COMMENTARY

The Effect of Physical Symptoms in Pregnancy

Marilyn W. Edmunds, PhD, CRNP; Laurie Scudder, MS, NP

Disclosures

April 22, 2009

Frequency, Severity, and Effect on Life of Physical Symptoms Experienced During Pregnancy

Kamysheva E, Wertheim EH, Skouteris H, Paxton SH, Milgrom J.
J Midwifery Women's Health. 2009;54:43-49

Study Summary

Pregnancy is often characterized as a time of excitement, anticipation, and uncertainty; however, it is also accompanied by significant uncontrollable changes in the functioning of a woman's body. The physical changes associated with pregnancy affect all major body systems, producing a range of physical symptoms, from nausea, vomiting, and heartburn to leg cramps, hemorrhoids, and shortness of breath. Many of these symptoms exist to such a degree that they are both unpleasant and have potentially negative effects on a woman's life.

This study was designed to: (1) describe the number, frequency, and severity of discomfort and effect of symptoms on life of 29 physical symptoms women experience at 15 to 25 weeks of gestation; (2) determine whether experiencing this group of physical symptoms more frequently and intensely is associated with a higher score of depressive symptoms and lower self-esteem; (3) examine whether discomfort and effect ratings aid prediction of well-being over and above symptom frequency; and (4) investigate which individual physical symptoms contribute most to predicting depressive symptoms and self-esteem.

Two hundred fifteen pregnant women completed the Beck Depression Inventory, Rosenberg Self-Esteem Scale, and a physical symptoms questionnaire. Frequency, discomfort, and the effect of physical symptoms consistently correlated with higher scores for depressive symptoms, but not as consistently with lower self-esteem. The level of discomfort and the perceived effect of symptoms predicted variance in depressive symptoms after accounting for symptom frequency. The higher the frequency, the more the discomfort, and the presence of both fatigue and flatulence were related to the degree of depressive symptoms. Relationships between physical symptoms related to pregnancy, depressive symptoms, and low self-esteem suggest that when women report any of these 3 factors, further screening is indicated. The clinician should assess physical symptoms for their frequency, level of discomfort, and effect on life.

Viewpoint

It is no surprise that some women are uncomfortable during pregnancy and that, because of their symptoms, they may be depressed and feel worse about themselves. However, this study suggests that when women report all 3 of these factors (discomfort, depression, and low self-esteem), clinicians need to pay attention. This constellation of complaints should alert clinicians to more thoroughly assess for risk for severe depression and low self-esteem that may trigger other emotional problems during or following the pregnancy.

Abstract

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