I am due to deliver my second baby in October, after seeing two pink lines on my pregnancy test in mid-February, not long before the first death from COVID-19 was reported in the U.S. It is a pregnancy defined by a pandemic, and the stress that comes with it. I was used to day-to-day stresses while pregnant with my firstborn son, but the stress of COVID-19 is different — it's a great unknown, closer to the kind of natural catastrophe I grew up fearing in California (topping off my stress, an earthquake could still take place during the pandemic).
There is a lot to worry about as a pregnant person, but a good friend recently reassured me that plenty of babies have been born during times of war, famine, plague, and other tragedies. COVID-19 is just the latest case study in how women under major stress manage to deliver healthy, well-adjusted babies.
So what are the factors that have historically defined the impact of periods of stress on infants and mothers, and what is the good news for pregnant people right now?
What History Tells Us About Babies & Adverse Events
There is ample research that suggests severely stressful situations can affect unborn babies from the time they're born through adulthood and beyond, and that the first 1,000 days of life can shape a child’s development, but these events usually involve food insecurity or traumatic levels of stress says, Dr. Tessa (T.J.) Roseboom, a professor of early development and health at the University of Amsterdam's faculty of medicine.
Roseboom conducted a study showing a link between the Dutch famine (also known as the Dutch Hunger Winter of 1944-45) and long-term outcomes for unborn babies, and finding that health issues followed babies who were conceived during the Dutch Hunger Winter throughout their lives. They had a higher risk of cardiovascular disease and obesity as adults.
A 2014 study conducted on the Dutch Hunger Winter turned up similar results. The children of women pregnant during the famine were heavier and more prone to diabetes, obesity, and schizophrenia. The babies also had higher rates of death between the ages of 18 and 63. Further, journalist Carl Zimmer assessed that the famine likely led to miscarriages and early deaths in a 2018 New York Times piece.
As long as you find someone who supports you and helps you reduce your stress levels, it seems to really be protective against all the negative effects of stress.
Other major crises, such as natural disasters and the flu pandemic of 1918, have been shown to have similar effects on unborn babies.
The 1918 flu pandemic had a really high mortality rate, says Roseboom, "so everyone knew someone who died due to the pandemic," creating a population-wide trauma. Other events, like the 1998 ice storm in Quebec, have shown the effects from high levels of stress in a pregnant mom on unborn babies.
Looking at the ice storm, which saw houses go for days without power during winter, a Nature study found an association between low birth weights and women who were early in their pregnancies when the storm hit. The children born later were found to have higher rates of anxiety and depression throughout their young lives.
Some of these changes might be related to epigenetics, by which external factors change the way genes express themselves, especially where malnutrition is concerned (a factor that is a current threat to America’s poor), and during very early pregnancy. There is reason to believe trauma might trickle down through the generations based on epigenetics data.
The Stress Response In Mothers
When we are stressed, the hypothalamus and pituitary and adrenal glands modify the production of hormones like adrenaline and cortisol, says Dr. Sourav Sengupta, assistant professor of psychiatry and pediatrics at the University of Buffalo. A prolonged stress response can take a toll on your body, and right now, “there's no way that any of us as adults aren't at a heightened stress level during this period."
You have to be a little bit careful about not getting too caught up into genes and biology or the future [being] written already because I think the things that we do environmentally, socially, [and] interpersonally can absolutely modify those kinds of stresses.
Stress during pregnancy has been associated with preterm labor and pre-eclampsia in mothers, and certain behavior and performance-related issues for the babies in their first five years of life, says Dr. Subhashini Ladella, an associate professor and the director of maternal fetal medicine at University of California San Francisco at Fresno.
"Stress related to anything that happened before or during pregnancy can be associated with [adverse] outcomes," Ladella says. "Right now, I know everybody is under stress, not just pregnant moms. Everyone is under stress, so during pregnancy, that probably is even more exaggerated and has been multiplied." Still, there are ways to handle stress, as we will see.
The Opaque Link Between Miscarriage & Stress
I suffered a miscarriage prior to this pregnancy and was nervous about suffering from another the moment I learned of my current pregnancy. These fears were amplified by COVID-19. But the link between miscarriage and stress is not well-defined, and Ladella says there are many reasons for pregnancy loss that have nothing to do with stress. Especially in the first trimester, pregnancy loss can be caused by anything from infection to hormone changes to immunological, chromosomal, or physiological abnormalities in the fetus or mother. Fibroids can even play a role.
Though women with recurrent pregnancy losses may get tested and hope for some sort of explanation for this pattern, Ladella says sometimes doctors never identify what causes the losses.
The data is too limited to offer detailed takeaways, but "in general, stress during pregnancy is not good for the duration of the pregnancy," says Ladella. "Stress during pregnancy has resulted in preterm birth. We know there is that correlation."
Handling COVID-19 Stress During Pregnancy
This is a scary time to be parent, but children are resilient and adapt quickly, and Sengupta says we shouldn't be so quick to assume that the future of our kids, born and unborn, is set in stone.
"You have to be a little bit careful about not getting too caught up into genes and biology or the future [being] written already because I think the things that we do environmentally, socially, [and] interpersonally can absolutely modify those kinds of stresses," he says. "But I think it does mean during these stressful times that we have to pay attention to those."
Roseboom recommends that pregnant women who are currently riddled with concerns acknowledge rather than deny their fears. "This is a normal physiological reaction of your body responding to uncertainty, and that's a good thing, but the situation will end at some point and your body is very well capable of letting your child grow and adapting to the situation," she says.
She added that staying in touch with loved ones, even from afar, will assist with stress regulation. "There's lots of positive signals we're picking up from research in terms of women who find that they're supported through staying connected to their partner or still are able to contact their midwife on the phone or through other digital ways. That's sort of an antidote to the stress. So as long as you find someone who supports you and helps you reduce your stress levels, it seems to really be protective against all the negative effects of stress."
Know, too, that the worry is not proportional to the risk. The threat of the virus itself is no higher for pregnant people than the general population, though pregnant people with preexisting conditions are more likely to be admitted to hospital, as a May pre-print publication from the University of Oxford found. The prevalence of asymptomatic pregnant women who tested positive for COVID-19 at New York City hospitals suggests infection can often be mild, and research shows moms who have the virus don't seem to be passing it on during pregnancy, though a new study from Northwestern Medicine found a possible link between pregnant moms with COVID-19 and placenta injury.
At my first maternal-fetal center ultrasound appointment, I interrupted the sonographer just as she was starting the exam and trying to tell me that my bladder was full.
"Is my son's heart still beating?" I said, my upper lip sweating through my face mask as my own heart thumped in panic.
"You're scaring me," she replied, pausing briefly before reassuring me that everything looked normal. "Try not to worry so much. He's going to be just fine."
As she said this, I summoned the bravery to finally look at the screen in front of me. At 13 weeks, my son was sucking his thumb, arching his back, and free floating in my womb, unaware of my inner turmoil or the fraught state of the world that awaits him this October. I nodded, having faith in that moment that the sonographer was right.
If you think you’re showing symptoms of coronavirus, which include fever, shortness of breath, and cough, call your doctor before going to get tested. If you’re anxious about the virus’s spread in your community, visit the CDC for up-to-date information and resources, or seek out mental health support. You can find all of Romper’s parents + coronavirus coverage here.
Dr. Tessa (T.J.) Roseboom, professor of early development and health at the University of Amsterdam's Faculty of Medicine
Dr. Sourav Sengupta, assistant professor of psychiatry and pediatrics at the University of Buffalo
Dr. Subhashini Ladella, associate professor and the director of Maternal Fetal Medicine at UCSF Fresno
Roseboom, T.J., van der Meulen, J., Ravelli, A., Osmond, C., Barker, D., Bleker, O. (2001) Effects of prenatal exposure to the Dutch famine on adult disease in later life: an overview. Molecular and Cellular Endocrinology, https://jamesclear.com/wp-content/uploads/2015/01/tessa-roseboom-effects-of-prenatal-exposure-to-the-dutch-famine-on-adult-disease-in-later-life.pdf
Ekamper, P., van Poppel, F., Stein, A., Lumey, L. (2014) Independent and additive association of prenatal famine exposure and intermediary life conditions with adult mortality between age 18–63 years. Social Science & Medicine, https://doi.org/10.1016/j.socscimed.2013.10.027
Paxman, E., Boora, N., Kiss, D., Laplante, D., King, S., Montina, T., Metz, G. (2018) Prenatal Maternal Stress from a Natural Disaster Alters Urinary Metabolomic Profiles in Project Ice Storm Participants, Scientific Reports, https://www.nature.com/articles/s41598-018-31230-x
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Sutton, D., Fuchs, K., D’Alton, M., Goffman, D. (2020 Correspondence: Universal Screening for SARS-CoV-2 in Women Admitted for Delivery. New England Journal of Medicine, https://www.nejm.org/doi/full/10.1056/NEJMc2009316
Shanes, E., Mithal, L., Otero, S. Azad, H., Miller, E., Goldstein, J. (2020) Placental Pathology in COVID-19. American Journal of Clinical Pathology, https://doi.org/10.1093/ajcp/aqaa089