If you are pregnant or if you just had a baby during the coronavirus pandemic, then this episode is for you. Today we'll be talking about stress during pregnancy. It's an important one. So I hope you enjoy it. Welcome to Episode 18 of the Care Center.
Welcome to the curious neuron podcast, parenting advice that is backed by science. My name is Cindy Hovington. And I'm the founder and your host. I have a doctorate degree in neuroscience and I'm a mom of three. My goal is to bring you information from research that will help you parent your child, whether you just had a baby or you have a teenager curious neuron is here to answer your questions. Learn with us by visiting our website at curious neuron.com. Join us on Instagram or Facebook, join our courses or live webinars or our weekly family meetings on Monday nights. Send in your comments or questions at info I curious neuron.com
Hi, welcome back to another episode of curious neuron Podcast. I am glad that you are here with me today. And today is really an important episode because we are talking about stress during pregnancy. And one of the things that you know is coming up a lot now with this pandemic is Stress Stress in parents stress and mothers who are experiencing a different workload right now, if they are homeschooling their kids as well and stress during pregnancy, which is why I wanted to address it. This topic might be a little bit scary to some of you, especially if you just got pregnant or you are pregnant. But I want you to know that it is important for you to listen to this episode all the way to the end, because at the beginning of this episode, we will talk about, you know what the research suggests, you know what the outcome has been in some parents who had high levels of stress. However, Dr. King who's our guest today, she will outline beautifully at the end what we can do, to sort of lessen the impact of stress during pregnancy, and what we can do during pregnancy, to lessen the levels of anxiety that we might have or stress. So This to me is one of the most important episodes so far, because of the topic that we're covering. Before we begin the interview, I just wanted to share something that happened this week in our home, because I think it's an important lesson. So one of my kids had, you know, some big emotions around having been told no for something. And I've learned through one of the accounts that I follow on Instagram called our mama village, and Jessie who who runs this account, and also has a website and some courses. She shared a piece of advice a few months ago now I've been implementing it and it helps a lot. Basically one of my kids wanted to watch TV right before going to bed. But in our home, it's not something that we do. We watch TV, usually at some point in the morning, and then my kids will get some time once or twice a week while my baby sleeps to watch something a bit longer in the afternoon. So we watch on average around I would say three to four hours of TV in a week. We cut it up in little bits and pieces. We watch TV on alternative days. So we have certain rules around screen time here in our home. But my kids really enjoy the Mickey Mouse show. One of them wanted to watch it before going to bed. Now me saying no lead to really big outburst and lots of big emotions. And nothing I was seeing was calming my child down. So I applied what I learned through our mama village. And this was to talk about it in the future. So I told my son, you know, you can watch this tomorrow. But of course that won't work. So what I said is what episode Do you want to watch tomorrow? Hey, he just started taking deep breaths to speak because he wanted to tell me which episode so he said I'd like to watch the one with the haunted house. I said, Oh, yeah, I remember that one. That was a really fun one. What happens in that episode, and then he continued to talk about it, which led to him distancing himself from those big emotions from him being told no. And that really helped calm him down. And then I looked at him and I said, I can't wait for you to watch this episode tomorrow morning. I think it'll be lots of fun, and we're gonna watch it together. But right now it's bedtime. Again, he started getting upset a bit and then I had to remind him, you don't but tomorrow, you're really going to have a lot of fun watching this episode while we take your shower. Can you talk to me about this episode a little bit more, just so that I was able to keep his mind off of it for a little bit longer and also so that he can talk about it and just get excited about what he'll do tomorrow. So this is just a little bit of advice that I've learned that helps in our home. I hope it can help in your home as well, if you are enjoying the curious non podcast, please take a moment to go into the review section. Read it on five stars however you wish. And please leave a review. This helps a lot in terms of understanding. If you are enjoying it. If you'd like to learn more with us, we have many different ways to help you. There's our blog, I curious neuron.com every single Monday night at 8:30pm eastern time, we get together on a zoom call. And we chat about different topics. Sometimes I have a special guest. And this past week we spoke about character skills and how to build these character skills. Every single webinar, which is anywhere between 30 to 60 minutes is up on my website, but available to the members. So we have a new membership that we launched about a month ago. And you can access all of this through our website, or you can visit patreon.com slash curious neuron. If you'd like to become a member, we have different prices from one, five and $10 a month. My guest today is Dr. Susan King, who's a researcher here in Montreal at McGill University.
She studies maternal stress in utero as the result of natural disasters. So in her longitudinal studies, she has really looked at a wide range of outcomes on a child's development. And this is why I really wanted to speak with her. She's currently running three studies of children exposed to natural disasters in utero. In order to understand the nature and the mechanisms of effects of prenatal stress. I hope you enjoy my talk today. And like I said, Please listen till the end, because we do offer a lot of advice for new moms. Dr. Susan King is here with me today to talk to us about stress during pregnancy. And I've received so many emails from from mothers who have been going through very difficult times right now during COVID. And I thought that it would be relevant to have this discussion. And you know, the information we're going to talk about, you know, is is from her research. She's been researching this topic for many, many years and many different natural disasters. So we're gonna learn a lot from her. Thank you so much, Dr. King from joining me today.
Oh, it's my pleasure to be on the phone.
today. I guess before we begin, I always like to bring it down to a level where we can all understand each other. So when we talk about stress, how would you define this stress and during pregnancy?
Sure. So as people probably know, when, when people use the word stress, thinking so many different things, it might mean that they're under time pressure, that might mean that they're feeling anxious. So when when I've been doing my research, which has always been for the last 22 years, on women who are pregnant during natural disasters, so we try to capture their stress experience. So I try to break that down into three primary things that are happening inside the mom. The first is objectively what's happening to her. So during the 1998, ice storm here in Quebec, I looked at, you know, asked questions about, objectively, you know, what are the facts about what happened to the mother? What were her levels of loss? What was her level of threat? Or how much change Did she go through? And how long did it last? What was the scope? So I would ask things like, was she injured from the ice storm? How much financial loss was there? How many different houses did they move to during the during the ice storm? And then also, how long did it last? How long was their power outage for? And then we put that all together and come up with a score on their objective hardship. Then the next thing that we look at is the the woman's cognitive appraisal of what happened. So we asked the women from Project icestorm. You know, if you think about all the consequences of the ice storm on you and your family, would you say that the consequences were very negative, negative, neutral, positive, or very positive. And surprisingly, even though, in Project icestorm, the women were without electricity, on average, 14 days, and some women as long as 45 days in the middle of winter, about half the women said that it was a positive experience. So they were without electricity, and maybe they were living with their in laws, and they were, you know, because they didn't have electricity, they would be telling stories and, you know, telling jokes and things like that. So, right, so we've got the objective hardship, then we've got their cognitive appraisal of what's happening to them. And then we've got their subjective distress. So how upset were the women about the disaster, that we we tend to look at things like post traumatic stress kinds of symptoms, okay, so, so that's kind of the model that we, that we study. So, objective hardship, cognitive appraisal, subjective distress, and it's probably That subjective distress that triggers the release of the stress hormones in in the woman in the pregnant mother, and that can then go through the placenta and alter the development of the fetus.
The subjective part is the one that we have control over.
That's right, and even the cognitive. So maybe we can't control how many days were without electricity during during a disaster. But there are, you know, psychologists work on helping people with their anxiety or the depression by changing the way they think about things. And then also there's our, our distress.
And just to give it layout in terms of what the product what the ice storm was here in, in Quebec, in 1998, received a hailstorm or a nice, nice storm here. And it resulted in a loss of power outage in I think, how I don't know how far how vast it was. But we were some people were left with, like you said, no power for up to 45 days,
right? Yes. So there were five days was unprecedented. There were three different weather systems that move through that, where the temperature was just slightly above freezing during the day, and we had five days of freezing rain, and the weight of the ice on the high tension poles and all the all the electrical lines was so great. They're just toppled all of those big, high tension pylons that you see. Yeah, we're about at about 1.5 million households without electricity for up to 45 days.
I remember I was lucky enough to be in a part of Montreal and a suburb that we lost power for two or three days, I think it was more than that. And we were lucky enough to go to my grandparents house who they had power and they had a stove. And so we you know, we were safe in case anything happened. But unfortunately, many people are not as lucky as that. I think
most people who were children at the time thought it was a great time.
Yeah, that was
that wonderful. recollection of the time,
I know that you you you study different natural disasters. Now looking at this stress in the way that you study stress. does this apply very similarly, across these natural disasters? Are you seeing very similar levels of stress? objective versus objective, regardless of what type of natural disaster.
So it's difficult to compare the objective hardship across the different studies because we have to measure it. Right. So we've got three studies of floods and one wildfire out in Fort McMurray, Alberta, in 2016. And I would say that the the greatest level of subjective distress was from the Fort McMurray wildfires where people were, you know, running for their lives, quite literally, with, you know, walls of flames on either side and trying to recuperate their kids in the middle of a school age to get everybody out and trying to find their husbands who were away at the oil camps, and so on. So, I would say that the fort Mac has the greatest objective hardship. And second was really the ice storm. And what I see is common between those two is the fact that the scope was so great. And what we mean by the scope is how long the situation lasted for people. So it was lasting for months, and months after the fire where people were evacuated. Um, so there's the duration, but then there's also the density of or the density of the impact. So in Fort McMurray, everybody had to get out. So 88,000 people had to evacuate all at once, there was nobody who could really help you because everybody was in the same situation. Same with the ice storm, even if you never lost power, the ice was everywhere, disruptive everybody's lives. So there are differences between between the different disasters.
And compared Now, let's say to COVID, with everything that's going on, it's it's something that is prolonged. And I think longer than any of us ever anticipated. What you know, what are you sort of anticipating a little bit, I guess, in terms of this natural disaster?
Exactly. So if we just look at the kinds of things that we measure in terms of the objective hardship, so the amount of loss for example, so many people have lost so much because they've lost their jobs. They lost income, even if they didn't lose their jobs, their income was reduced. In terms of change. Everything has changed. Just go to the grocery store, just going for a walk around the block. Everything about our lives has changed. And then the scope, you know, if you think of the duration, you know, we've been at this for six months, non stop. And, and also for the for the for the scope of it. It's worldwide. So it's not like you can go somewhere unless you want to go to Nunavut or the South Pole, you know, where you can go to really away from it. And then finally, that the level of threat every day, you hear how many people have died. In here, you know, how many cases are there. So there's a constant constant. communication about the threat, though, so I'm I'm not terribly optimistic about what this is going to do to pregnant women and their unborn children. There is one ray of light. However, that is a bit surprising, and it hasn't been completely confirmed. But there are a lot of anecdotal reports from different countries that have been looking at these data, that since the pandemic since the shutdown, the the rate of preterm birth has plummeted in Denmark 70% fewer preterm births in Ireland, 30 and 40%, fewer preterm and one of the thoughts is that people are staying at home, there's less day to de stress on catch the metro going to work, that somehow this is, in some ways reducing Women's Day to day routine stress. I don't know.
And that was going to be one of my questions. So let's maybe define a little bit more what happens when we are stressed and you know, to the brain and to our body, when we are stressed there are there's an increase in cortisol in our brain, whether or not you're pregnant, there is that increase in cortisol. And then the longer that that increased remains or how often that's happening, then that's when we're seeing some physical consequences or like some consequences to the brain as well. But now, during pregnancy, you mentioned that it does go into the placenta. So it's the cortisol that goes into the placenta.
Exactly. So okay. So that the pregnant woman would be releasing cortisol if, if if she's under stress. But normally, inside in the placenta, there's an enzyme, it's called the barrier enzyme 11, beta HSD, which is an enzyme that would convert the mother's cortisol, which could be in some ways noxious to the fetus, hurts it into cortisone, which would be benign for but during instances of very high stress, the mother has a lot of cortisol that wants to go through the placenta, that barrier enzyme can't manage it, and it affected. And so then the cortisol will get through to the to the fetus and alter the fetuses brain there other aspects of their physiology.
Does it matter at what point during the pregnancy this high stress occurs?
It does. So in in all of our studies, we found that the timing that disaster began, so your life is going on as normal, and then all of a sudden, there's a wildfire or ice storm or there's a flood. That sudden change the date of that sudden change. And the point in pregnancy that that happens, seems to be very important to determining which system in the fetuses physiology is being affected. So we've we've found, really, that there's no good time to be stressed in pregnancy. We found across our studies that being stressed in the third trimester, so if the disaster starts in the third trimester, that this is a very critical time for motor development of a child and we've seen the this effect of late pregnancy, disaster onset in children as young as five, possibly younger, yes, even younger. And all the way to age 19. There's slightly delayed compared to to their peers.
The motor for the motor skills. Yeah,
wow. We've found the effects of early pregnancy, on early pregnancy stress on some aspects of cognitive development. And especially at the age of eight years and younger, we were seeing that There was an effect after that
much difference in terms of delivery and woman who is stressed during pregnancy have? Have you seen differences in terms of the delivery itself? does it lead to more c sections does it lead to an earlier delivery.
So we predicted that the greater the stress the the shorter the pregnancy, and the smaller the baby, we do that and Project icestorm, which is I mentioned was the second most stressful event. What we saw was that for women who are pregnant in their first or second trimesters, at the time of the icestorm, that their babies were significantly lighter, and their pregnancies were shorter. But by about a week and a half or two weeks. Okay. You didn't have any severely preterm. Interestingly, in in the Australian floods, the the Qf 2011 study, there, we found that, well, we asked the mothers questions about how did their diet change during pregnancy because of the floods. And then we'd be rated their diet as either like a negative impact. So eating more salty, more sugary, like that fewer proteins, less dairy, or an improvement, by all of the good things, or bad things. And what we found was that the greater the moms objective hardship from the flood, the worse their diet. So you can imagine if they're stranded in their home, and they can't get out, you know, that they're down to eating candy or something very healthy. And then their diet influenced the size of the baby at birth. But what was really interesting about that was that, and we found this in the icestorm, as well, was that one of the patterns we see in the size of the baby at birth, was a larger head circumference, relative to the length of the beam. So it wasn't that their heads were any bigger, it's more that the head was a normal size, but the length was shorter. And something called head sparing, or brain smearing the idea that the the placenta is a bit like perceptual Oregon, so it perceives the mother's stress, it's perceiving that there's something bad happening outside. And it preserves the sight of the size of the head, and the development of the brain. But it's the expensive, the length of the bailing, interesting, stressful world out there, you've got to have a good brain, but you don't have to be tall, you don't have to. So this is actually a phenomenon that fits that's called a predictive adaptive response. The placenta perceives what's going on in the outside environment, and modifies the development of the fetus in ways to help ensure its immediate survival after even if it means that the long term health is not going to be as good.
That's fascinating. Wow. And is that where you see these motor delays because of this response?
That's a great segue. But I I don't know. Hard to figure why having a delayed motor development would be advantageous. I yeah, something's like model and other things that this whole idea of head sparing. It's the model where the placenta may be afraid. The placenta might proceed, that resources might end up being limited. Oh, we're going to invest in the brain, but not moment.
So this is interesting, because then the next stage is really in infants, where I think you had mentioned temperament might be altered in terms of in mothers who had high stress. What if the, if the body or the placenta does is detecting the stress and sparing the brain? Is it? from the research I have from your research? I'm assuming it's varying the size and the development of it, but there still are consequences cognitively.
So pretty much across the board, I can say that. Yes. Others stress whether it's their objective, or their cognitive or their subjective distress, does have some effects on the on the temperament.
So there were different areas. Now we can look at the children overall. You had looked at infants and two and a half year olds, I believe, and five year olds and like you said, Older. So let's walk through that and to to maybe explain to parents, what are the what are we seeing overall in children now? Yeah.
So if we look at cognitive development, so you know what it would commonly be referred to as IQ in Project icestorm. And in the Iowa flood study, what we were seeing was that, you know, if the mother was pregnant in the first or second trimester, at the time of the onset of the disaster, that those, those children were very sensitive to the amount of stress that the mother had experienced. So for example, in project by storm, when the kids were two years old, we took those families, we separated them into low, medium, and high stress from the objective stress questionnaire, didn't have much money. So we only looked at the low stress and the high stress kids. And we found that the kids whose mothers had been the longest without electricity, so the high, the high stress kids had 10 to 15 point lower IQ, then the low stress kids. And we found the same thing in terms of the language development, that the the high stress kids were understanding and speaking, fewer words than the low stress kids. Interesting was it, it made no difference whatsoever. How distressed the mother had been, from the storm, it was only, let's say, like the number of days without electricity was predicting, and language development.
So regardless, if she rated her own stress, high or low, that didn't have an impact.
Exactly. Wow. in that study, we were only looking at PTSD like symptoms, as the subjective stress measure, okay, make a difference. Then, when the kids were five years of age, we fight, we finally got our first grant, in order to test the kids when they were five and a half. So now we had the low, the medium and the high stress. And we found that actually, the kids that had medium stress, had slightly better IQ, and slightly better language development than the low stress kids. Well, the high stress kids were that much lower stones, high stress was clearly bad. But the some slight advantage to the mother, having experienced some stress, kind of a medium level of stress.
I'm placing myself in the shoes of somebody listening right now. And they might say, okay, so high stress is bad. But how did they How does a mother listening right now who might be expecting their child? Is there anything that they can do right now to Besides, you know, there are things like you said, we don't have control over and that might still have an impact on the child and the stress level. But in terms of what we do have control over? How can we Is there anything we can do to rate our own stress? Or?
Well, I think everybody knows what their what their baseline is, you know, some people are just always anxious all the time. Polar, pretty calm, most of the time. I think everybody has their own kind of barometer,
just maybe having more insight in terms of what is bringing the stress perhaps.
So I think there are things that we can do, both to control some of the objective hardship that we're going through, and the subjective stress and the cognitive appraisal that we do have current stressors from COVID, for example. So we can limit our objective hardship. Remember, we we studied the threat, the loss, the scope, and the change. So one can try as much as possible to keep to limit the change. So try to keep daily routines the same. Try to change as little as possible, the diet course eating very well, if you're pregnant, just limit change as much as possible. There's not much that we can do about the duration or the you know, the scope. In terms of threat, we can certainly limit threat. So a pregnant woman could limit her threat by just being very vigilant in terms of washing and mask wearing, and avoiding crowds. There's a huge literature on any kind of infection during pregnancy. It's not good for the mom, it's not good for the pregnancy, and it's not good for the fetus. We have to be very careful just to avoid all kinds of infection. So you're right when you say there's not much that we can do about the objective hardship, in terms of the cognitive appraisal, It is possible to surround yourself with the good news with the heartwarming stories. If you look for them, they're out there they are you
Can you define cognitive appraisal a little bit more?
It's it's the way you think about a thing that's happening to you. So one could easily say, Oh my God, this this Coronavirus is terrible. I can't deal with this. It's too much. But it doesn't take that much to flip a switch and say, Okay, this is a challenge. But I can deal with it. If I look around me, you know, I still have a home, I slept partner. I've got people who love me. And we've actually been doing a lot of analyses of our data from the from the different studies and finding that women who were going through disasters, if they were able to keep a positive appraisal of what was happening, that their own PTSD symptoms, their own distress, was much less and do at times, also super bad also protects the fetus from somehow.
So there is research showing that this has a positive impact on the fetus. Wow. I've heard of journaling, you know, maybe I don't know enough about that area. But maybe there are ways like you said for somebody who's going through this right now and who's pregnant to to gain a little bit more control, because it's that, that sense of loss of control, right? That just really, whether there's a pandemic or anything going on that loss of control really spikes our stress levels.
Exactly. Yeah. Yeah. So I think are there things that we can do as well, in terms of limiting, limiting the intake of bad news. So in the in the first couple of weeks after the lockdown, we have the news on all day long, if nothing but bad news, it was nothing but but scary stuff. And I realized that my own distress was increasing. Every day, I was getting more and more tense across the shoulders and my neck. And finally, I just made the decision. Nope, we're going to watch the news at noon, and at six o'clock. And yeah, that was enough. So there are control to, you know, limit our distress.
And I think also part of that maybe something that adds to stress with what we're experiencing now, as well as we, we don't see the end yet. So I think for some that I've spoken with not being able to perceive that end date or knowing, you know, in a month or two months, or we don't know, and that's kind of difficult, you know, especially for some older people or regardless of their ages, actually. So, um, some things, like you said, I think in terms of the mindset, or the the appraisal of it, and just maybe we don't see the positive part of that yet, but maybe just, I don't know, not thinking of it, but not trying to, because that could add a lot of stress as well.
Yeah, send you one thing that I really been struck with, over the past 20 years of looking at these data is the power of the objective hardship, the thing that control. So in project based on like I said, these women were without electricity, on average for 14 days and some as long as 45. And what I found over the years is that it's the object of hardship that the women went through. So like the number of days that they were without electricity, which they had absolutely no control over, that had the greatest effect on the physical development, the unborn child, whether it was their insulin secretion, when they so when the kids were 13, he did a an oral glucose tolerance test, it was only the objective hardship that predicted that or days, TriCity, higher insulin secretion, which kind of sets up the situation for diabetes and so on. It was also only the objective parship that predicted the immune function in the kids at 13. So something called cytokines which are like the chemical messengers of the immune system. So the pro inflammatory and the anti inflammatory were only correlated with The objective exposure and also the
kind of appraisal, the children, meaning that their immune system was a little weaker, it's
used something called a teach to shift. That. So it's kind of the the balance between the proinflammatory and the anti inflammatory cytokines, that could set the child up for being more vulnerable to as an analogy. But what we found was most striking was the effect of the objective hardship on the children's body mass index. So their obesity. So we saw this first when they were five years old, and we measured the kids. So the more days without electricity, the mother was the the higher was the BMI and the child, the greater, the more likely they were to meet criteria for obesity. And every time we saw them, so at age five 811 13 1619, we measured them, and the older they got, the bigger the effect was, not only the bigger the child was the effect. So we would have expected that the the older the child, the less of an effect, something that happened during pregnancy would have been. But in fact, for the least for obesity, it was actually the effect was getting larger.
And is that entirely because of the stress during pregnancy? Or is the mother also carrying anxiety and stress throughout her current life.
So every time we see the kid and measure the kid, we also measure the mother's depression and anxiety and we control for that in our analysis. And of course, the whether or not the mother is depressed one day doesn't influence our measurement, right. And then the other thing is that it's the objective hardship from the ice storm. And the mother's cognitive appraisal of the ice storm is either negative, neutral or positive, that influence something called epigenetics. So DNA methylation, and then that DNA methylation seems to go on and influence some of these other traits in the child like the insulin, the immune system, the BMI, things like that.
And for those who have never heard the term of epigenetics, what can you explain what that field of study is,
nothing you do can change the DNA. But there's these little things that stick on to the DNA called Little methyl groups. And what they do is they turn on or they turn off the different genes. And so as an example, if you take a piano keyboard, there's nothing you can do to change the white and the black keys, they're just going to stay exactly where they are. But you can play different notes different music, on that piano without changing the keys, but by just choosing which ones you play when you play them harder or softer. So that's a bit with the epigenome. So it can do minor changes to the traits of the child without actually changing their DNA.
And this is environmental changes that cause these changes.
Yes, so and then environment is not only the pollution, for example, there's studies that show there's somebody in Toronto who has a machine, he can go in this big box, and they can, they can provide the air just like in Beijing, Toronto, or the air in Bali, or wherever. And they can show that there's an immediate change in some of these epigenetic signals. Another, epigenetics is a musical score, like for Beethoven's Fifth, right, everybody, every orchestra may play it a little bit differently. And so some conductors may go through and put little marks and say, make this note stronger, make this one softer. Some of those alterations they might make in pen. So they're permanent, were in pencil that they can erase and change. So some of these, some of these epigenetic changes are permanent. So it's quite amazing, actually, that we were able to see these epigenetic changes in children from project by storm beach 13. So this is 13 years after, could have been up to a 13 plus nine to you know, 22 years before we actually measured In their blood, these epigenetic signals, so this was pretty permanent.
