In the last decade, scientists have become increasingly interested in the effects a pregnant mother's anxiety has on birth outcome and her child's well-being. High levels of anxiety, along with stress and depression, appear to have negative influences on pregnancy outcomes. Anxiety among pregnant women, for example, predicts higher risk of preterm birth and lower birth weight. And when anxiety is combined with depression, the negative effects are much stronger. This is a problem because children born preterm or at low birth weight are at increased risk for mortality, medical conditions such as diabetes and hypertension, poor developmental outcomes, and behavioral problems.



Of course, it's always important to remember that scientific findings almost always represent a bird's eye view—that is, in this case, we're able to see the relations between risks such as anxiety and outcomes for the entire population. But such general scientific findings do not mean that it is true for every individual. So, if you are a pregnant woman feeling some level of anxiety, remember that there is no one-to-one relation between anxiety and poor birth outcomes. Anxiety is a risk factor, and it is important to address, but if you are feeling high levels of anxiety during pregnancy, it does not mean you will necessarily give birth early, or that your baby will be underweight. So take a breath, relax, and keep reading.

General Anxiety Versus Anxiety About the Pregnancy

One important research finding in the last decade is that while general anxiety is a risk factor, anxiety about the pregnancy itself is even more of a risk. Women who are highly anxious about their pregnancy and upcoming birth experience tend to experience even worse outcomes than women who only have high levels of general anxiety.

Over ten studies have found that pregnancy anxiety (including anxiety about the pregnancy, birth, the child's well-being, or becoming a mother) is related to shorter gestation periods. So far, we don't know why that is. The studies have controlled for possible confounding factors like medical risk, ethnicity, education, and income. That said, we know that the effect of pregnancy anxiety is independent of these influences. Scientists are working to try to better understand the mechanisms behind the way anxiety impacts birth and child outcomes. In the meantime, the existing research indicates that managing anxiety during pregnancy should be on the minds of doctors and researchers.

Alleviating Pregnancy Anxiety to Ensure a Healthy Baby

Pregnant women with high levels of anxiety should, of course, talk to their doctor. Anti-anxiety medications may be effective, but it is also important to make sure that prescribed medications are safe for the fetus. Fortunately, one of the best treatments for high levels of anxiety, Cognitive Behavioral Therapy (CBT), does not involve medication, but rather just talking and thinking.

Recent intervention studies have found that reducing high-risk pregnant women's stress and depression via CBT reduces risk for low birth weight and preterm birth. These mental exercises help alleviate stress during pregnancy and could be supplemented by relaxing activities such as yoga or massage.

Clinical Findings on Social Support and Pregnancy Anxiety

My own work has taken a different approach. Research indicates that support from one's partner is a key influence on expectant and new mothers' mental health. My team and I have focused on helping expectant women and their partners develop mutually supportive relations, enhancing communication, problem solving, conflict resolution, and co-parenting support.

The program we developed, Family Foundations, has been shown in randomized-trial research funded by the National Institutes of Health to have a positive effect on a wide range of mother, father, child, and family outcomes—including postpartum depression, father-infant relationship quality, supportive co-parenting, parenting quality (including less over-reactive and harsh parenting), and better child sleep, self-regulation, and adjustment. In fact, seven years after birth, teachers of these children whose parents attended the eight-class Family Foundations series reported that the children showed fewer emotional and behavioral problems than children whose parents did not attend the class series. This evidence is so strong, in fact, that the Department of Defense is disseminating the program for active duty military families.

In our most recent work, we found that programs like Family Foundations not only benefit families in all the ways mentioned above, but are also associated with more positive birth outcomes for mothers who demonstrated higher levels of a stress biomarker. Among pregnant women who had relatively higher levels of cortisol (a stress-related hormone), taking these type of classes and programs result in improved birth outcomes, such as longer gestation period, higher birth weight, and a shorter hospital stay for the newborn. Again, we don't understand the precise mechanisms in play, but we believe that enhancing couple support helped expectant mother's feel less anxious, depressed, and stressed, which of course leads to reduction in mental health problems had positive biological effects on the pregnancy.

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