Pregnancy is the period of embryonic and fetal development, or gestation. In humans, a normal pregnancy lasts 40 weeks from conception to birth. Delivery before 37 weeks of gestation, known as preterm delivery, is associated with greater risk for a number of adverse conditions in the newborn including low birth weight (less than 2,500 g). Low-birth-weight babies are at substantially increased likelihood of dying during their first year of life; many survivors experience long-term physical health and developmental problems.
Pregnancy is a common experience for women. In the United States, more than 4 million births occur each year. The number of pregnancies is higher, however, because not all pregnancies result in a birth. Some women elect to terminate their pregnancies, a procedure known as therapeutic abortion, and approximately 15%-20% of pregnancies end by spontaneous abortion (miscarriage). There is research on psychological aspects of therapeutic and spontaneous abortion, such as how women adapt afterward, but that research is not discussed in this article. The focus here is on pregnancies that result in a birth.
Studies find that pregnancy is a momentous experience, with women retaining clear memories of their pregnancy and birthing and strong feelings about them as much as 20 years later. A woman’s age, health status, reproductive history, education, marital or relationship status, and other important characteristics have been shown to influence her experience of pregnancy. However, researchers find that some aspects of pregnancy are typical of the experience of most women. The most common physical symptoms include nausea and vomiting, fatigue, indigestion or heartburn, swollen feet and hands, difficulty breathing or sleeping, leg cramps, breast tenderness, headaches, hemorrhoids, and frequent urination. Psychological or lifestyle adjustments may be necessary to adapt to these physical discomforts.
Also common in pregnancy are the changes in appearance that women experience. Studies find that some pregnant women feel unattractive, whereas others welcome their body’s changes as confirmation of their child’s growth. Women view their appearance differently as pregnancy progresses, and these views are affected by how their friends, family, and even strangers treat them. Pregnant women are sometimes subjected to unkind comments about their size, unsolicited advice, touch, and staring.
Pregnancy is an important topic of study for health psychologists because it is both a biomedical and a psychosocial event. In addition to the physiological processes that occur, pregnancy can influence women’s emotions, actions, thoughts, and social relationships. Furthermore, a number of interactions occur between pregnant women’s physical and psychosocial states. Three topics that comprise most psychological research on pregnancy illustrate the reciprocal effects of biomedical and psychosocial factors. First, how does advancing pregnancy affect women’s emotional state? Second, how do women cope with the strains and challenges that they experience during pregnancy? Third, how do psychosocial factors such as stress affect the health of pregnant women and their fetuses? The following sections address each of these questions.
Pregnancy and Emotional State
Most studies of women’s emotional state in pregnancy have examined levels of anxiety and depression. Well-conducted studies find that most women do not experience fluctuations in anxiety during pregnancy, and most are within normal levels throughout this 9-month period. However, there is evidence that a portion of women experience changes in anxiety across pregnancy, with some experiencing increases, some decreases, and others a combination. Patterns of anxiety in pregnancy are not related to a woman’s age, level of education, ethnic background, marital status, or other individual characteristics. Thus, there is no way to identify beforehand the women most likely to become highly anxious during pregnancy.
In comparison to the studies of prenatal anxiety, studies of prenatal depression are less well conducted and their findings are more contradictory. However, most of these studies suggest that for women who do experience depression during pregnancy, the symptoms (such as feeling hopeless or sad) are usually within normal ranges and do not warrant treatment. Of course, some women may desire and need help to overcome depressive symptoms. Women who experience depression prior to pregnancy are more likely to become depressed during their pregnancy, particularly if the pregnancy adds to their preexisting levels of stress.
Taken together, studies of prenatal anxiety and depression illustrate that there is no single, universal emotional response to pregnancy. This is because anxiety and depression are emotional responses to life conditions that vary from woman to woman. Most women experience normal, stable levels of negative emotion during this period of time.
Coping in Pregnancy
Coping includes anything people do to manage problems or their emotional responses, whether successful or not. Four types of coping have received most attention in research on pregnancy: avoidance, problem solving, positive appraisal, and prayer. Avoidant coping, by which people remove themselves physically or psychologically from problems, is associated with greater emotional distress in pregnant women, and in other people who cope this way. Avoidant coping may also have harmful nonemotional consequences in pregnancy, such as neglecting to get assistance or medical attention when it is needed.
A second type of coping, called problem solving, active coping, or approach-oriented coping, tends to be effective in other people, but the evidence in pregnancy is mixed. One reason is that these ways of coping may lead to an increased focus on problems that cannot be remedied in pregnancy. For example, in a recent study of pregnant women with medical conditions that put them at high risk for having a miscarriage or a preterm delivery, women were worse off emotionally if they coped by preparing for the baby’s arrival, such as acquiring furniture, baby clothes, or supplies. The researchers reason that this type of coping focuses attention on the baby, which is distressing among women whose pregnancy may not result in a healthy child. Although problem-focused coping strategies such as preparation are associated with positive outcomes in some stressful situations, there is evidence that this type of coping is less effective for people facing severe threats.
A third type of coping that has been examined in pregnant women is prayer. A few recent studies find that prayer is the most frequently reported type of coping used by pregnant women. However, in one of these studies, use of prayer was associated with increased emotional distress. The study’s authors explained that the type of prayer used by women in their study may have been a form of worrying, or rumination, which typically produces unfavorable emotional consequences.
Positive appraisal is the only type of coping that has consistently been associated with lower distress in pregnant women. This way of coping involves viewing a stressful situation positively, emphasizing what can be gained or what benefits might accrue from it. Positive appraisal has been shown to be an adaptive form of coping in many types of people undergoing stressful events.
What leads pregnant women to use particular ways of coping? There is recent evidence that women who are optimistic and those who view their pregnancy as controllable select more effective ways of coping, and, as a result, they experience lower emotional distress during pregnancy.
Effects of Stress in Pregnancy
Pregnancy is a stressful event for some women because they are coping with physical strains and psychological challenges while carrying out demanding family, work, and other roles. Research shows that high levels of stress can have a deleterious effect on pregnancy, increasing the likelihood of adverse birth outcomes such as low birth weight and preterm delivery. Studies have examined stress in a variety of ways. Some measure the number of stressful life events that occur during pregnancy, such as whether a close friend or family member dies, or the loss of a home. Other studies examine how women perceive the life events that they experience—specifically, how stressful or disturbing they are. Still other studies measure levels of anxiety in pregnant women. In scientific studies published during the last several decades, a consistent association has emerged between the number of stressful life events experienced in pregnancy and low birth weight, and somewhat less consistent associations with preterm delivery. Anxiety and women’s perceptions of life event stress have been linked to serious labor and delivery complications. Additional studies have measured stress by examining the combination of stressful life events, anxiety, and other stress factors such as financial or family strains. These studies provide some of the scientifically strongest evidence documenting the deleterious effects of stress in pregnancy.
What accounts for the impact of stress on birth outcomes? Both physiological and behavioral processes are affected by stress. There is some evidence that stress causes the release of hormones and other chemicals in the nervous system that trigger early delivery. Stress reduces the flow of blood and oxygen to the fetus, which can result in fetal growth problems. In addition, stress may disrupt the immune system, making women more susceptible to infections, which can bring on early delivery or otherwise affect the fetus. Behaviorally, studies find that pregnant women who experience high stress have poorer nutrition and physical activity, and they are more likely to smoke cigarettes, to consume alcohol, and to use other substances that have severe effects on birth weight and newborn health.
Pregnancy is an important life event that is experienced by most women. It entails physical and psychosocial changes that are stressful for some. Nevertheless, the majority of women cope successfully with the strains and challenges of pregnancy. Those who do experience high levels of stress and resultant emotional distress during pregnancy face increased risk of adverse birth outcomes including low birth weight and preterm delivery.
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