OB-GYNs Explain The Connection Between Stress & Miscarriage

We all know that stress can be hard on the body. And anyone who’s ever been pregnant knows that, even in the best of circumstances, pregnancy can be a stressful time in a persons life. You’re preparing for one of the biggest transitions of adulthood — particularly if you’re having your first child — and that is bound to involve a stressful or anxious moment or two (or more). Pregnancy is also a time when we tend to be fixated on health and well-being, because we’re told that every little decision we make could have lasting effects on our child. But the last thing a stressed out pregnant person needs is to worry that stress itself could be causing damage to your fetus. Particularly in the first trimester, it’s normal to worry about miscarriage — after all, early miscarriage is extremely common — and to want to do every little thing you can to avoid having one. What does actually cause a miscarriage, and can stress cause miscarriage? How does stress affect pregnancy?

Can stress cause miscarriage in first trimester?

“There is no concrete evidence that stress can cause miscarriage,” says Dr. Alex Robles, assistant professor of obstetrics & gynecology at Columbia's Vagelos College of Physicians and Surgeons. “In most cases, miscarriages are caused by chromosomal abnormalities or other medical problems.”

However, if you’re experiencing a lot of stress on an on-going basis, studies have found that it is worth trying to mitigate that stress as much as you can. “The side effects of stress can be harmful to your overall health and to a pregnancy,” cautions Dr. Lisa Thiel, an OB-GYN and maternal fetal medicine specialist at Corewell Health. “Stress is defined as any situation that overwhelms our ability to cope.” Because stress is so broadly defined, it is a difficult area of study, so no direct cause-and-effect link between stress and miscarriage have been found. Nonetheless, it is known that — pregnant or not — stress is hard on our bodies.

Can depression cause miscarriage? What about anxiety?

You do not need to add to your list of worries that feelings of depression during pregnancy or anxiety alone could cause you to miscarry. “There is no evidence that anxiety or depression affects miscarriage rates,” Robles assures. If you’re experiencing depression or anxiety, though, you certainly deserve to receive support and you may want to bring your feelings up with your health care provider.

If you’re already managing depression or anxiety with medication, our experts say it’s likely best to continue to manage your depression with medication during pregnancy. “Anxiety and depression do not have any direct cause or link to miscarriage,” says Thiel. “However, untreated depression is associated with low birth weight, premature birth and long-term concerns such as behavioral and developmental concerns.”

Proper care and support of anxiety and depression during pregnancy is essential for the health of both parent and child, says Thiel. She suggests a wholistic approach to mental health support that includes therapy, support groups, time with friends and family, mindfulness exercises, light therapy and medication, saying that all of these things can all be beneficial treatments for individuals with anxiety and/or depression. And if you discover that you’re pregnant while taking an antidepressant, Thiel urges: “Please do not immediately stop taking your medication with a positive pregnancy test prior to discussing with your doctor. Most antidepressants are continued in pregnancy. The risk of untreated depression is greater than the minimal risks of the medication in the vast majority of pregnancies.”

How does stress affect pregnancy?

Although stress does not directly cause miscarriage, it’s hard on your body and should be addressed if you’re experiencing it on a constant basis. “Chronic stress may increase your susceptibility to infection and other medical conditions,” says Robles. Because of this, he emphasizes the need to “speak with a healthcare professional if you are experiencing high levels of stress on a frequent basis.”

High stress is known to lead to behavior changes that affect overall health and well-being, says Thiel, including things like:

• Poor appetite
• High blood pressure
• Overeating
• Lack of sleep
• Substance use

All of these habits and behavorial shifts can have an impact on a pregnancy, “such as changes in birth weight (high or low) and an increased risk of preterm delivery,” Thiel says. Research is really limited in this arena, though, and Thiel suggests that — while we know that lowering stress is important — more research in the area is critical.

Things that can cause a miscarriage in the first 8 weeks

By far, the most common cause of miscarriage is a factor that is fully beyond your control. “Miscarriages in the first trimester are usually caused by chromosomal abnormalities in the developing fetus,” Robles explains. What exactly does “chromosomal abnormality” mean? “There is a mismatch of the DNA within the egg and sperm when they meet,” says Thiel. “Often, there’s nothing you can do to prevent a miscarriage.” However, if you experience a miscarriage and want to better understand what happened, Thiel says there are few different ways to assess the genetics of a miscarriage, and your OB-GYN can talk to you about those if you’re interested.

Despite the fact that most miscarriages are caused by chromosomal abnormalities, and are largely outside of your control, both Robles and Thiel suggest that taking care of your overall well-being — mental and physical — during pregnancy is important. What does that look like? “I recommend treating high blood pressures, lowering obesity, obtaining normal blood sugars if diabetic and decreasing flares if you have autoimmune disease,” Thiel tells Romper. “Treatment of sexually transmitted infections such as gonorrhea and syphilis and avoiding risky behaviors, such as smoking and illegal drugs will also decrease your risk of a miscarriage.” So, while you cannot fully control whether or not you experience a miscarriage, experts agree that by taking care of your overall health, you can significantly reduce the risk of miscarriage and overall pregnancy risk.

For many pregnant people, the first trimester is a stressful time and, particularly if you’re not telling people close to you that you’re pregnant, it can be lonely. Worrying about what may or may not cause a miscarriage is normal, but know that — for the most part — it’s beyond your control. If you do experience a miscarriage, seek support from loved ones and definitely let your health care provider know. Miscarriage is both an “important and very emotional topic,” Thiel says. “We take miscarriages very seriously and want patients that experience loss to feel supported and cared for in all areas of the reproductive journey.”

Studies cited:

Qu, F., Wu, Zhu, Y., Barry, J., Muscat, R. (2017) The association between psychological stress and miscarriage: A systematic review and meta-analysis. Scientific Reports, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5431920/

Experts:

Dr. Lisa Thiel, DO, maternal fetal medicine specialist at Corewell Health

Dr. Alex Robles, assistant professor of obstetrics & gynecology at Columbia's Vagelos College of Physicians and Surgeons