taken from http://www.marchofdimes.com/professionals/681_1158.asp

Pregnancy is a special time for a woman and her family. It is a time of
many changes—in a pregnant woman’s body, in her emotions and in the
life
of her family. As welcome as they may be, these changes often add new
stresses to the lives of busy pregnant women who already face many
demands
at home and at work.

Stress, however, does not have to be all bad. When managed properly,
stress can provide us with the drive to meet new challenges. A pregnant
woman (or anyone else) who feels she is coping well with
stress—taking
good care of herself, feeling energized, rather than drained, and
functioning well at home and work —probably does not face health
risks
from stress.

However, when physical or emotional stress builds up to uncomfortable
levels, it can be harmful for pregnant women. In the short term, a high
level of stress can cause fatigue, sleeplessness, anxiety, poor
appetite
or overeating, headaches and backaches. When a high level of stress
continues for a long period, it may contribute to potentially serious
health problems, such as lowered resistance to infectious diseases,
high
blood pressure and heart disease. Studies also suggest that high levels
of
stress may pose special risks during pregnancy.

The good news is that stress is unlikely to cause problems in pregnancy
for most women. Pregnant women who are concerned about the level of
stress
in their lives, and their ability to cope with it, should talk with
their
health care provider. A health care provider may be able to point a
woman
to resources in her community and show her simple, effective steps to
help
her reduce and cope with physical and emotional stress.

What special stresses do pregnant women face?
Pregnancy-related discomforts (such as nausea, fatigue, frequent
urination, swelling and backache) can be stressful, especially if a
pregnant woman attempts to accomplish everything she did prior to
pregnancy. A pregnant woman can help reduce her stress by recognizing
that
these symptoms are temporary, and her health care provider can
recommend
ways to cope with them. She also can consider cutting back on
unnecessary
activities when she is uncomfortable.

Hormonal changes may be partly responsible for the mood swings
experienced
during pregnancy. These mood swings are common and normal, so a
pregnant
woman should not be overly concerned about them. However, she should
keep
in mind that mood swings may make it more difficult for her to cope
with
stress.

In addition, many pregnant women and their partners worry about the
health
of their unborn baby, their ability to cope with labor and delivery and
their ability to become good parents. Added financial responsibilities
are
another common source of stress, especially if the parents anticipate a
reduction in income—whether brief or long-term—after the baby is
born. All
of these worries can be magnified if the pregnancy is high-risk, in
which
the pregnant woman must significantly reduce her activity and,
possibly,
leave her job early.

A number of studies have suggested that very high levels of stress may
increase the risk of preterm labor and low birthweight. A 1999 study at
the University of California Los Angeles School of Medicine found that
women who reported high levels of stress at 18 to 20 weeks of pregnancy
were more likely to have high levels of a hormone called
corticotropin-releasing hormone (CRH) in their blood. This and other
studies have found a potential link between high levels of CRH and
preterm
labor.

CRH, which is produced by the brain and the placenta, is closely tied
to
labor. It prompts the body to release chemicals called prostaglandins,
which trigger uterine contractions. CRH also is the first hormone our
brains secrete when we are under stress. Researchers continue to
explore
the possibility that women who experience high levels of stress early
in
pregnancy have elevated levels of CRH that set their placental clock
for
early delivery.

Another recent study suggests that the timing of stress during
pregnancy
may influence pregnancy outcomes.

Researchers at the University of California at Irvine found that the
earlier in pregnancy a woman experienced a very stressful event (in
this
study an earthquake), the earlier she was likely to deliver. The
researchers speculate that women become less sensitive to stress as
pregnancy progresses, possibly helping protect the baby from adverse
effects of stress.

Babies who are born prematurely are often low birthweight. However,
studies suggest that babies of women who suffer from high levels of
stress
and anxiety are more likely to be born low birthweight even when born
at
full term. Some stress-related hormones (such as norepinephrine) may
constrict blood flow to the placenta, so the baby may not receive the
nutrients and oxygen it needs for optimal growth.

Stress also may exert potential adverse effects indirectly by affecting
the pregnant woman’s behavior. For example, women who experience high
levels of stress may not follow good health habits. They may skip meals
or
not choose nutritious foods, or they may react to stress by reaching
for
cigarettes, alcohol or illicit drugs, all of which have been linked to
low
birthweight. Use of alcohol and certain illicit drugs also increases
the
risk of birth defects.

Studies also suggest that high levels of stress may contribute to other
pregnancy complications. A few studies suggest that women with
stressful
jobs may be slightly more likely than women with low-stress jobs to
develop preeclampsia (a pregnancy-related disorder that includes high
blood pressure and can result in poor fetal growth and other problems).
There also is a concern that high levels of stress may increase the
risk
of miscarriage. Studies to date suggest that these risks—if they
exist at
all—are likely to be small for most women.

Do individuals respond differently to stress?
Each of us finds different tasks or situations stressful. A task that
one
person finds enjoyable can be highly stressful to another. Each
individual
also reacts differently to an event perceived as stressful. There
appear
to be distinct differences in how our bodies respond to stress, and
some
of these differences may have an impact on pregnancy.

James McCubbin, PhD, and other researchers at the University of
Kentucky
College of Medicine measured pregnant women’s blood pressure
following a
stressful arithmetic task. All of the women had normal blood pressure
readings prior to the task. This 1996 study reported that women with
larger diastolic blood pressure increases (a blood pressure reading is
given as the systolic over the diastolic pressure; for example, 110/80)
were more likely to have smaller-than-average or low-birthweight babies
and premature babies. The researchers speculate that increased levels
of
stress-related hormones may affect both maternal blood pressure and
fetal
growth and development. Studies like this one suggest that it may
eventually be possible to identify a group of women who are at risk of
preterm labor and of having a low-birthweight baby, and provide
stress-reduction techniques to help reduce their risk.

How can a pregnant woman reduce stress?
Each pregnant woman needs to identify the personal and work-related
sources of stress in her life and develop effective ways to deal with
them. Any woman, whether pregnant or not, can cope better with the
stresses in her life if she is healthy and fit.

A pregnant woman should eat a healthy diet, get plenty of sleep, avoid
alcohol, cigarettes and drugs and exercise regularly (with her health
care
provider’s consent). It is important that a pregnant woman not skip
meals
because the fetus needs constant nutrition, and long fasts put stress
on a
woman’s body. She should eat three meals plus at least two healthy
snacks,
or five to six small meals a day. Exercise keeps pregnant women fit,
helps
prevent some common discomforts of pregnancy (such as backache, fatigue
and constipation) and relieves stress.

Having a good support network— which can include the pregnant
woman’s
partner, extended family, friends and others—also helps a pregnant
woman
relieve stress. These individuals may provide information, emotional
support or help with tasks around the home. Some studies suggest that
having good support actually may reduce the risk of preterm labor and
low
birthweight, especially for poor, highrisk women or women who are
feeling
stressed.

A number of stress reduction techniques have been used successfully in
pregnancy. These include biofeedback, meditation, guided mental imagery
and yoga (specifically for pregnant women). Unless a pregnant woman has
practiced these techniques previously, she may need instruction from an
expert. Childbirth education classes teach relaxation techniques and
help
reduce anxiety by educating parents-to-be about what to expect during
labor and delivery.

Dr. McCubbin has developed a simple relaxation plan that any pregnant
woman can use:
Relax for the health of your baby and yourself. Maternal stress can
affect
your developing baby.
Allow sufficient time to relax each day. Relaxation is important for
you
and your baby.
Get comfortable. A quiet room with no phone works best. Lying down or
reclining is good. Lie slightly tilted to one side with your belly (and
baby) partially supported by a pillow.
Prepare mentally. Clear your mind of distractions and focus on your
relaxation.
Take control. You control the relaxation you give to your body and your
baby.
Focus on your breathing. Use slow, steady, deep breaths from your
belly,
not your chest.
Monitor your muscles. Learn to recognize tension in your body’s major
muscle groups.
Release the tension in each muscle group. Become familiar with the feel
of
tension dissolving.
Imagine yourself in your favorite restful place—maybe on the beach,
by a
stream or on a mountain top.
Practice and enjoy the pleasant feelings that you have given to
yourself
and your baby. Do it at least once a day for 20 to 30 minutes. Relax
throughout pregnancy.

Fortunately, most women adjust well to the physical and psychological
changes of pregnancy. However, if a pregnant woman feels overwhelmed by
stress, she always should consult her maternity health care provider
who
may recommend that she see a mental health professional.