Effects of psychological stress on adverse pregnancy outcomes and non-pharmacologic approaches for reduction: an expert review

TRAYLOR, Claire S.; JOHNSON, Jasmine; Kimmel, Mary C.; MANUCK, Tracy A.

Both acute and chronic stress can cause allostatic overload, or long-term imbalance in mediators of homeostasis, that results in disruptions in the maternal-placental-fetal endocrine and immune system responses. During pregnancy, disruptions in homeostasis may increase the likelihood of preterm birth and pre-eclampsia. Expectant mothers traditionally have high rates of anxiety and depressive disorders and many are susceptible to a variety of stressors during pregnancy. These common life stressors include financial concerns and relationship challenges and may be exacerbated by the biologic, social and psychologic changes occurring during pregnancy. In addition, external stressors such as major weather events (e.g., hurricanes, tornados, floods) and other global phenomena (e.g., the COVID-19 pandemic) may contribute to significant stress during pregnancy. This review investigates recent literature published about the use of non-pharmacologic modalities for stress relief in pregnancy and examines the interplay between psychiatric diagnoses and stressors, with the purpose of evaluating the feasibility of implementing non-pharmacologic interventions as sole therapies or in conjunction with psychotherapy or psychiatric medication therapy. Further, the effectiveness of each non-pharamacologic therapy in reducing symptoms of maternal stress is reviewed. Mindfulness meditation and biofeedback have shown effectiveness in improving one’s mental health such as depressive symptoms and anxiety. Exercise, including yoga, may improve both depressive symptoms and birth outcomes. Expressive writing has successfully been applied post-partum and in response to pregnancy challenges. Though some of these non-pharmacologic interventions can be convenient and low cost, there is a trend towards inconsistent implementation of these modalities. Future investigations should focus on methods to increase ease of uptake , ensure each option is available at home, and a standardized way to evaluate whether combinations of different interventions may provide added benefit.