Nerves of sugar

My big appointment is tomorrow.  How do I feel?  NERVOUS.  How am I handling it?  Oh, just eating my feelings.  I had 2 rice krispies treats and a dilly bar yesterday, and THREE dilly bars today.  What can I say, when I’m nervous I eat!  (Nom nom nom!)

What am I nervous about?  Well, obviously I’m nervous that we’re going to find some catastrophic structural issue, just like we did at our last 12 week appointment (omphalocele, poor spinal ossification, etc.) or just like we would have if we’d had a 12 week appointment for my pregnancy before that one that went that far (anencephaly, which would have been seen at 12 weeks, was not diagnosed until 15 weeks).  I’m also nervous that there will be something catastrophically wrong, but we WON’T see it at the 12 week appointment, and instead will see it at our 15/16 week appointment, or our 20 week appointment, or (worst of all) not until after baby is born.

I did some searching on a variety of topics.  One was just the general risk of miscarriage, particularly when age is factored in.  (I’m 39 now y’all!  Hubby’s turning 41!) http://onlinelibrary.wiley.com/doi/10.1046/j.1469-0705.1996.07030170.x/pdf  This article says what we all know—miscarriage risk increases with age, decreases the longer baby sticks around, and increases if you have bleeding (which fortunately I do not have this time).  However, it did not find an association with previous pregnancy loss and miscarriage rate.  (I don’t believe it, but I’ll take it!) The article also says that for losses between 8-15 weeks (the zone we’re in now), 45-70% of the cases are likely due to chromosomal abnormalities.  We do not appear to have those—at least any of the common ones.

Another topic was, what are the chances of miscarriage of a chromosomally normal baby after a normal 12 week scan?  Well, the internet has an answer!  It’s about 0.5%, which means 1/200.  That number sounds pretty low, or pretty high, depending on how you look at it.  http://onlinelibrary.wiley.com/doi/10.1002/uog.5138/pdf  “In singleton pregnancies with estimated risk of Down syndrome < 1:250 according to NT screening at 12-14 weeks, the spontaneous fetal loss rate before 25 weeks is likely to be around 0.5%. NT thickness up to 3 mm does not seem to affect the risk of miscarriage in such pregnancies. Instead, the risk seems to increase with number of previous miscarriages and deliveries, and possibly the risk is highest in the youngest and oldest women.”  Ugh again on the old mom shaming.

Okay, the topic that’s really got me stressing—how much does stress impact fertility/birth defects?  It turns out, probably some.  https://www.nature.com/articles/s41598-017-01792-3  This article looked at a variety of prior studies and suggests that stress does increase miscarriage risk: “Whilst chromosomal abnormalities underlie many cases of early pregnancy loss, the present results show that these psychological factors can increase the risk by approximately 42%.”  The article appears to accept that stress does not cause chromosomal abnormalities, but suggests that stress can increase miscarriage risk “from activation of the hypothalamic-pituitary-adrenal axis by recruitment of hypothalamic neurones which secrete corticotrophin-releasing hormone, increasing pituitary secretion of adrenocorticotrophic hormone secretion and hence of adrenal cortisol. This hormone has direct effects on decidual and placental metabolism but also interacts with progesterone signalling. Stress-related early pregnancy failure could also result from suppression of the hypothalamic-pituitary-gonadal axis…. These mechanisms are relevant because progesterone activity is crucial for the maintenance of pregnancy; low levels in early of gestation predicting miscarriage. Among its multiple effects, this hormone contributes to the suppression of maternal immune response to the conceptus.”  They also cite a study that “reported a live birth rate of 86% in women with recurrent (≥3) miscarriages who were enrolled into a program of emotional support, compared to 33% in similar women who had no formal supportive care.”  Maybe that’s why my OBs are pushing therapy on me!  I’m not sure what they would think of my rice krispies bar and dilly bar therapy plan….  (The article also cited an article I’ve seen before that says working out more than 7 hours a week increases miscarriage risk up to 18 weeks gestation.  http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2007.01496.x/abstract;jsessionid=549CA759D4EC7D5FF1256DE51DE4C1B5.f03t04)

Here's the one that really bums me out—the potential link between stress and birth defects. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2094125/  Here, the researchers looked at the 2 months before conception through 2 months after conception and evaluated the mother’s stressful life events to see if there was a correlation with birth defects.  The mothers answered an 18-item inventory of stressful life events, such as:

whether she or her husband (or partner) had started a new job or lost a job;

whether she or anyone close to her had had a serious illness or injury, serious legal or financial problems, problems with drinking or drugs, or had problems with immigration;

whether she or anyone close to her had been a victim of violence or crime;

whether anyone close to her had died; whether she was separated or divorced or had had serious difficulties with her husband or partner;

whether she had moved;

whether she had had serious problems or disagreements with relatives, neighbors, or in-laws.

Most of the mothers of in the study were Hispanic, many had less than a high school education, and a majority took a folic acid-containing supplement during the periconceptional period.  The researchers found that birth defects tended to increase with the more stressful events the women had experienced.  The specific birth defects they say increased from stress were oral clefts, neural tube defects (ugh), and conotruncal heart defects.  They theorize that stress causes increased production of corticosteroids, which are teratogenic (ie bad).  They concluded, “more stressful life events experienced by the mother around the time of conception were associated with increased risks of orofacial clefts, NTDs, and conotruncal heart defects among offspring.”

Of course, if I were a participant in this study, I would have answered no to every single question they asked.  But going through fertility treatments—especially after a history of loss—is VERY stressful.  Plus, I have a demanding job that can be stressful at times.  How do I know if my life stresses—admittedly nothing to those faced by many other women—contributed to our birth defects?  I don’t.  And apparently stressing out about it is not going to make it any better.  So I’ll just have to wait and see what happens tomorrow....And maybe find something to eat.