Effects of psychological stress on adverse pregnancy outcomes and nonpharmacologic approaches for reduction: an expert review.

Both acute and chronic stress can cause allostatic overload, or long-term imbalance in mediators of homeostasis, that results in disruptions in the maternal-placental-fetal endocrine and immune system responses. During pregnancy, disruptions in homeostasis may increase the likelihood of preterm birth and preeclampsia. Expectant mothers traditionally have high rates of anxiety and depressive disorders, and many are susceptible to a variety of stressors during pregnancy. These common life stressors include financial concerns and relationship challenges and may be exacerbated by the biological, social, and psychological changes occurring during pregnancy. In addition, external stressors such as major weather events (eg, hurricanes, tornados, floods) and other global phenomena (eg, the coronavirus disease 2019 pandemic) may contribute to stress during pregnancy. This review investigates recent literature published about the use of nonpharmacologic modalities for stress relief in pregnancy and examines the interplay between psychiatric diagnoses and stressors, with the purpose of evaluating the feasibility of implementing nonpharmacologic interventions as sole therapies or in conjunction with psychotherapy or psychiatric medication therapy. Further, the effectiveness of each nonpharmacologic therapy in reducing symptoms of maternal stress is reviewed. Mindfulness meditation and biofeedback have shown effectiveness in improving one’s mental health, such as depressive symptoms and anxiety. Exercise, including yoga, may improve both depressive symptoms and birth outcomes. Expressive writing has successfully been applied postpartum and in response to pregnancy challenges. Although some of these nonpharmacologic interventions can be convenient and low cost, there is a trend toward inconsistent implementation of these modalities. Future investigations should focus on methods to increase ease of uptake, ensure each option is available at home, and provide a standardized way to evaluate whether combinations of different interventions may provide added benefit.

急性和慢性应激均可导致非稳态负荷，即体内平衡调节因子的长期失衡，从而导致母体 - 胎盘 - 胎儿内分泌和免疫系统反应紊乱。在怀孕期间，体内平衡的紊乱可能会增加早产和子痫前期的可能性。传统上，准妈妈们焦虑和抑郁障碍的发生率较高，而且许多人在怀孕期间容易受到各种应激源的影响。这些常见的生活应激源包括经济方面的担忧和人际关系方面的挑战，并且可能会因怀孕期间发生的生理、社会和心理变化而加剧。此外，外部应激源，如重大天气事件（例如飓风、龙卷风、洪水）和其他全球性现象（例如2019冠状病毒病大流行）可能会导致怀孕期间的应激。 本综述研究了近期发表的关于在孕期使用非药物方法缓解应激的文献，并探讨了精神疾病诊断与应激源之间的相互作用，目的是评估将非药物干预作为单一疗法或与心理治疗或精神药物治疗相结合实施的可行性。此外，还综述了每种非药物疗法在减轻母体应激症状方面的有效性。正念冥想和生物反馈在改善心理健康方面，如抑郁症状和焦虑方面已显示出有效性。运动，包括瑜伽，可能会改善抑郁症状和分娩结果。表达性写作已成功应用于产后以及应对孕期挑战。尽管这些非药物干预措施中的一些可能方便且成本低，但存在这些方法实施不一致的趋势。未来的研究应侧重于提高接受度的方法，确保每种选择在家中都可进行，并提供一种标准化的方法来评估不同干预措施的组合是否可能带来额外的益处。