War Stress During Pregnancy Linked to Schizophrenia in Offspring

by Ze'ev Ben-Yechielif

Children born to women exposed to extreme stress or trauma during pregnancy are at a significantly greater risk of becoming schizophrenic later in life, according to a study published Thursday on mothers pregnant in Jerusalem during the Six Day War. The study, conducted by the New York University School of Medicine, concluded that women exposed to the severe psychological stress of war or other traumatic conditions in the second month of their pregnancy are several times more likely to give birth to children that will ultimately develop the devastating mental illness.

The findings of the study, published online in an open-access and peer-reviewed medical journal from the BioMed Central Publishing house supported the conclusions of other recent studies showing a correlation between exposure to severe stress in pregnant women and a higher rate of severe psychiatric disorders such as schizophrenia. Additional factors found in medical studies to be linked to schizophrenia risk are low birth weight and premature birth.The disease, considered the most frightening and complex of all psychiatric disturbances, affects about 1% of the Israeli population. The authors of the study said that their findings are not conclusive and said that their research should not be cause for alarm among expecting mothers. Psychiatrists Dolores Malaspina and Anita and Joseph Steckler stressed that their research "only supports but does not prove" their hypothesis that the second month of fetal development is the one in which the child is most vulnerable to schizophrenia-inducing stress, citing the narrow sample base: 88,829 Jerusalemites born in the capital between 1964 and 1976, collected from the Jerusalem Perinatal Study, linked to birth records from the Israel’s Psychiatric Registry. They said that the study also did not take into account the length of pregnancy, as premature babies have been found to have a higher risk of developing the disease.Natural disasters, terrorist attacks or the sudden death of a loved one could have the same effect on the child’s risk of contracting the mental illness as a war zone, say the three doctors, but they also said that pregnant women should “not be alarmed about handling daily stressors during pregnancy. A developing fetus requires some exposure to maternal stress, as it normalizes their stress functioning. But women experiencing anxiety or excessive stress would do well to address it before a planned pregnancy and to have good social support systems." The battle for Jerusalem, which was won in the third day of the war, endangered the lives of many residents of the capital. The children of Jerusalemite women in their second month of pregnancy at the time were found to have developed a higher incidence of schizophrenia over the following 21 to 33 years.

The NYU study found that girls born from that sample were 4.3 times more likely to develop schizophrenia as young adults than those born at other times between 1964 and 1976. Meanwhile, boys were only 1.2 times more likely to do so. The reasons for the vast gender discrepancy are not clear. Traditionally it was believed that men are at a slightly higher risk for schizophrenia than women, but a study by a group in Germany found that data supporting this conclusion could be skewed by data they found: men tend to develop the disorder three to four years earlier than women. Commenting on the findings of their study, Dr. Malaspina said, "It's a very striking confirmation of something that has been suspected for quite some time. The placenta is very sensitive to stress hormones in the mother. These hormones were probably amplified during the time of the war." The findings of the study have been well-received in the Israeli medical community. One senior Israeli psychiatrist said that the study was a very interesting one that “confirms previous reports of an excess incidence of schizophrenia in offspring born to mothers who experienced stress in early pregnancy.” Prof. Avi Weizman, a senior psychiatrist at Petah Tikva’s Geha Mental Health Center, went on to add that the research “suggests a relatively narrow window of vulnerability in the second month.... It deserves to be replicated in a larger sample," he said in an interview with the Jerusalem Post.The range of birth years for the children in the sample include 1973, which saw the most intensive war Israel fought since its independence, the Yom Kippur War.

That war lasted much longer than the one in 1967, saw higher casualty rates, and was arguably the most stressful one nationwide as it put the country in its greatest risk of defeat since 1948. Prof. Arieh Shalev, chief of the psychiatric division at Hadassah-Hebrew University Medical Center, thinks this war, along with other periods of conflict in Israel, should be the focus of additional studies and repeated the researchers’ advice for pregnant women not to be overly concerned."Even if the increased risk of schizophrenia is a few times higher, it is still very low; it can still mean a small minority. Women should not be frightened. Severe stress in pregnant women during the Yom Kippur War, the Lebanon wars and the intifada should also be studied to see if there is support for their hypothesis," said Shalev.Another expert on mental illness expressed qualified approval of the research, pointing out that it is not the stress itself that creates the risk for pregnant women, but rather the subjective factor of their reaction to it. "The study is important. The authors are clearly on to something, but what is really still missing is a subjective perception of the stress by the mothers,” said Dr. Danny Brom, psychologist and director of the Temmy and Albert Latner Israel Center for the Treatment of Psychotrauma at Herzog Hospital in Jerusalem. “One of the most important effects of stress/trauma happens when the person experiences severe helplessness and horror. The study, therefore, as the authors suggest, creates a hypothesis but not proof. This is an interesting direction, but the evidence so far is not very convincing evidence.”Dr. Brom criticized the researchers for what he considered to be premature publishing of the article. “Although they state that mothers should not be worried, I think that their article creates too much anxiety and possibly guilt feelings in parents without a stable basis for it," he said.

Stress During Pregnancy as a Miscarriage Cause

By Krissi Danielsson

Evidence of a Link

Theories vary on exactly why stress during pregnancy would affect the baby, but some center around a hormone called cortisol. Cortisol tends to be elevated in people feeling stressed. Some elevation is normal during pregnancy but above average elevations could be related to miscarriage. Some scientists believe that this elevated cortisol could cross the placenta and interfere with development.

In a 2008 study, researchers administered the 12-item General Health Questionnaire (GHQ) about stress during pregnancy also found that women reporting higher levels of stress seemed to have an 80% higher risk of stillbirth when compared to women with intermediate levels of stress. Adjustment with a variety of other factors, such as mother's age or health risk factors, did not change the results.

In addition, a 2006 study found evidence that cortisol levels increased above average for pregnancy meant an increased risk of early miscarriage, such as within the first three weeks after conception. A 2002 study also linked depression as being a risk factor for further miscarriages in women who had recurrent miscarriages.

Looking at preterm birth, which is a risk factor for newborn infant loss, a 2003 study examined 1,962 women and found that those who reported high counts of anxiety were more likely to experience preterm labor and subsequent birth. Other studies had previously had similar findings showing stress as a risk factor for preterm birth and low birth weight, with outcomes varying by the level of stress and timing of the stressful events. A 2003 review found that stress during early pregnancy was most likely to be associated with "shortened gestation."

Evidence Against a Link

Not every study looking at stress during pregnancy has found evidence of a link with miscarriage. A 1998 study found no increased risk in women who had elevated cortisol and other hormonal markers associated with stress.

Another 2003 study found that women reporting high stress in early pregnancy did not have an higher risk of miscarriage when looking at stress alone, but the study did find that women under stress were more likely to use drugs like cigarettes and marijuana, which might be risk factors for miscarriage independently.

With these studies in mind, one could argue that the exact link between pregnancy stress and miscarriage is not fully understood or accepted.

Where it Stands

Currently, no one is able to say conclusively that "stress causes miscarriages," but it also doesn't seem accurate to say that it's a myth that stress can cause pregnancy loss. The truth is that it is possible that anxiety and stress could be linked with miscarriage but the evidence is too unclear to draw conclusions.

It is unlikely that normal everyday stress and worries, such as worrying about your finances or deadlines at work, would have any effect on pregnancy, but it is possible that major levels of stress could cause miscarriage or later pregnancy loss.

But regardless of the link with miscarriage, stress during pregnancy may affect the baby in other ways also and it's always a good idea to make stress management a priority in your life. Stress may be unavoidable for many people, especially if you're dealing with something like infertility or recurrent miscarriages, but it might be a good idea to look into doing whatever you can to alleviate your anxiety and to get your mind off things. In doing so, you might improve your odds for a healthy pregnancy as well as your overall health. Simply put, there is no downside to incorporating more relaxation and to addressing any anxiety disorders that might be affecting your quality of life.

12 Tips for Coping With Stress During Pregnancy How to Gain Control of Your Life

From Henry Lerner, M.D.,

As a psychologist friend of mine once told me if you don't feel stress in your life you're not paying attention. Everyone experiences stress, even pregnant women. What is not clear, however, is whether stress can have harmful affects on pregnancy.

For years obstetricians have looked to see whether an increase in stressful events can either cause miscarriage, result in preterm delivery, or in some other way harm a fetus. Up until recently the consensus had been that while excessive physical work can bring on preterm labor, emotional stress did not seem to have negative effects on pregnancy outcomes. This conclusion, however, has recently been challenged. There now is information to indicate that stress can cause the body to produce certain hormones that can perhaps cause miscarriage and that very likely can bring on preterm labor. Additionally, even if doctors have no "smoking gun" linking stress with negative pregnancy outcomes, pregnant women would want to decrease the amount of stress they have to contend with just because of how unpleasant it makes them feel. These emotional consequences of stress can range from a mild sense of being overwhelmed to severe episodes of depression. They can eventually lead to pregnant women feeling withdrawn and being unable to function.

Are there things pregnant women can do to reduce the stress they have and to change how it makes them feel? The answer is yes. Below are listed several techniques that both women and the clinicians who care for them have found useful in helping to relieve the sense that life is getting out of control. I have divided these techniques into two groups: (1) readjusting your lifestyle to reduce stress and (2) specific maneuvers and activities you can do to change how you feel -both physically and emotionally-about the stress you are under.

Gaining control of your life:

1. Take a close look at your lifestyle. Make yourself do this on paper. Look at your work activities, home and family responsibilities, other obligations (church, community activities, clubs and organizations to which you belong). Then look to see how "doable" it is. Make sure you include in your calculations time for yourself for such activities as exercise, down time, and socializing Once you have done this, be honest with yourself as you ask the following: Is this schedule achievable? Sustainable? Satisfying? If not, accept the reality that you have to change the schedule.

2. Accept the fact that even if you currently can thrive on your busy and demanding lifestyle, you likely will not be able to sustain it as pregnancy progresses and makes more physical demands on you. Therefore prepare yourself to cut back on what you're doing and to allow yourself more time for rest and relaxation. You will need to sleep more. You will need to change the time you a lot for meals to make sure that you are able to eat a balanced diet. You will feel better if you allow time to engage in a reasonable exercise program. Finally you will need to allow yourself some "mental growth" time. This is time for reading, thinking, and planning for the new, incredibly important role of mother you will soon assume.

3. Be prepared to give up some control over the life-style you have worked so hard to attain. Many things about pregnancy are not in your control. You may experience severe morning sickness. You may have overwhelming fatigue. You may develop a pregnancy complication requiring hospitalization or home bed rest. For many women, especially those who have demanding jobs, the thought that biology might interfere with their responsibilities borders on the intolerable. But it happens. Be prepared to accept this.