exposure to interpersonal racial discrimination. American Journal of Public Health, 94(12), 2132-2138. https://doi.org/10.2105/AJPH.2004.045922
Davis, E. P., & Sandman, C. A. (2010). The timing of prenatal exposure to maternal cortisol and psychosocial stress is associated with human infant cognitive development. Child Development, 81(1), 131-148. https://doi.org/10.1111/j.1467-8624.2009.01385.x
Duncan, L. G., & Bardacke, N. (2010). Mindfulness-based childbirth and parenting education: Promoting family mindfulness during the perinatal period. Journal of Child and Family Studies, 19(2), 190-202. https://doi.org/10.1007/s10826-009-9313-7
Dunkel Schetter, C., & Tanner, L. (2012). Anxiety, depression and stress in pregnancy: Implications for mothers, children, research, and practice. Current Opinion in Psychiatry, 25(2), 141-148. https://doi.org/10.1097/YCO.0b013e3283503680
Epel, E., Jimenez, S., Brownell, K., Stroud, L., Stoney, C., & Niaura, R. (2004). Are stress eaters at risk for the metabolic syndrome? Annals of the New York Academy of Sciences, 1032(1), 208-210. https://doi.org/10.1196/annals.1314.022
Feldman, P. J., Dunkel-Schetter, C., Sandman, C. A., & Wadhwa, P. D. (2000). Maternal social support predicts birth weight and fetal growth in human pregnancy. Psychosomatic Medicine, 62(5), 715-725. https://doi.org/10.1097/00006842-200009000-00018
Goodman, J. H., Chenausky, K. L., & Freeman, M. P. (2014). Anxiety disorders during pregnancy: A systematic review. The Journal of Clinical Psychiatry, 75(10), e1153-e1184. https://doi.org/10.4088/JCP.14r09035
Guardino, C. M., & Dunkel Schetter, C. (2014). Coping during pregnancy: A systematic review and recommendations. Health Psychology Review, 8(1), 70-94. https://doi.org/10.1080/17437199.2012.752659
Kuo, D. Z., Cohen, E., Agrawal, R., Berry, J. G., & Casey, P. H. (2012). Medical complexity and pediatric preventable hospitalizations. Pediatrics, 129(5), e1170-e1176. https://doi.org/10.1542/peds.2011-3475
Li, J., Olsen, J., Vestergaard, M., Obel, C., Baker, J. L., & Sørensen, T. I. A. (2020). Prenatal stress and risk of asthma hospitalization in childhood: A prospective cohort study in Denmark. Psychosomatic Medicine, 82(1), 31-38. https://doi.org/10.1097/PSY.0000000000000762
Lobel, M., Cannella, D. L., Graham, J. E., DeVincent, C., Schneider, J., & Meyer, B. A. (2008). Pregnancy-specific stress, prenatal health behaviors, and birth outcomes. Health Psychology, 27(5), 604-615. https://doi.org/10.1037/a0013242
Misra, D. P., Guyer, B., & Allston, A. (2010). Integrated perinatal health framework: A multiple determinants model with a life span approach. American Journal of Preventive Medicine, 25(1), 65-75. https://doi.org/10.1016/s0749-3797(03)00090-4
O'Connor, T. G., Heron, J., Golding, J., Beveridge, M., & Glover, V. (2003). Maternal antenatal anxiety and behavioural/emotional problems in children: A test of a programming hypothesis. Journal of Child Psychology and Psychiatry, 44(7), 1025-1036. https://doi.org/10.1111/1469-7610.00187
O'Hara, M. W., & McCabe, J. E. (2013). Postpartum depression: Current status and future directions. Annual Review of Clinical Psychology, 9(1), 379-407. https://doi.org/10.1146/annurev-clinpsy-050212-185612
Räikkönen, K., Seckl, J. R., Pesonen, A. K., Simons, A., & Phillips, D. I. W. (2009). Stress, glucocorticoids and liquorice in human pregnancy: Programmers of the offspring brain. Stress, 12(1), 1-14. https://doi.org/10.1080/10253890802042067
Stafne, S. N., Salvesen, K. Å., Romundstad, P. R., Stuge, B., & Mørkved, S. (2012). Does regular exercise during pregnancy influence gestational weight gain, fetal growth, and pregnancy outcomes? A randomized controlled trial. Acta Obstetricia et Gynecologica Scandinavica, 91(5), 201-229. https://doi.org/10.1111/j.1600-0412.2011.01333.x
Talge, N. M., Neal, C., & Glover, V. (2007). Antenatal maternal stress and long-term effects on child neurodevelopment: How and why? Journal of Child Psychology and Psychiatry, 48(3-4), 245-261. https://doi.org/10.1111/j.1469-7610.2006.01714.x
Volkow, N. D., Wang, G. J., Fowler, J. S., Tomasi, D., & Telang, F. (2010). Addiction: Beyond dopamine reward circuitry. Proceedings of the National Academy of Sciences, 108(37), 15037-15042. https://doi.org/10.1073/pnas.1010654108
Wadhwa, P. D., Entringer, S., Buss, C., & Lu, M. C. (2011). The contribution of maternal stress to preterm birth: Issues and considerations. Clinical Perinatology, 38(3), 351-384. https://doi.org/10.1016/j.clp.2011.06.007
Woods-Giscombé, C. L., Lobel, M., & Crandell, J. L. (2010). The impact of stress, anxiety and coping on pregnancy outcomes. Journal of Psychosomatic Obstetrics & Gynecology, 31(3), 219-228. https://doi.org/10.3109/0167482X.2010.504870