Can Stress Cause Miscarriage? A Physician Explains
The good and the bad about stress and pregnancy.
Miscarriage — defined as pregnancy loss within the first 20 weeks — occurs in about one in four pregnancies. But despite the fact that miscarriages are relatively common and are almost never the parents’ fault, they can be emotionally traumatic and cause feelings of shame, stress, and anxiety. With pregnancy already being a stressful experience — especially in light of recent rulings — should pregnant people also have to stress about their stress affecting their baby? In other words, can stress cause a miscarriage?
There is no data to support the claim that stress causes miscarriage, and parents shouldn’t blame themselves when a miscarriage occurs, says Brittany Booth, M.D., a reproductive psychiatrist at the University of California, Los Angeles’ Maternal Mental Health program. In one prospective 2018 study of more than 300 pregnant women, the researchers found no correlation between a women’s stress levels and miscarriage.
“This is a conversation I have with my pregnant patients all the time,” Booth says. “So far in my career, I have not seen a case where a person had a miscarriage and I could say, ‘This person’s level of stress directly led to a miscarriage.’”
One 2017 meta-analysis found women who had a history of psychological stress — including financial or marital problems, abuse, or emotional trauma — had about a 40% higher chance of having a miscarriage compared to women who did not. However, the study’s findings should be interpreted cautiously, Booth says. Because pregnant people were asked about their stress levels after-the-fact, there may be some recall bias at play.
“Miscarriage itself is a very stressful event,” Booth says. “There’s potentially more stress being reported that’s maybe leading into the stress from the miscarriage rather than leading up to the miscarriage.”
Another study linked stress and the associated hormone cortisol to miscarriage. However, the study was small with just 22 pregnancies examined, and the authors acknowledged that increased cortisol levels could also be a byproduct of a miscarriage rather than the other way around.
“There are associations that have been made, but we still don’t have causality established,” Booth says. “I think that’s an important distinction.”
The most common cause of miscarriage, occurring in more than half of cases, is a chromosomal abnormality in the embryo. Other medical conditions such as diabetes, thyroid disease, or problems with the uterus, as well as the use of tobacco, alcohol, or caffeine — which may be used to cope with stressful situations — can also increase the risk for miscarriage.
But there does appear to be a link between stress and certain pregnancy outcomes. People with high levels of stress have been shown to be more likely to experience infertility. A new study, for instance, found that of 444 women who were trying to get pregnant, those with higher stress scores based on nine indicators such as cortisol and cholesterol were less likely to get pregnant within a year. Lower level stressors in pregnancy have also been associated with early labor and infants born small for their age.
Although the way that stress causes these outcomes is unclear, it may be because of the production of excess cortisol. This hormone can send the balance of pregnancy-related hormones like progesterone and prolactin out of whack, affecting the placenta and the uterus, Booth says.
Oddly enough, stress may also make a pregnant person more likely to have a girl. Research has found that people who experience stress during pregnancy are less likely to give birth to a boy. That may be because fetuses that would have been assigned male at birth are more vulnerable to miscarriage, the researchers speculated.
If you’re worried about the effects of stress on your baby, there are effective ways to reduce stress in pregnancy. In addition to seeing a therapist, you can try lower-cost options that can be done at home to reduce stress in pregnancy, such as mindfulness, meditation, and yoga.
But don’t get too stressed about being stressed. What’s important to remember is that everyone experiences day-to-day stressors, and pregnant people and their partners should seek help when the stress becomes overwhelming or prolonged, Booth says.
“There's really no way to just completely erase stress from your life when you're pregnant,” she adds. “Don't stress about the stress itself, but rather focus on trying to mitigate it where you can and to not be afraid to seek out help when it's getting to be too much.”
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