Christine Dunkel Schetter, PhD, professor of psychology and psychiatry at University of California Los Angeles, discusses the connection between preterm birth and high stress for moms.
Can you tell me about why preterm birth and high stress for moms was an area that you and your colleagues were interested in looking at and about the study?
DUNKEL SCHETTER: We’ve done many studies in this area. The newest one is notable because it was stress before pregnancy. But we also have for many years, three decades, been studying stress during pregnancy and its relationship to timing of birth, earlier birth. The interest in that came about in the 1980s. When I arrived at UCLA, I was invited to collaborate on a California state-wide study to prevent preterm birth. And then I was encouraged as a stress researcher, young stress researcher, to write a grant to see if we could show that stress was related to earlier birth. And I did and was funded by the March of Dimes. And we did a first study published in 1992 showing that maternal stress, especially distress, that is a mother’s experience of it as stressful and emotionally upsetting, that mom’s distress in pregnancy predicted earlier birth and lower birth weight. That launched several studies over several years, most of them with my collaborator Calvin Hobel at Cedars Sinai, who is a maternal fetal distinguished expert in that area and clinician, and with others, several others at other institutions and many students and postdocs.
Your most recent research is based on a long body of research and a lot of information in the field. Can you tell me what this latest study focuses on and what you found?
DUNKEL SCHETTER: We study in that cohort of women that were national from, in this case, three sites across the U.S. a mixed urban suburban county north of Chicago, Lake County, the Washington, D.C. area, and eastern North Carolina, several rural counties of North Carolina. The original study was also based on women in Los Angeles and in Baltimore. In the original study what we just published showed that in 2,637 women who were very racially and ethnically diverse, largely Black and Latino and mostly poor, it showed that there were two kinds of stress, technically three, but two primary ones that were measured with multiple measures. And the findings were that one of them was stressors that is things that happened to them that are outside of them and that are relatively objective. So those were their major life events. Many people know about that. But also, financial strain, interpersonal violence usually in their home, often, unfortunately, from partner and racial and ethnic discrimination. So those things together were a measure of how much stress a woman was being exposed to in the environment. And then the second measure was what we call stress appraisals. And that was the extent to which she felt overwhelmed and unable to cope and out of control and distressed around perceived stress in her life for any purpose. Just the level of that, any cost. And the second piece of that was parenting stress and feeling overwhelmed by being a parent because all these women had at least one child in the home. The third kind was what we called chronic relationship stress because it had to do with stress with families and partners. And that one is less important for these findings. So, in a smaller sample then of 360 of these women who later got pregnant, we looked at the effects of those kinds of stress before the pregnancy on their length of gestation or the outcome of that next pregnancy. And that pregnancy was as much as – or an average of four years later, four and a half years later. Some were relatively soon, but on average they were a few years later. What we found was that two these two first two kinds of stress did predict outcomes but in different ways. We found the most important finding here is that how much a woman perceives she is experiencing stress before she gets pregnant as much as four years before predicts how long her pregnancy will be in the next pregnancy in well controlled models. In other words, moms who were experiencing heavy stress before they even became pregnant had shorter gestation, shorter pregnancies.
How much shorter are the gestational and why would a short pregnancy be concerning?
DUNKEL SCHETTER: It will be several weeks shorter. In large studies we look at preterm birth, which is less than 37 weeks gestation. We have done studies with large samples and looked at preterm birth. But in this kind of research where we are trying to get down to the nuances and the deeper understanding of what kinds of stress might be important in when a woman goes into labor and delivers early, we typically don’t look at preterm birth necessarily but instead – they’re not epidemiologic studies with large samples – instead, we’re looking at fine-tuned interviews on a smaller sample. So that’s why we look at weeks gestation. So, it’s suggestive that if we study thousands of women and look at appraisals of stress, that in the same way we did, that you would find, and there are studies that do find this though not as consistently as we’d like. We already know that women who experience more stress during pregnancy, especially in our work in the form of feeling anxious during pregnancy and anxious about their pregnancy, we already know that they have – they give birth earlier and are at higher risk for preterm birth. So, the study is innovative or novel because it’s looking at before the pregnancy.
Was there an average of how much earlier, the moms gave birth, if they were under this perceived stress? Was there any average or did it range?
DUNKEL SCHETTER: The way the analyses are done won’t tell you the average, at which time they gave birth.
If we know that this perceived stress or distress is indicative of preterm birth, it sounds simple, but what can a woman do? We know that stress is bad, but what can women in these situations do? What are the implications for having this research in front of us?
DUNKEL SCHETTER: Well, the first thing is, don’t freak out. If you are a woman with high stress in your life and you got pregnant or you think you want to get pregnant and you or you are pregnant, the first thing you should not do is start to worry about the fact that you have stress and it’s going to harm you or your baby because that’s not going to get you anywhere. The evidence that we have out there in the popular press should not lead women to that kind of anxiety. What you can do if you feel that you are experiencing a lot of stress and particularly anxiety, again, I’m going to emphasize that based on our big program of research, is seek ways. There are programs, there are things like mindfulness, meditation, which has significant effects on anxiety. There are other things women find useful like yoga and other complementary or other alternative medicine sorts of ways of reducing stress and improving your stress physiology. There are stress reduction programs. We have done a little work in that area in pregnancy. There may be one available in the area in which you live, and it might be advisable. But for the women in our study who were low income with the kinds of things like financial stressors and IPB, they probably need to go through their medical their health care system, request social services assistance. If it’s something like IPB, request social services help if it’s financial and you need assistance. If you’re in a community health center as opposed to a major medical center for prenatal care, again, even more, make sure that you ask for help for those additional life circumstances that might be influencing the ability to have a calm and healthy and happy pregnancy.
Why is it important for women to have this information?
DUNKEL SCHETTER: One study doesn’t tell women what to do, but the bulk of evidence across many dozens now, dozens of studies including ours, many of ours, suggest that women should pay attention to having a healthy pregnancy. The healthy pregnancy is not smoking, moderate exercise, not being sedentary or overexercising, high stress jobs where you’re on your feet all day may be a risk factor. Talk to your doctor about that. All the things about healthy pregnancy are, by and large, in prenatal care. So, the most important thing would probably be to get prenatal care early and regularly and listen to your prenatal care provider, accept programs offered to you that might be set for – designed for improving pregnancy health. And in your home life when you’re not in prenatal care, the impact of the work on stress and pregnancy is other than changing your life circumstances, try to reduce anxiety, remain calm, have a positive mindset in order to have a healthy pregnancy. Now, I think that sounds naive and stupid when I hear myself say it. But you asked me the question. And the question’s answer is good prenatal care early and regularly, listen to your provider, take advantage of programs. And if you do all of that and you’re anxious, try to calm down, and there are ways. There is online meditation, mindfulness meditation, apps people can access. There are support groups for women out there. Now there’s online support during Covid. I would add that the effects of Covid on pregnancy are causing a lot of anxiety. Thus far we do not have strong reasons to be as worried about it as pregnant women have been. So again, there is something to be said for the notion that a pregnancy is an evolutionarily normal life event, life transition, and that taking it in stride to the best of your ability is a good idea. Our preconception work, which you are asking me about, suggests that if you’re going to get healthy, don’t wait till you’re pregnant, for heaven’s sakes. Stop smoking before you have pregnancies. When you think you might want to get pregnant, when you think that you might accidentally get pregnant, might be a good time to get healthy, reduce stress, increase your mental health and physical health.
I know that you said since the early ’90s this has been, you know, your area of expertise but was there anything about this study in particular that surprised you, even with that past body of knowledge?
DUNKEL SCHETTER: It’s among the first preconception studies, so it certainly is surprising to be able to show that you can go that far back and affect an outcome of a nine month pregnancy, you know, in a significant way, even if it’s a couple months, even if it’s a week, even if it’s a half a week, those are significant, important findings for understanding the science behind this, and I’m a scientist so that’s what I care about. A little bit surprising is that we also found a relationship with these stressors, these things that are external but that women are exposed to. For that, we didn’t find what we found with appraisals. Let me go back and say the first finding I mentioned is that the more stress, the earlier the delivery. It’s what we call a linear effect. The more you appraise stress in your life, the earlier the delivery that was more feelings of being overwhelmed, out of control, unable to cope, nervous and stressed, as well as parenting, feeling – appraising yourself as overwhelmed by parenting. Together, those two things indicated that the more of those you have, the earlier you deliver. Every increment of increase in those is a potential increment of a little bit earlier delivery. You know, half a day, it depends on the graph. But that’s what we found in that case. But for the other events, the ones I described as events, life events, financial – food insecurity, IPB, discrimination, life events, we found an interesting curvilinear effect such that you delivered earlier if you had a lot of those. You delivered a little bit later if you had moderate amounts. But if you didn’t have as much of those you delivered earlier. We don’t know what that means. We are – the reason I wouldn’t have spoken about it until you asked me about being surprised is that we don’t know what that means. We don’t know whether that means that the women who are really, really low on these exposures have unstimulating lives, perhaps. You can look for a quote at the end of the article where we try to explain that.
Some of these stressors, especially among women in low-income situations, may feel or may actually be out of their control, sometimes even the relationship status may be difficult to control. Is there a need for looking into outside assistance?
DUNKEL SCHETTER: Absolutely, there are lots of things in our lives that are difficult to control. Nonetheless, if we can’t stop it, how we cope with it, we can control. Seeking assistance may, in those cases that you just alluded to, help us both reduce it. For example, if you seek help for women who experience IPB, you may be able to get help in leaving that situation, which may be indicated. If it’s financial strain and food insecurity, seeking help should help you be able to increase your – there are public assistance for obtaining food through various means. So those are things where getting help alone is very helpful. Also, those are ways in which women cope by doing something, you know, with problem solving and may also lead to other feelings like efficacy, feeling good that you did something, and feeling good about yourself that you reached out and did something. You may inadvertently, without it being the purpose, get support as well.
Interview conducted by Ivanhoe Broadcast News.
END OF INTERVIEW
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