Stress is a response to environmental pressures. It is a force which can be from the outside or the inside world. Management of the adverse effects of stress is important in pregnant women, because it also affects the foetus.
Factors in maternal stress:
- Poor interpersonal relationship
- Traumatic life events
- Family responsibilities
- Fright, sudden shock
- Pregnancy stress includes the anxiety or fear about the pregnancy or delivery and such mothers may go for premature deliveries.
- Physical factors
- Nutritional status of mother
- Endocrine disorders
- Diseases during pregnancy such as Pre eclampsia, Gestational diabetes mellitus, Antepartum haemorrhage, Uterine infections or Inflammations.
Endocrine Mechanism of Pregnancy Affecting the Foetus
Maternal cortisol will get converted to cortisone which is an inactive form in the presence of 11βHSD2 in order to control the cortisol level in the foetus. 11 βHSD2 can act only as a partial placental barrier, so when the mother is under stress a high amount of cortisol will be produced and some will cross the placental barrier.
Another possible way is:
Mother under stress
Increased secretion of corticotrophin releasing hormone from the placenta
This regulates the duration of pregnancy and foetal maturation.
Premature delivery, small size of gestational age.
This may be a cause for neurodevelopmental problems, ADHD, schizophrenia. The mother’s stress may cause secretion of epinephrine and nor epinephrine which in turn causes constriction of the blood vessels which in turn causes oxidative stress which may lead to developmental defects.
ROLE AND EFFECT OF CORTISOL IN FOETAL DEVELOPMENT
Cortisol has an important role in the development of the brain and other organs. Increased cortisol levels can lead to impaired foetal brain growth. Studies done in humans and animals have shown that elevated levels of glucocorticoids cause affective disorders, internalising behaviour and social anxiety, as it causes alteration in the development of the hippocampus and amygdala. The Hippocampus plays a role in memory and learning. Impaired cortisol levels may cause learning disabilities. It may also causes low IQ levels in childhood.
CRH has an immune modulatory role during reproduction. It can disrupt the BBB which causes activation of mast cells and release of pro inflammatory cytokines and the child may present with behavioural manifestations of autism.
Since cortisol plays a role in the development of other organs, there can also be developmental defects of other organs.
Maternal stress has to be managed well to prevent the increased secretion of these stress hormones. This gives protection to the foetus from the adverse effects of these hormones. Ask the mother to take rest and relax, talk with her unborn baby. It will help her to increase the bond with baby. She should go to sleep early if exhausted.
- Ask her to share the worries about pregnancy and baby with midwife, partner etc.
- Diet should include omega 3 fatty acids (oily fish and sea food) which may reduce depression. Also include items containing tryptophan (nuts and seeds, fresh turkey and chicken, fish, eggs, yoghurt and cheese).
- Drink 6-8 glasses of water in a day as dehydration may alter your mood or cause headache.
- Do gentle exercises. Take a daily walk for at least 20 minutes.
- Educate the mother about what happens during labour and have her attend antenatal classes.
- Meditation and yoga are ways to reduce the cortisol level.
- Ask her to meet her friends and talk freely.
When we deal with a child it is essential to ask about the prenatal history of the mother. This includes the mother’s mental state during pregnancy, any events which could cause mental trauma for the mother, her health during pregnancy especially related to infections, vaginal bleeding, toxaemia which may adversely affect the foetus. It is also important to ask about the birth history as studies have confirmed that some of the behaviours of the child are related to premature delivery, type of delivery such as spontaneous, forceps assisted or caesarean section.
It is also important to enquire about the father: his impact on the family, his behaviour, addictions etc. While treating the child, we have to find out the cause effect relationship in each case. There are various neuro-endocrine mechanisms which cause adverse effects on the foetus when the mother is under stress.
Synthesis Repertory by Friedrick Shroyens
FEMALE GENITALIA/SEX – DELIVERY – during; complaints – grief; from: Causticum
FEMALE GENITALIA/SEX – DELIVERY – during; complaints – premature – fear or fright, from: Opium
MIND – FEAR – pregnancy, during: Aconite, Ant-t,. bar-c., Causticum, Cimic., con., ign., kali-br., lyc., lyss., Nux-m., psor., stann.
MIND – FEAR – baby will die in utero: kali-fcy., phos, vib.
MIND – FEAR – pregnancy, during – abortion in latter part; of: op.
MIND – ANXIETY – pregnancy, in: acon., Ant-t., bar-c., con., ign., kali-br., psor., stann.
MIND – ANXIETY – delivery, during: cupr.
Homoeopathic Medical Repertory by Robin Murphy
Pregnancy – MENTAL problems, during – abandoned, feels: puls.
Mind – ANXIETY, general – pregnancy, in: acon., Ant-t., bar-c., ign., psor., stann.
Mind – FEAR, general, phobias – pregnancy, during: Aconite, Arsenicum, Caulophyllum, Cimic., con., lyc., lyss., Nux-m., stann.
Mind – FRIGHT, ailments from – anxiety, after fright – seventh month of pregnancy, during: Ignatia
Fear of death during pregnancy.
Predicts the day she will die, restless, anxious, does everything in haste, anguish. Impending abortion from fright with vexation; circulation excited, rapid breathing. Fear will often cause abortion. During pregnancy: restlessness, jaundice; blood spitting; disturbed between 12 & 3 a.m, compelled to get up to urinate; has no affection for anybody. Pains of labour: distressing; vagina hot, dry, tender & undilatable, violent pains following in rapid succession, particularly with a large child (head seems immovable), contractions insufficient, pains overwhelming; shrieking; red, sweating face; thirsty; head & hands glowing, pulse hard, skin scarcely moist, increased action of heart;
Ineffectual from defective position of child. New born children, with difficulty breathing, after the use of forceps or from a tedious labour. The child is breathless, there is difficulty with the heart and in a few hours fever comes on.
Adapted to hysterical women. After fright; threatened abortion at third month, nervous, anxious. Complaints in pregnancy: nausea: false labour like pains; sharp pains across abdomen; sleeplessness. Given during last month, it shortens the labour. Her troubles alternate with each other. Nausea: during pregnancy.
Shivering in the first stage of labour. Rigidity of os uteri in labour (should be taken some weeks before labour). Labour pains: severe, tedious or spasmodic, with fainting fits or cramps; too strong, spasmodic; feels < from least noise; ceased for thirty six hours. During confinement if she is subjected to any emotion the pain will stop.
Cough during pregnancy. Spasmodic labour pains. Symptoms during labour attributable to debility from night watching, grief or other depressing influences.
Children are slow in learning to walk; unsteady tottering gait, during meningeal tuberculosis. Child during first sleep wets the bed. Child lies on her stomach, with one knee inserted in hollow of the other, feet drawn upon buttocks, making spasmodic jerks, muscles of face contorted.
For women of nervous hysterical temperament. Threatened abortion from sudden depressing emotions, fright. During pregnancy dimness of sight; double vision, headache, drowsiness, vertigo, pulsating carotids, small, low pulse; cannot walk, for muscle will not obey the will; cramps in abdomen & legs; convulsions, with complete unconsciousness. With every pain child seems to ascend instead of descend. Insufficient labour pains from uterine inertia.
Albumen in urine during pregnancy. Convulsions during confinement; pulse large soft; face puffed & expression heavy. Convulsions during labour.
Child starts and grasps the nurse, and screams as if afraid of falling. Infantile paralysis, complete relaxation of the entire muscular system
Especially suited to women of a sensitive easily excited nature, dark hair and skin. Nervous temperament. Mild disposition, quick to perceive, rapid in execution. Mentally and physically exhausted by long concentrated grief.
Bad effects of grief, anger disappointed love. Emptiness, qualmishness & weakness in region of stomach, with flat taste; distention of abdomen after eating; hiccough; sour eructations; frequent regurgitation of food, & of bitter liquid; vomiting of food taken in evening; empty retching, > eating. During morning sickness. After great fright, during seventh month of pregnancy, severe pain in epigastrium, undefined anxiety, restlessness, falls asleep late at night; also pain low down in left side of abdomen
Marked disposition to weep, sad weeping mood, without cause. Bad effects of grief, fright, vexation, mortification or reserved displeasure. Morning sickness of pregnancy. During pregnancy: dysuria, albuminuria, faint gone feeling at pit of stomach; hunger without appetite; fond of salt & salted food; congestion to chest, palpitation; haemorrhoids; cough with escape of urine. Ineffectual labour pains. Labour slow, pains feeble, apparently from sad feelings & forebodings.
Child: refuses breast, has flabby scrotum, chills; constant fever, nursing sore mouth.
Ailments with insensibility & partial or complete paralysis. Especially adapted to children and old people; diseases of first and second childhood. Spasms of children, from approach of strangers, from nursing after fright of mother.
During pregnancy: Insomnia; retention of stool; continued hiccough; frequent nausea & vomiting after eating. Violent or painful movements of foetus.
Abortion threatening after great fright especially if in later parts of pregnancy.
Labour pains: spasmodic, extremely painful, but ineffectual; great pain in small of back; false or suppressed; from fear or fright; twitching & jerking of muscles; sopor, red face, injected eyes, retention of stool & urine. During & after labour, spasm, with loss of consciousness, & drowsiness, open mouth; coma between paroxysms. New born children, pale, breathless, cord pulsates; after Aconite, if pulse remain perceptible, face purple. Suckling of a few weeks, had not grown, but was like an old man; limbs lax, skin wrinkled; bones of skull had lapped over during birth, the parietals over each other & over the occiput.
Adapted to tall, slender persons of sanguine temperament. Fair skin, delicate eyelashes, fine, blond red hair, quick perceptions, and very sensitive in nature.
During pregnancy, unable to drink water; sight of it causes vomiting, must close her eyes while bathing. Nymphomania with spasm during seventh month of pregnancy; weak empty feeling in abdomen, cutting pains; narrow, dry, long & difficult stool, like a dog stool. Vomiting of pregnancy: nausea to faintness, aggravation fasting, drinking at night, assuming an erect posture, cold extremities, flow of water from mouth, vertigo, vomiting of sour & bilious matter. During pregnancy: pale, bluish, puffed face, blue lips & nails, undulation of jugular vein; cramps. Labour pains: distressing but of little use; cutting pains, through abdomen.
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Fantastic, a very good discussion.