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Mar 29Liked by Molly Dickens, PhD, Chelsea Conaboy

This was such an interesting read. Thank you !

I think one way to combine your two perspectives, is by thinking of the concept of biological interactions. There is a biological interaction between Pregnancy and acute stressors - in relation to health outcomes. Such that pregnancy itself changes your susceptibility to the stressors. The stressors themselves might not cause adverse health outcomes by themselves, and pregnancy itself would not - but together they do. A biological interaction - when two factors are necessary. This way of defining causal relationship is well described by epidemiologist - Kenneth Rothman

Interactions is also just a way to acknowledge the complex biology of health and disease and that there may also be unknown causes that are part of the causal network of factors that ultimately led to the outcome.

Anyway. Much appreciated to read your discussion and love your project !

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Yes! Thanks Majken. This is such an important framing, and very much what was on my mind when we were having this conversation. In many ways this is the path we kept circling.

If the stressors aren't stressors without the presence of the pregnancy, then what does that mean for how we think about the pregnancy itself?

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This is an interesting way to think about it. And I'm coming around to the circular, intertwined , complicated nature of the biological processes and psychological framing of stress during pregnancy.

And thanks for the reference Majken! Admittedly, this quote in the abstract -- "Philosophers agree that causal propositions cannot be proved, and find flaws or practical limitations in all philosophies of causal inference." -- has me spinning a bit and having flashbacks to a Philosphy of Science course I took in college 😄

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Feb 15Liked by Chelsea Conaboy, Molly Dickens, PhD

This was super interesting! I think it would’ve made a great podcast also.

I felt anxiety during pregnancy in anticipation of having a baby. I think I would have felt the same thing if I had been preparing to adopt. What about pregnancy as the state of expecting a baby to show up being a stressor?

(I struggle a bit to understand the definition of a stressor, so please excuse me if this is a silly thought!)

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No thoughts are silly!

Anticipation of baby is definitely a stressor, regardless of whether or not you are a birth parent or the non-birth parent.

It feels related to the "lack of control" that the brain identifies as "stressor" before triggering a stress response. I would still classify it as a stressor *related to* pregnancy (again, regardless of whether you are the birthing parent or not... in some ways, the stress of "expecting a baby" could be harder for adoptive parents who truly have little control)

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Mar 29Liked by Molly Dickens, PhD

Yes I think you are! And realizing that some factors are causes under certain circumstances (eg pregnancy might require other factors present as well ) but not under other circumstances.. you can imagine that for each adverse pregnancy outcome a multi factorial set of causes were present - but many different such causal structures can be found and they might include some unknown.

I realize I’m now mixing stressor and risk factor - but just totally got brought back to this framework by your thread. Of course way better explained in the original https://pubmed.ncbi.nlm.nih.gov/16030331/

B

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That definitely makes sense. Does that give as a heuristic we can use to determine whether pregnancy is a stressor? We can differentiate anticipation of baby from pregnancy because it applies to all parents-to-be?

I also experienced what I am tempted to describe as dysphoria during pregnancy. The fact that my body was pregnant was extremely troubling to me in a way I have difficulty describing, even though my pregnancy was planned. I guess in that case it's not pregnancy but the dysphoria (or whatever the appropriate term would be) that's the stressor?

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Great questions, Jensen! Just to stir the pot—Molly, how would you separate the dysphoria from the pregnancy? If pregnancy causes dysphoria, and dysphoria activates the stress pathways, then is pregnancy the origin of the stress?

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yes! great questions! And keep stirring, Chelsea!

For me, I have been separating up to this point by considering what is initiated internally and what is stimulated externally. (You know that I can't resist drawing stuff so I added a footnote with a drawing about this 😅)

The statement "pregnancy is not a stressor" came out of my stance that a "stressor = a stimuli that initiates an acute stress response" and the physiological changes of pregnancy, themselves are not activating an acute stress response.

But, yes, that distinction blurs when you consider that there are certainly elements of pregnancy that are psychological stressors, like birth anticipation and dysmorphia, and the other examples you point out, Chelsea. These are stressors *associated with* pregnancy.

Does that make pregnancy, itself, a stressor? Ehhhh.... I still want to be careful with that because it makes a universal statement for a very personal interpretation of this time of life. There are stressor nodes on the map that are directly associated with pregnancy (birth experience, perinatal care journey, complications... and I should add in dysmorphia!) and who is exposed to those stressors and how the brain interprets, and responds to them is very individual. Also, for some (dare I say most?) of them, you can address the stressors at each stage of the way with how we support and care for birthing and non-birthing parents.

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