UNIVERSITY PARK, Pa. -- Pregnant women with moderate to high levels of stress and anxiety are at higher risk for complications during pregnancy and delivery. However, Penn State researchers have developed an educational preparation program for expectant couples that has recently been shown to improve birth outcomes.
"Because stress, anxiety and depression are widespread, it's crucial to find ways to help pregnant women and their partners become more emotionally healthy during pregnancy without the use of prescription drugs -- which may carry side effects for the pregnancy and fetal development," said Mark E. Feinberg, research professor of health and human development and senior scientist of the Prevention Research Center for the Promotion of Human Development.
Feinberg received funding from the National Institutes of Health 10 years ago to develop and test an educational and preventive program, Family Foundations, offering a series of classes for expectant parents. By developing emotional self-management, conflict management, problem solving and communication that foster coordination and mutual support in parenting an infant, the classes have been shown to help reduce maternal stress and depression, among other long-term benefits.
The program, which can be delivered alone or integrated with childbirth education, focuses on how a first-time expectant couple can prepare for a new baby together, developing new skills and perspectives helpful in raising a child.
In the current study, the researchers looked at a sample of 169 heterosexual couples who were each expecting their first child. The couples were randomly assigned to either participate in the program or not; those not participating served as the control group.
Feinberg and colleagues predicted that the classes would have a relatively greater beneficial impact for women with elevated levels of stress during pregnancy.
The researchers measured pregnant women's stress by assessing levels of cortisol in their saliva. All women experience increasing levels of cortisol, commonly known as the stress hormone, throughout pregnancy.
"Near the end of pregnancy, cortisol levels rise and likely play a role in triggering labor," said Feinberg. "Thus, it may be that pregnant women with relatively high levels of cortisol due to stress and anxiety are more likely to have a preterm birth. Their babies are more likely to have a low birth weight. And those babies are more likely to have longer hospital stays and to be at risk for future health problems."
But among women who had relatively higher cortisol levels, those who participated in the program experienced fewer pregnancy and delivery complications compared to mothers in the control group, the researchers reported online today in the Maternal and Child Health Journal. Maternal anxiety and depression are associated with pregnancy and delivery complications, including preterm birth, low birth weight, Cesarean section, and prolonged hospital stays, for both mothers and infants. In turn, these issues are associated with longer-term health problems and psychological disorders into adulthood.
"Despite research indicating that partner support is a key influence on new mothers' mental health, no prevention studies have tested whether reducing maternal psychological distress via increased couple support and cooperation could impact birth outcomes," said Feinberg.
Future research will likely include looking at expectant mothers’ and fathers’ cortisol levels throughout pregnancy and fine-tuning educational programs to have the greatest impact on improved health outcomes for new families.
With NIH funding, Feinberg has also developed a version of the class consisting of a series of DVDs and workbooks that couples can use as a home-study program available from Family Foundations.
Working with Feinberg were Michael E. Roettger, research associate, and Damon E. Jones, research assistant professor, both at the Penn State Prevention Research Center for the Promotion of Human Development; Ian M. Paul, professor of pediatrics and public health sciences, Penn State College of Medicine; and Marni L. Kan, research psychologist, RTI International, Research Triangle Park, N.C.