Prenatal Maternal Stress

IntroductionPrenatal maternal stress (PNMS) or prenatal stress is exposure of the expectant mother to distress, like environmental or stressful life events, which can result in hormone or immune system changes in the mother and result in harm to the fetus and later psychosocial development of the child (1). The theory is that glucocorticoids during stress pass the placenta to the fetus and results in long-term reprogramming and dysregulation of the fetal hypothalamic pituitary adrenal (HPA) axis (1).One study of the Iowa floods in 2008 on pregnant women and their offspring two years later showed that PNMS lead to long-term changes in the functioning of the HPA axis (1). Another study with a sample of 54 early adolescents (13 years old) from the 1998 Quebec ice storm showed that stress exposure in their mothers in their third trimester was later associated with increased eating disorder manifestations (2).A recent review (3) looked at maternal prenatal cortisol concentrations and child outcomes (physical/health, cognitive/motor, psychological/ behavioral, and cortisol). They found in the few studies available that maternal cortisol was related to altered child outcomes, but most of the studies did not find significant associations, which might suggest that maternal cortisol may not to be the sole or even main underlying mechanism in the relation between maternal prenatal stress/anxiety and child outcomes (3).Population based studiesPrenatal stress associated with preterm birth, low birth weight, peripartum anxiety and depressive symptoms has been shown in epidemiologic studies (4). One study during 1990-1995 from 11 states in the United States found that 64% of women surveyed reported experiencing at least one stressful life event (SLE), although the prevalence declined slightly over the study period (4). A more recent study (4) used data for the years 2000-2010 and found that most women in the sample reported experiencing more than one SLE in the year before their infant's birth, although the prevalence of experiencing SLE decreased during 2000-2010 (4). In 2010 with data from 27 states, 70.2% of women reported more than one SLEs. The mean number of SLE was 1.81, ranging from 1.41 in New York City to 2.26 in Oklahoma. The most frequently reported life event was financial and younger, less educated, unmarried and Medicaidcovered women had the highest prevalence of SLE (4).Stress preventionThere are individual and collective stress factors in our lives. Some we are able to prevent and some without our range. A recent review (5) looked at ways to intervene and reduce strees for pregnant women. They found the following intervention studies: group prenatal care, care coordination, health insurance expansion, expanded prenatal education/support in the clinic, home visitation, telephone contact or stressreduction strategies with group prenatal care the most evidence for prevention (5). …

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