Stress and Its Adverse E Ects On Pregnancy: Care of The Unborn Child With Yoga

4/11/2020 JaypeeDigital | eBook Reader
Care of the
Unborn Child with
Yoga
Shamanthakamani
Narendran
Stress And Its Adverse

4
E ects On Pregnancy
 1: Basic Medical Facts About Pregnancy
 2: Prenatal Care
 3: Perinatal Problems
 4: Stress And Its Adverse E ects On Pregnancy
 5: Fundamentals Of Yoga: Theory, Practice
Pregnancy is a special time for a woman and her family. It is a time of many
And Applications changes in the pregnant woman's body and her emotions. These changes (as
 6: Concept Of Pregnancy And Childbirth In welcome as they may be) often add new stresses to the life of the busy
Yoga And Spiritual Lore
pregnant woman, who already faces many demands at home and at work.
 7: Description Of Pregnancy In Upanishads
And Puranas
To add to this, today's household work is carried on with less physical
 8: Yoga Practices During Pregnancy
 9: Discussion Of The Research Study movements using electric gadgets in the home and the kitchen—if a woman has
 APPENDIX: Integrated Advanced Yoga a career outside her home she is always in a rush. In the workplace most of the
Techniques For Pregnancy women have sedentary habits. Obesity may set in. Hence, the muscle and
Bibliography
ligaments of the pelvis and spine get less exercise and cannot ex easily, which
may cause di culty during pregnancy and labor. It may lead to instrumental
delivery and cesarean intervention. Further, complications like High Blood
 Pressure, Diabetes Mellitus and Premature Delivery may also result due to these
habits.
Stress 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 feeling energized, rather
than drained, and functioning well at home and work probably does not face
health risks from stress. However, when stress builds up to uncomfortable
levels, it can be harmful for the pregnant woman and the fetus.
However, there are many short-term and long-term harmful effects of

excessive stress. In the short-term effects, a high level of stress can cause
fatigue, sleeplessness, anxiety, poor appetite or overeating, headaches and
backaches. When high levels of stress continue for long periods, it can
contribute to potentially serious health problems, such as infections, high blood
pressure and high blood sugar, etc.
Pregnancy-related discomforts, such as nausea, fatigue, frequent urination,

swelling and backache can be stressful, especially if the 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 that there are ways to cope with them. She also can consider
cutting back unnecessary activities when she is uncomfortable.

DEFINITION OF STRESS
Stress can be de ned in many ways—one of them is a genetically determined

pattern of response to a demanding situation of the human physiology. Such
demanding situations could be of two types:
1. Physical stresses—like accidents, burns, major surgeries, infections,

pregnancy, etc. which make demands on the entire physiology.
2. Psychological stresses—which can occur independently or as a reaction to
the physical stress. Examples are, life situations that evoke emotional
responses– like fear, anxiety, tension, worry, jealousy, hatred, anger, 68
TOC Index  excitement, con icts, etc. It may be a temporary stress, demanding only an
https://www.jaypeedigital.com/eReader/chapter/9788180616747/ch4 1/11
immediate adaptation process. Or it may be a long-standing one, leaving

deep-seated subconscious impressions leading to prolonged tension.
Care of the Despite marked advances in stress research, confusion, as to what stress
Unborn Child with is, continues in the 1990s. Thus, it may be of bene t to brie y mention the
Yoga de nitions of four key concepts related to stress—those of homeostasis,
Shamanthakamani stressor, stress, and adaptive response. Life exists by maintaining a complex
Narendran
dynamic equilibrium, or homeostasis, that is constantly challenged by intrinsic
or extrinsic adverse forces or stressors. Stress is, thus, de ned as a state of
threatened homeostasis, which is re-established by a complex repertoire of
physiologic and behavioral adaptive responses of the organism. The adaptive
responses may be inadequate for the reestablishment of homeostasis or
excessive and prolonged; in either case a healthy steady state is not attained,
 4: Stress And Its Adverse E ects On Pregnancy and pathology may ensue. With these straightforward de nitions, the frequently
 5: Fundamentals Of Yoga: Theory, Practice interchangeable use of the terms—stress, stressor, and adaptive response will
And Applications
hopefully be avoided.*
 6: Concept Of Pregnancy And Childbirth In
_____________
And Puranas
*
The 1997 Hans Selye Memorial Lecture; George P. Chrousos; Stressors,
Stress and Neuroendocrine Integration of the Adaptive Response.
 9: Discussion Of The Research Study
 APPENDIX: Integrated Advanced Yoga

Techniques For Pregnancy
Bibliography HORMONES AND REGULATION OF THE MATERNAL
HYPOTHALAMUS PITUITARY ADRENAL (HPA) AXIS
 Corticotropin-releasing hormone (CRH) is produced and secreted by the

hypothalamus. It plays a central role within the HPA axis and is involved in the
physiologic response to stress. CRH stimulates adrenocorticotropin-releasing
hormone (ACTH) production and secretion by the pituitary. In turn, ACTH
stimulates the production and secretion of cortisol by the adrenal cortex.
Regulation of these hormones is achieved by a negative feed-back mechanism.
This occurs in pregnant and non-pregnant women alike, although important
changes take place in the course of pregnancy. From about 8 to 10 weeks'
gestation, CRH is also produced by the placenta. This placental CRH has the
same biological activity as hypothalamic CRH and is secreted to both the
maternal and fetal compartments. Moreover, it is known that cortisol stimulates
synthesis and release of Placental Corticotropin-releasing hormone (pCRH),
which is opposite to the inhibitory effect of cortisol on the CRH-producing cells
of the hypothalamus. In the mother, pCRH is inactivated to a large extent by a
CRH binding protein (CRH-BP) under normal conditions, except for the last two
to four weeks of pregnancy. In this period, there is a rapid increase in free pCRH.
The mentioned alterations result in a shift from normal negative feedback
regulation of the maternal HPA axis to a positive feedback, or better feed-
forward, mechanism through the effect of peripherally produced pCRH. In the
course of pregnancy, blood concentrations of CRH, ACTH, and cortisol increase
gradually, but during the few weeks before parturition, they rise rapidly. Under
abnormal circumstances (pre-eclampsia, threatened preterm delivery, maternal
stress), these alterations may be initiated prematurely.

STRESS SYNDROME
PHENOMENOLOGY
The stress response is subserved by the stress system located in both the
central nervous system (CNS) and the periphery. This system receives and
integrates a great diversity of neurosensory (higher cortical, limbic, visual, 69
auditory, olfactory, gustatory, somatosensory, nociceptive, visceral) and blood-
borne signals (blood composition signals, hormones, cytokines, other
TOC Index 
mediators) that arrive through distinct pathways. Activation of the stress

system leads to a cluster of time-limited behavioral and physical changes that
are remarkably consistent in their qualitative presentation and collectively
Care of the called the general adaptation or stress syndrome. These changes are normally
Unborn Child with adaptive and improve the chances of the individual for survival. Components of
Yoga
the stress syndrome are stimulated in a stressor-speci c fashion; however, as
Shamanthakamani
Narendran
the potency of the stressor increases, the speci city of the response decreases
to eventually produce the relatively “nonspeci c” stress syndrome. Behavioral
adaptation includes increased arousal, alertness and vigilance, improved
cognition, and focused attention, as well as euphoria or dysphoria, depending
 1: Basic Medical Facts About Pregnancy on the stressor and the memory of the organism. It also includes enhanced
 2: Prenatal Care analgesia and elevations in core temperature, along with concurrent inhibition
 3: Perinatal Problems of vegetative functions, such as appetite, feeding and reproductive function.
 4: Stress And Its Adverse E ects On Pregnancy Concomitantly, physical adaptation changes take place to principally promote
And Applications
an adaptive redirection of energy. Thus, oxygen and nutrients are shunted to the
 6: Concept Of Pregnancy And Childbirth In CNS and the stressed body site(s), where they are needed the most.
 7: Description Of Pregnancy In Upanishads Increases in cardiovascular tone (heart rate, cardiac ejection fraction,
And Puranas arterial blood pressure), respiratory rate and intermediate metabolism
(gluconeogenesis, lipolysis) all work in concert to promote availability of vital
substrates. Detoxi cation functions to rid the organism of unnecessary
Techniques For Pregnancy metabolic products from the stress-related changes in metabolism are
Bibliography activated, while digestive function and growth, reproduction and immunity are
inhibited. The organism also activates restraining forces during stress, which
prevent an over response from both central and peripheral components stress
 system. These forces are essential for successful adaptation. If they fail to
contain the various elements of stress response, the “adaptive” changes may
turn excessive, prolonged and maladaptive and may, thus, contribute to
development of pathology.

AUTONOMIC NERVOUS SYSTEM AND PREGNANCY
The autonomic nervous system responds rapidly to stressors and controls a

wide range of functions. Cardiovascular, respiratory, gastrointestinal, renal,
endocrine and other systems are regulated by the sympathetic nervous system,
the parasympathetic system, or by both. Generally, the parasympathetic system
can both assist sympathetic functions by withdrawing and antagonize them by
increasing its activity.
Sympathetic innervation of peripheral organs is derived from the efferent

pre-ganglionic bers, whose cell bodies lie in the intermediolateral column of
the spinal cord. These nerves synapse in the bilateral chain of sympathetic
ganglia with postganglionic sympathetic neurons that widely innervate the
smooth muscle of the vasculature, heart, skeletal muscles, kidney, gut, fat and
many other organs. The preganglionic neurons are primarily cholinergic,
whereas the postganglionic neurons are mostly noradrenergic. The sympathetic
system through the adrenal medulla also has a humoral contribution because it
provides all of the circulating epinephrine and some of the norepinephrine.
In addition to the “classic” neurotransmitters acetylcholine and 70

norepinephrine, both sympathetic and parasympathetic subdivisions of the
autonomic nervous system include several subpopulations of target-selective
and neurochemically coded neurons that express a variety of neuropeptides
and, in some cases, adenosine triphosphate (ATP), nitric oxide, or lipid
mediators of in ammation. Thus, CRH, NPY and somatostatin are found in
postganglionic noradrenergic vasoconstrictive neurons. Transmission in
sympathetic ganglia is also modulated by neuropeptides released from
preganglionic bers and short interneurons, as well as by primary afferent nerve
collaterals.

TOC Index 
PRENATAL STRESS AND DEVELOPMENT OF THE CENTRAL

NERVOUS SYSTEM
Care of the
Unborn Child with Pregnancy in the third trimester is characterized by hypercortisolism of a
Yoga degree similar to that observed in severe depression, anorexia nervosa, and
Shamanthakamani
mild Cushing syndrome, the only known physiologic state in humans in which
Narendran
CRH circulates in plasma at levels high enough to cause activation of the HPA
axis. Although circulating CRH, which is of placental origin, is bound with high
a nity to CRH-binding protein, it appears that the circulating free fraction is
 1: Basic Medical Facts About Pregnancy su cient to explain the observed escalating hypercortisolism when the
 2: Prenatal Care concentration of CRH binding protein starts to gradually decrease in plasma
 3: Perinatal Problems after the 35th week of pregnancy. The recent development of nonpeptidic CRH
 4: Stress And Its Adverse E ects On Pregnancy receptor antagonists, that cross the blood-brain barrier and have very promising
 5: Fundamentals Of Yoga: Theory, Practice actions in preclinical studies in rats and monkeys, offer us a new major
And Applications
opportunity to intervene in states in which excessive CRH secretion appears to
Yoga And Spiritual Lore play a key pathophysiologic role. Melancholic depression, anorexia nervosa,
 7: Description Of Pregnancy In Upanishads obsessive compulsive disorder and withdrawal from certain narcotic agents are
And Puranas
only a few of the target diseases that will be evaluated in the near future.

Techniques For Pregnancy STRESS AND PREGNANCY
Bibliography
In daily life, humans and animals are often confronted with situations that
demand adaptation. There is stress if adaptation is with great di culty or
 impossible. The physiologic and behavioral responses to stressors are
generally well known, though mainly for male adults. Stressors may vary from
life events (e.g. divorce, serious illness or death of a relative or friend) to daily
hassles (e.g. domestic affairs, nancial or relational problems and queuing).
During exposure to a stressor, the whole system of stress regulation, that is the
hypothalamus pituitary adrenal cortex system (HPA axis) and the sympathetic
nervous system-adrenal medulla system, is activated. Various hormones,
including corticotropin-releasing hormone (CRH), adrenocorticotropin-releasing
hormone (ACTH), cortisol and (nor)adrenaline, are released in large quantities
to the blood. However, individuals may respond differently to an identical
stressful stimulus. The degree of stress response depends also on genetic
factors, personality characteristics, previous experience, support from the
social environment and the way of coping with stress. This applies to pregnant
women as well. However, they are also confronted with other possible stress
factors, such as physical alterations, hormonal changes (often associated with
rapid changes in mood), and pregnancy-speci c anxiety, e.g. fear of child
integrity and fear of pain during delivery. Moreover, young age, poor education,
low socioeconomic status, sexual abuse, unwanted pregnancy, having no
partner, poor preparation for pregnancy or delivery, and depressive symptoms
and a psychiatric history are known to negatively in uence psychic well-being of 71
the pregnant woman, while other factors, e.g. adequate social support, older
age and having a paid job, contribute positively to this. The interaction between
all these factors renders stress research in pregnant women to be complicated
and requires a multidimensional concept of stress involving psychologic, social
and physiologic components. However, researchers of prenatal stress have
generally con ned themselves to only one aspect of stress or anxiety, such as
the effects of life events, work load, or general stress that were evaluated by
using self-administered inventories. Physiologic and hormonal responses to
stress in pregnancy or the effects of pregnancy-speci c anxieties have only
sporadically been investigated to date.
It is presently unclear if prenatal programming of brain functions also

occurs in the human. We do know that exposure to an increased maternal
stress level in uences fetal brain growth (reduced head circumference) and that
prenatally stressed infants have lower scores at neonatal neurologic
TOC Index  examination.
During ultrasound observation, fetuses of high anxious women have been

found to be more active than those of low anxious women. This is in line with
the observation of dramatically increased fetal movements during acute
Care of the maternal panic caused by an earthquake. This nding illustrates that a maternal
Unborn Child with stress signal reaches the fetus and that he or she responds to it.
Yoga
Shamanthakamani Some studies performed within two to three days after birth have
Narendran
demonstrated that newborn infants cry more and are di cult to smooth if their
mothers were more anxious, had more depressive symptoms, or were classi ed
as a type-A mother ( urried, impatient and competitive). These studies suggest
that the differences in neonatal behavior emerged before birth (either due to
prenatal stress or genetically determined), as they were unlikely caused by
environmental in uences in the short period thereafter. However, the mode of
 4: Stress And Its Adverse E ects On Pregnancy delivery may have played a role. Recently, it was found that infants born after
 5: Fundamentals Of Yoga: Theory, Practice assisted delivery (forceps or ventouse) showed a greater stress response to
And Applications
inoculation at eighth week (they cried more and for longer periods, and had
Yoga And Spiritual Lore higher cortisol secretion) than infants born vaginally or by cesarean section.
And Puranas In psychiatric literature, exposure to prenatal maternal stress is often
 8: Yoga Practices During Pregnancy regarded an important factor underlying several forms of psychopathology,
 9: Discussion Of The Research Study including attention de cit hyperactivity disorder (ADHD), schizophrenia, and
 APPENDIX: Integrated Advanced Yoga depression. Increased concentrations of cortisol (blood) and CRH
(cerebrospinal uid), and a hyper responsive HPA axis which is di cult to
Bibliography
in uence with the dexamethasone-suppression test, are characteristic for adult
depressive patients. Attention de cits, as seen with ADHD, are also known to
occur in prenatally stressed animals. So, also in the human, early

neuroendocrine disturbances may predispose for psychic and/or other
disorders in later life but only prospective longitudinal studies with multiple
measurements of prenatal stress and thorough follow-up of the children may
answer this question. At present, only two such studies have made a start and
are still in progress.

STRESS SYSTEM INTERACTIONS WITH OTHER CNS COMPONENTS
In addition to setting the level of arousal and in uencing the vital signs, the
stress system also interacts with other major CNS elements, including the
mesocorticolimbic dopaminergic system, the amygdala, the hippocampus, and 72
the arcuate nucleus pro-opiomelanocortin (POMC) neuronal system. All are
activated during stress and, in turn, in uence the activity of stress system. In
addition, the stress system interacts with the thermoregulatory and appetite-
satiety centers of the CNS.
The relationship between the Hypothalamus Pituitary Adrenal (HPA) axis

and the reproductive system in the pregnant woman is complex and intriguing.
The hormones of the HPA axis primarily have strong inhibiting effects on the
hypothalamo-pituitary gonadal axis (HPG) (Mulder EJ, 2002). There is also
evidence suggesting that the endometrium, myometrium and ovaries are
abundant in receptors for corticotropin releasing hormone and cortisol
receptors. Given this functional relationship, it is not hard to hypothesize that
psychological (and physical) stress may lead to poor reproductive outcomes.

PERINATAL PROBLEMS DUE TO STRESS
The HPA axis and the reproductive system show a complex relationship in both
pregnant and non-pregnant women. The hormones of the HPA axis have strong,
mainly inhibiting, effects on the HPG axis. Moreover, CRH and cortisol receptors
are abundant in the endometrium, myometrium and the ovaries. It is therefore,
not surprising that psychologic (and physical) stress may disturb the sexual and
reproductive capacities. Anovulation, oligomenorrhea and reduced libido are
TOC Index  often seen under these circumstances.
In vitro fertilization (IVF) patients with functional disorders of the HPG axis
often have higher stress-scores than women who are infertile on the basis of
anatomic problems (tubal obstruction, malformations of the cervix or uterus).
Care of the Some IVF studies, but not all, have also demonstrated that the chance to
Unborn Child with conceive and to bring the pregnancy to a good end is smaller if the patient
Yoga
reports more stress or anxiety at the onset of therapy.
Shamanthakamani
Narendran
Animal experiments have shown that exposure of the pregnant dam to
stressful conditions (capture, noise, immobilisation, introduction of a strange
male, rowding, etc.) often results in a smaller litter size (embryo resorption),
structural malformations, growth retardation, lower birth weight of the puppies
and even a shift in the sex ratio. Recent well-controlled studies in humans also
suggest a direct relationship between prenatal maternal stress and a number of
 4: Stress And Its Adverse E ects On Pregnancy pregnancy complications.
And Applications
 7: Description Of Pregnancy In Upanishads SPONTANEOUS ABORTION
And Puranas
An increased risk of spontaneous abortion has been found for a recent life
 APPENDIX: Integrated Advanced Yoga event (death of a relative or being victim of criminality), and for stress in the
Techniques For Pregnancy work place.
Bibliography
STRUCTURAL MALFORMATIONS

A strong relationship has been found between the (unexpected) death of an
older child during early pregnancy and the occurrence of craniofacial
malformations and heart defects. A number of studies have shown that
structural malformations can also emerge in the context of increased
psychosocial problems, especially for quarrels with the partner or members of
the family.

PRETERM DELIVERY
The relationship between stressful experiences during pregnancy and an

increased risk of preterm delivery has been a consistent nding of independent
studies for several decades. It has been suggested that preterm uterine activity
and shortened length of pregnancy result from stress during the third trimester. 73
Remarkably, serum concentrations of placental CRH are already raised at 15th
to 20th week of pregnancy in women who deliver preterm babies.

BIRTH WEIGHT
Recent well-controlled research has documented that high levels of anxiety and
depression result in reduced birth weight and smaller head size (a measure of
brain development). This effect of prenatal stress is of the same magnitude as
the effect of smoking. The chance of delivering a low birth weight baby is higher
if exposure to stress, daily hassles in particular, occurs during the rst three
months of pregnancy. This may explain why others found a normal birth weight
in infants of women whose husband died after the fourth month of pregnancy.
Recently, some more studies suggest a direct relationship between prenatal

maternal stress and pregnancy complications. Spontaneous abortions
increased in women with a recent stressful life event (Neugebauer R. 1996) and
increased stress at work (Fenster L. 1995). Structural malformations are
associated with death of an older child during pregnancy (Hansen D. 2000) and
with marital disharmony (Nimby GT. 1999). Risk of preeclampsia is increased
with rst trimester depression and anxiety (Kurki T. 2000) and with increased
TOC Index 
serum concentrations of placental corticotropin releasing hormone (pCRH is a

stress hormone) between 18th to 20th week of gestation (Hobel CJ. 1999;
Perkins AV. 1995). Preterm labor and preterm delivery associated with mid-
Care of the trimester stress and elevated pCRH between 15th to 20th week of gestation
Unborn Child with (Hobel CJ. 1999; Leung TN. 1999). Anxiety and depression is also documented
Yoga
to decrease birth-weight and head circumference (Lou HC. 1994). Maternal
Shamanthakamani
Narendran
administration of natural or synthetic corticosteroids can also induce changes
associated with maternal stress, such as growth retardation (Benesova O.
1989), structural malformations (Uno H. 1994), and impaired growth of lungs
and the brain (Gramsbergen A. 1998; Uno H. 1994).
Hormonal changes may be partly responsible for the mood swings
experienced during pregnancy. These mood swings are common and normal,
 4: Stress And Its Adverse E ects On Pregnancy so a pregnant woman should not be overly concerned about them. However,
 5: Fundamentals Of Yoga: Theory, Practice she should keep in mind that they may sometimes make it more di cult for her
And Applications
to cope with stress.
In addition, many pregnant women and their partners worry about the
And Puranas health of their baby, their ability to cope with labor and delivery, and their
 8: Yoga Practices During Pregnancy abilities to become good parents. Added nancial responsibilities are another
 9: Discussion Of The Research Study common source of stress, especially if the parents anticipate a brief or long-
 APPENDIX: Integrated Advanced Yoga term reduction in income after the baby is born. All of these worries can be
magni ed if there is a high-risk pregnancy, where the pregnant woman must
Bibliography
leave her job early and possibly signi cantly reduce her activity or stay in bed
for an extended period of time.


STRESS-RELATED DISORDERS
These include most instances of high blood pressure, migraine and tension
headaches, and peptic ulcer as well as many other problems. It is commonly
estimated that 50 to 80 percent of physician visits are motivated by symptoms
of stress-related illnesses. These problems can usually be prevented or treated
effectively by learning to regulate the autonomic nervous system, the
musculature and the central nervous system. 74

ADDICTIVE DISORDERS
Alcohol addiction, anorexia, bulemia, drug addiction, multiple substance abuse,

overeating/obesity, smoking.

ANXIETY DISORDERS
Agoraphobia, generalized anxiety disorder, obsessive/compulsive disorder,

panic attacks, performance anxiety, phobias (simple), post-traumatic stress
disorder, social phobias, and test anxiety.

AUTOIMMUNE DISORDERS
Allergies, arthritis, bromyalgia, bromytosis, lupus, multiple sclerosis,

rheumatoid arthritis, Sjögren's syndrome, vitiligo.

CANCER
Bone cancer, brain cancer, breast cancer, cervical cancer, colon cancer,
Hodgkin's disease, leukemia, liver cancer, lung cancer, lymphoma, multiple
TOC Index  myeloma, ovarian cancer, pancreatic cancer, prostate cancer, skin cancer.
CARDIOVASCULAR DISORDERS
Care of the
Unborn Child with Arrhythmia, arteriosclerosis, Buerger's disease, essential hypertension,
Yoga brillation, mitral valve prolapse, palpitations, peripheral vascular disease,
Shamanthakamani Raynaud's disease, stroke, tachycardia, Wolff-Parkinson-White syndrome.
Narendran
Recent studies suggest 70 to 80 percent of all illnesses seen in medical
practice are either caused by or made worse by stress. Yet few doctors have
been trained in either recognizing or treating stress. The end result is that tens
 1: Basic Medical Facts About Pregnancy of millions of people develop illnesses.
TRANSMISSION OF MATERNAL STRESS TO THE UNBORN BABY
And Applications
 6: Concept Of Pregnancy And Childbirth In The question of how signals of maternal stress may reach the fetus, has not
Yoga And Spiritual Lore been dealt with so far. It seems most logic that this occurs through (stress)
 7: Description Of Pregnancy In Upanishads hormones. Three mechanisms may be distinguished, which may operate
And Puranas
simultaneously and may amplify each other's effects. The possible
 9: Discussion Of The Research Study mechanisms involve:
1. Reduction in blood ow to the uterus and fetus at increased levels of
Bibliography maternal stress;
2. Transplacental transport of maternal hormones;
3. Stress-induced release of placental CRH to the intrauterine environment.

REDUCED UTEROPLACENTAL BLOOD FLOW
Corticosteroids and catecholamines are known to exert strong effects on the

tone of peripheral blood vessels. Besides, the placenta is abundant of receptors
for these hormones. Activation of the sympathetic nervous system by stress
may lead to reduced blood ow to the uterus and fetus, and may contribute to
fetal growth restriction. Indeed, Doppler blood ow studies have shown
increased resistance of the uterine artery in women with high anxiety scores at
about 32nd week of gestation.

TRANSPLACENTAL TRANSPORT OF MATERNAL STRESS

HORMONES
Corticosteroids pass the placenta readily in many animal species. In contrast,

the human fetus is relatively (so not completely) protected against direct
exposure to high cortisol concentrations. In the placenta, 50 to 90 percent of
maternal cortisol is converted to cortisone by the enzyme 11h-hydroxysteroid-
dehydrogenase (11h-HSD-2). Cortisone is biologically inactive. The activity of
11h-HSD-2 increases near the end of pregnancy just at the time that 75
hypercortisolemia develops in the mother, and thus seems to be of adaptive
signi cance.
On the other hand, maternal cortisol levels have been found to be linearly
related with the (much lower) fetal cortisol levels at antenatal umbilical cord
blood sampling (cordocentesis), a very stressful event to the mother. This
means that a small increase in maternal cortisol may cause a substantial
increase in fetal cortisol. It is, therefore, conceivable that cortisol reaches the
human fetus under certain circumstances. This may happen normally, since
maternal cortisol is not completely inactivated in the placenta, or under speci c
conditions. For example, if the maternal cortisol concentration is very high, if
the activity of 11h-HSD-2 is reduced (interindividual differences;
polymorphisms?) or impaired, when the placenta is immature (early pregnancy),
TOC Index  or when placental function is poor as with some pregnancy complications.
SECRETION OF PLACENTAL CRH TO THE FETUS

Care of the
Unborn Child with Fetal cortisol is important for the maturation of virtually all fetal organ systems.
Yoga The fetal HPA axis is regulated through negative feedback from early in
Shamanthakamani gestation onward. In a later stage of pregnancy, placental CRH enters the fetal
Narendran
circulation via the umbilical vein. Since CRH-BP is absent in the fetus, pCRH
stimulates the fetal HPA axis to produce and secrete ACTH, cortisol and
androgens (dehydro-epiandrosterone-sulfate; DHEA-S). Subsequently, fetal
cortisol enters the placental circulation via the umbilical arteries and further
stimulates the production of pCRH. This way, the fetal HPA axis is also
 3: Perinatal Problems regulated by a feed-forward mechanism at the end of pregnancy. On the one
 4: Stress And Its Adverse E ects On Pregnancy hand, this results in a large increase in cortisol by which maturation of the fetal
 5: Fundamentals Of Yoga: Theory, Practice organs is enhanced. On the other hand, pCRH initiates, through an increase in
And Applications
DHEA-S (the precursor of estrogens), a cascade of events which may lead to
Yoga And Spiritual Lore increased uterine activity and eventually delivery.
And Puranas At the end of normal pregnancy, the simultaneous stimulation of organ
 8: Yoga Practices During Pregnancy maturation and initiation of parturition constitute a positive effect of a feed-
 9: Discussion Of The Research Study forward mechanism. However, premature activation of either or both in the
 APPENDIX: Integrated Advanced Yoga placenta coupled feed-forward systems, may result in preterm labor and
Bibliography
delivery. This is evidenced by the earlier mentioned association between
prematurely raised blood pCRH (and decreased CRH-BP) levels in pregnant
women who were confronted with preterm delivery and pre-eclampsia only in a
 later stage of pregnancy. Diminished supply of nutrients and oxygen
(hypoxemia) may cause a stress response in the fetus. This involves increased
secretion of pCRH that, in turn, contributes to the feed-forward mechanisms at
either side of the placenta.
Maternal stress may affect the development of the fetal brain and also the
activity of the HPA axis. Maternal cortisol, that has escaped from inactivation by
11h-HSD in the placenta, may participate in the feed-forward loop between the
placenta and the fetal pituitary–adrenal axis. Overproduction and
hypersecretion of fetal cortisol thus, may arise from maternal cortisol in the
fetal compartment and/or from pCRH secretion. Increased fetal cortisol (of
maternal or fetal origin) may inhibit growth and differentiation of the developing
nervous system, may damage the brain, and may have a programming or
organizing effect on the fetal neuroendocrine system resulting in the permanent
disorders.
Known biomedical risk factors, such as maternal diseases, teratogenic

agents, complications of pregnancy, and nutritional de ciencies and infections,
explain about half of the number of cases of low birth weight and prematurity 76
and their associated problems after birth. Prenatal maternal stress and anxiety
may be responsible for an important proportion of other (unexplained) cases.
This appears from recent well-performed studies that took into account medical
and obstetric histories, lifestyle (smoking and drinking behaviour),
socioeconomic status, and the course of pregnancy and delivery. These studies
have demonstrated that exposure to prenatal stress not only affects physical
development of the infants (birth weight, head size, and structural
malformations), but also their functional development, evidenced by poor
psychomotor performance and more di cult behavior during the rst 10 years
of life. Whether these problems will be long-lasting and permanent and will
eventually lead to psychopathology, has to be revealed by continuation of the
existing follow-up studies and by other independent studies.
In the past, several attempts have been made to reduce the amount of
stress in pregnant women to diminish its negative effects on the outcome of
pregnancy. By repeated telephone calls or home visits by a social worker,
extensive information was given about a healthy lifestyle during pregnancy. One
TOC Index  has also attempted to provide direct psychologic support and to optimize
support from the social environment. The results of such intervention programs
have appeared to be disappointing. However, the possibility exists that the
offered help in these studies has not been intensive or speci c enough.
Care of the
Unborn Child with Huizink has demonstrated that maternal stress in the rst half of pregnancy
Yoga is an important predictor of problematic infant behavior. This was found
Shamanthakamani especially for pregnancy-speci c anxieties, such as fear of the baby's health
Narendran
and fear of (pain during) delivery. This nding may be the clue to come to early
detection of high stressed or anxious pregnant women. By lling out a short
inventory in early pregnancy, information can easily be obtained about the
intensity of pregnancy-speci c anxieties. Pregnant women at increased risk
may then be invited to participate in a program aiming at stress reduction by
providing speci c information, education, or relaxation methods.
Many animal experiments and a number of retrospective and prospective
And Applications human studies (the latter with a limited follow-up period) indicate that it is very
 6: Concept Of Pregnancy And Childbirth In important to further investigate possible ways of preventing and reducing
prenatal maternal stress. This, the more so given the still increasing experience
And Puranas of stress by (pregnant) women in modern society. In addition, more information
 8: Yoga Practices During Pregnancy has to be acquired about stress regulation in pregnant women and about
 9: Discussion Of The Research Study mechanisms by which maternal stress in uences the course of pregnancy and
 APPENDIX: Integrated Advanced Yoga development of the unborn baby. Changes in the levels of speci c maternal
hormones (ACTH, pCRH, CRH-BP, prolactin, or oxytocin) may be early indicators
Bibliography
of a raised stress level in the intrauterine environment.

 POSITIVE THINKING AND OPTIMISM IN PREGNANCY
A key ingredient to a happy, healthy pregnancy is keeping the stress level under
control. One can begin by identifying the personal and work-related sources of
stress in one's life. For example, the physical symptoms of excess stress are
nervousness, upset stomach, headaches, fatigue or sleep disturbances. If one
feel that she is experiencing symptoms of excess or unrelieved stress, there are
several things she can do to reduce the amount of stress in her life, or improve
her ability to manage it. 77
In two studies of the relationships between optimism, perceived control,

coping and psychological distress, Yali, Lobel and their colleagues at the State
University of New York at Stony Brook found that optimism was associated with
less distress.

MEDICAL MANAGEMENT OF STRESS
There are many stress management programs that can teach you about the
nature and sources of stress, the effects of stress on health, and personal skills
to reduce the effects of stress. Examples of stress reducing skills include time
management and physical exercise.
For more serious stress related disorders, like post-traumatic stress

disorder [PTSD], research has demonstrated the effectiveness of cognitive-
behavioral therapy, group therapy, and exposure therapy, in which the patient
repeatedly relives the frightening experience under controlled conditions to help
her work through the trauma. Studies have also shown that medications help
ease associated symptoms of depression and anxiety and help promote sleep.
Identify and take control of your stressors. If you feel overwhelmed with
responsibility, look for ways to eliminate some commitments. It may mean
reducing your work hours or getting help for housework.
Seek help from your support network (partner, family, friends and others).
Avoid excessive intake of caffeine and other stimulants.
TOC Index  Exercise regularly to release physical and emotional tension.

Learn to reduce stress by using relaxation techniques and meditation.
Care of the STRESS SCALE

Unborn Child with
Yoga
Many Stress Scales have been formulated which are used in monitor stress
Shamanthakamani
Narendran levels.
The psychosocial stress scales were administered at enrollment for each

woman participating in the project. Psychosocial stress was measured using
the Perceived Stress Scale (PSS), the Prenatal Social Environment Inventory
(PSEI), and the Index of Spousal Abuse (ISA). Each scale measured a distinct
 3: Perinatal Problems construct of psychosocial stress incorporating both an assessment of external
 4: Stress And Its Adverse E ects On Pregnancy stress and subjective, perceived stress.
And Applications
And Puranas
Bibliography
TOC Index 

Stress and Its Adverse E Ects On Pregnancy: Care of The Unborn Child With Yoga

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Stress and Its Adverse E Ects On Pregnancy: Care of The Unborn Child With Yoga

Uploaded by

Copyright:

Available Formats

4/11/2020 JaypeeDigital | eBook Reader

Stress And Its Adverse

However, there are many short-term and long-term harmful effects of

Pregnancy-related discomforts, such as nausea, fatigue, frequent urination,

Stress can be de ned in many ways—one of them is a genetically determined

1. Physical stresses—like accidents, burns, major surgeries, infections,

immediate adaptation process. Or it may be a long-standing one, leaving

 Corticotropin-releasing hormone (CRH) is produced and secreted by the

mediators) that arrive through distinct pathways. Activation of the stress

AUTONOMIC NERVOUS SYSTEM AND PREGNANCY

The autonomic nervous system responds rapidly to stressors and controls a

Sympathetic innervation of peripheral organs is derived from the efferent

In addition to the “classic” neurotransmitters acetylcholine and 70

PRENATAL STRESS AND DEVELOPMENT OF THE CENTRAL

It is presently unclear if prenatal programming of brain functions also

During ultrasound observation, fetuses of high anxious women have been

STRESS SYSTEM INTERACTIONS WITH OTHER CNS COMPONENTS

The relationship between the Hypothalamus Pituitary Adrenal (HPA) axis

PERINATAL PROBLEMS DUE TO STRESS

The relationship between stressful experiences during pregnancy and an

Recently, some more studies suggest a direct relationship between prenatal

serum concentrations of placental corticotropin releasing hormone (pCRH is a

Alcohol addiction, anorexia, bulemia, drug addiction, multiple substance abuse,

Agoraphobia, generalized anxiety disorder, obsessive/compulsive disorder,

Allergies, arthritis, bromyalgia, bromytosis, lupus, multiple sclerosis,

REDUCED UTEROPLACENTAL BLOOD FLOW

Corticosteroids and catecholamines are known to exert strong effects on the

TRANSPLACENTAL TRANSPORT OF MATERNAL STRESS

Corticosteroids pass the placenta readily in many animal species. In contrast,

SECRETION OF PLACENTAL CRH TO THE FETUS

Known biomedical risk factors, such as maternal diseases, teratogenic

 POSITIVE THINKING AND OPTIMISM IN PREGNANCY

In two studies of the relationships between optimism, perceived control,

MEDICAL MANAGEMENT OF STRESS

For more serious stress related disorders, like post-traumatic stress

TOC Index  Exercise regularly to release physical and emotional tension.

Learn to reduce stress by using relaxation techniques and meditation.

Care of the STRESS SCALE

The psychosocial stress scales were administered at enrollment for each

You might also like