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Supporting a Pregnant Woman’s Physical and Mental Health

Factors such as resilience and social support are key.

Key points

  • Studies show that childhood adversity causes up to one-third of all mental health disorders and can be traced through tooth growth marks.
  • One study has associated pregnant mothers' perceived social support with telomere length in their newborns.
  • Elective C-sections can negatively impact the health of newborns.

Primary prevention is always preferable to treatment of a disorder. Here, I want to point to some studies that attempt to do just that for pregnant women and their babies.

Early Life Adversity

A new study by Erin C. Dunn, associate professor of psychiatry at Harvard Medical School, has just been published in JAMA Network Open. Dunn’s research focuses on exploring the long-term mental health effects of childhood adversity, which research suggests is responsible for up to one-third of all mental health disorders.

Dunn thought that just as the thickness of tree growth rings varies with the climate, water supply, and other environmental conditions, tooth growth lines can also vary based on the environment and experiences a child has pre- and post-natally when teeth are forming.

Exposure to physical or mental stress, poor nutrition or disease, can affect the formation of dental enamel and result in pronounced growth lines within teeth, called stress lines, which are similar to the rings in a tree that mark its age. Dunn concluded that thicker stress lines indicate more stressful life conditions. In particular, she suggested, one variety of these lines called the neonatal line (NNL), might serve as an indicator of whether an infant's mother experienced high levels of psychological stress during pregnancy and in the early period following birth.

To test this hypothesis, Dunn and her team analyzed the primary teeth of 70 children in Bristol, UK. Several clear patterns emerged. Children whose mothers had lifetime histories of severe depression or other psychiatric problems, as well as mothers who experienced depression or anxiety at 32 weeks of pregnancy, were more likely than other kids to have thicker NNLs. On the other hand, children of mothers who received significant social support shortly after pregnancy tended to have thinner NNLs.

If this research is replicated, then the NNL and other tooth growth marks could be used in the future to identify children who have been exposed to early life adversity and lead to early interventions.

Perceived Social Support

There is much research to support the dictum that good health is fostered by social support, by face-to-face interactions with extended family and friends, participating in social clubs and/or houses of worship, engaging in volunteer work, and enjoying the companionship of fellow workers.

A study at Charité University, Berlin, investigated 656 mother-child dyads. Over the course of pregnancy, the investigators assessed maternal stress, negative and positive emotional responses to pregnancy events, positive affect (mood), and perceived social support. Maternal stress significantly predicted shorter newborn telomere length and maternal resilience was significantly associated with longer newborn telomere length.

Telomeres protect the ends of our chromosomes by forming a cap, much like the plastic tip on shoelaces. If the telomeres were not there, our chromosomes may end up sticking to other chromosomes. When the telomere becomes too short, the chromosome reaches a "critical length" and can no longer be replicated. This critical length triggers the cell to die by a process called apoptosis also known as programmed cell death.

Resilience in this study was defined as a multidimensional measure that incorporates positive affect and perceived social support. Resilience may also exert a protective effect on telomere length by way of the immune system. Resilience, positivity, and social support are known to diminish stress-related autonomic arousal and lead to a more rapid and complete recovery from stress.

The Case Against Elective C-Sections

Many women choose to be delivered in hospitals by C-section in the belief that this method is safer and less painful than vaginal unassisted delivery in a hospital or at home. These women, like their doctors, are unaware of how such a decision may negatively impact the health of their children.

One of the reasons for that is that women in labor routinely receive antibiotics to ward off infection after a C-section. Antibiotics are also used to prevent a serious infection in newborns caused by Group B strep, a bacterium that 25% to 33% of U.S. pregnant women carry. Antibiotics are broad in their effects, not targeted. While they kill Group B strep, they also kill friendly bacteria, thus selecting for resistant ones.

Another reason is due to the fact that the first microbes colonizing the newborn begin a dynamic process. They instruct the developing immune system about what is dangerous and what is not. In this way, we develop adaptive immunity that will clearly distinguish self from non-self. C-sections and antibiotics disrupt this process with potentially detrimental long-term effects.

Finally, we need to remember that the founding populations of microbes found on C-section infants are not those selected by hundreds of thousands of years of human evolution. Babies born by C-section harbor bacterial communities found on the skin, dominated by Staphylococcus, Corynebacterium, and Propionibacterium. Their gastrointestinal tracts do not get colonized by their mother’s lactobacilli. As a result, these babies will have difficulty digesting their mothers’ milk which will lead to further problems.

Summary

Based on the evidence, C-sections, unless indicated for medical reasons such as breech presentation, prolonged labor, fetal distress, etc. should be avoided. The beneficial effect of resilience highlights the importance of attending to mothers’ physical and mental health during pregnancy and delivery to optimize both her and her child’s health. Naturally, this applies not only to pregnant mothers but to everyone.

References

Mountain, Rebecca V., Zhu, Yiwen, Dunn, Erin C. et al., (2021). Association of Maternal Stress and Social Support During Pregnancy With Growth Marks in Children’s Primary Tooth Enamel. JAMA Network Open; 4 (11): e2129129

Nguyen, T. T., Zhang, X., ... & Jeste, D. V. (2021). Association of Loneliness and Wisdom with Gut Microbial Diversity and Composition: An Exploratory Study. Frontiers in Psychiatry, 12, 395.

Shane, A. L. (2014). Missing Microbes: How the Overuse of Antibiotics Is Fueling Our Modern Plagues. Emerging Infectious Diseases, 20(11), 1961. https://doi.org/10.3201/eid2011.141052.

Verner, G., Epel, E., & Entringer, S. (2021). Maternal psychological resilience during pregnancy and newborn telomere length: a prospective study. American Journal of Psychiatry, 178:2

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