Many times, we get questions from members who were under a lot of stress during their pregnancies. Stress and anxiety can cause a temporary increase in blood pressure, and preeclampsia also involves high blood pressure. They want to know if this stress could have caused preeclampsia. We know that preeclampsia is caused by the placenta. High blood pressure is a symptom. Even if stress causes a temporary increase in blood pressure, that is a different process from the placenta raising blood pressure. But could stress cause preeclampsia, or make it worse?
There are studies on this topic, but I have yet to see one that I would consider to be of high quality. It is very hard to study the effects of stress on pregnancy. It would be unethical to lock women in a lab for a year from preconception through post partum, intentionally inflict stress on half of them while pampering the others, and compare the results. Instead, researchers try to find other ways to measure stress. They usually do this in one of two ways, either with retrospective surveys or through arbitrary definitions. There are drawbacks to both of these approaches.
A retrospective survey means researchers ask their subjects after the fact to look back on their pregnancies and rate their stress levels. The drawback is that our memories are not always accurate. Someone might have a relatively easy pregnancy, only to end with a traumatic complication. From then on, their pregnancy will be colored by that trauma. They might remember their pregnancy to be more stressful than it actually was. The opposite can also be true. Someone might have a rough pregnancy, but once baby is safely in their arms, they only remember the happy parts. Their pregnancy is colored by their good ending. When surveys find that subjects with complicated pregnancies report more stress than those with uncomplicated pregnancies, is it because they actually had more stress, or because their trauma has clouded their memories?
This second method involves scientists giving a score to different careers and life events. They give the subjects a stress evaluation based on this scoring system. But it does not take into account that different people might experience different levels of stress in the same situation. For example, I am naturally gifted at public speaking. Give me a topic, a timeframe, and a deadline, and I can lecture in front of 200 people without notes, no problem. But many people would find that same situation incredibly stressful. Can we really say that Doctor is always more stressful than Lawyer, is always more stressful than Teacher, is always more stressful than Fast Food Worker, etc? Or here is another example. When my father's father died, it was a shock to the whole family. No one was expecting it. It was a very stressful time, and we all grieved deeply. When my mother's father died, it was a relief. He had been sick for years, was confined to his bed, and did not recognize us. We still grieved, yes, but not in the same way. If Researchers arbitrarily gave "Death of a Parent" a score of, say, 8/10, my father would say it was more like a 10, and my mother would say it was more like a 4.
What do we know?
We know that preeclampsia happens at similar rates around the world, with all different circumstances and cultures. This includes refugee camps. Now, we may not all agree on how stressful public speaking is. We may not all experience the same level of stress with losing a parent. But I think we can all agree that the life of a refugee is stressful. Dodging bombs and gunfire, watching loved ones die, not knowing where your next meal will come from. No matter who you are or how easy-going your personality, that would be stressful. Yet we do not see higher rates of preeclampsia among refugees. I want to be clear that stress, grief, and trauma are not competitions. The stress in your life is legitimate and important. "Not as bad as a refugee" does NOT mean your problems are not still stressful. But if the stress of fleeing war does not increase the risk of preeclampsia, the loss of a pet, an overbearing boss, or an unsupportive partner probably will not do so, either.
I do not want any of you to feel guilty that you may have caused preeclampsia by being stressed, or worry that you will cause it. Preeclampsia is not your fault. I also do not want you to suffer under a stressful situation. Mental health care is so important. If you find yourself in a difficult situation, there is often help available. There may be local services that can help--support groups, help paying bills, etc. We encourage all of you to talk with their doctors about how you are doing emotionally. Therapy and medication can make a big difference as you process your stressful circumstances. Learning techniques for calming stress can be so helpful. You are not alone.