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. Author manuscript; available in PMC: 2025 Jun 1.
Published in final edited form as: J Reprod Infant Psychol. 2022 Aug 10;42(3):410–423. doi: 10.1080/02646838.2022.2110224

Emotion regulation strategies and perceived stress during pregnancy in expectant mothers and fathers

Francesca Penner a, Madison Bunderson a,b, Cody Bartz a,c, Rebecca J Brooker d, Helena JV Rutherford a
PMCID: PMC9911557  NIHMSID: NIHMS1830762  PMID: 35949103

Abstract

Background:

Stress during the prenatal period can increase risks for physical and mental health problems in parents and offspring. Emotion regulation (ER) during pregnancy may protect against prenatal stress; however, ER is understudied in expectant parents, particularly among expectant fathers. This study aimed to address this gap by evaluating associations between ER strategies (reappraisal, suppression, and the ratio of suppression to reappraisal) and perceived stress among expectant parents, and also by testing whether mothers and fathers differed in ER strategy use and perceived stress levels during pregnancy.

Methods:

N=83 expectant parents (62.7% mothers) in the third trimester of pregnancy completed measures assessing perceived stress and use of reappraisal and suppression strategies. ANCOVA, hierarchical regression, and conditional multilevel models were used to test for associations between ER strategies and perceived stress, and for sex differences in perceived stress and ER strategies.

Results:

Controlling for age and years of education, lower reappraisal and higher suppression independently predicted higher perceived stress in expectant mothers and fathers; in addition, greater tendency to use suppression over reappraisal (higher suppression-to-reappraisal ratio) was associated with greater perceived stress. Expectant mothers and fathers did not differ in perceived stress, reappraisal, or suppression; however, suppression-to-reappraisal ratio scores significantly differed, with fathers demonstrating higher suppression-to-reappraisal ratio scores than mothers.

Conclusion:

Increasing ER skills such as reappraisal while reducing suppression may be beneficial for decreasing stress in expectant mothers and fathers. Expectant fathers report similar levels of perceived stress to mothers and would benefit from prenatal mental health screening and intervention.

Keywords: prenatal stress, emotion regulation, cognitive reappraisal, emotional suppression, expectant mothers, expectant fathers

Pregnancy is a time of significant change that can also bring increased stress. The prenatal period is a sensitive developmental window during which stress—both objective and subjective stress—can have significant impacts for maternal-fetal health, caregiving, and child development (Coussons-Read, 2013; Glover, 2014). Stress in pregnant women has been associated with greater risk for maternal psychopathology and can also have fetal programming effects that increase risks for later mental and physical health problems in offspring (Lupien et al., 2009; Madigan et al., 2018; O’Donnell & Meaney, 2017; Parcells, 2010; Van den Bergh et al., 2020; Vehmeijer et al., 2019). Stress in expectant fathers may also have long-term effects: higher levels of prenatal stress in expectant fathers has been significantly associated with later parasympathetic functioning in infants, even when controlling for maternal prenatal stress (Gao et al., 2021). Given the serious outcomes associated with prenatal stress, it is critical to identify risk and protective factors for stress in expectant parents.

Emotion regulation (ER)—referring to attempts to influence one’s emotions and when they occur (Gross & John, 2003)—may be one important factor in reducing prenatal stress. ER can be conceptualized in terms of specific strategies, such as cognitive reappraisal and emotional suppression. Reappraisal refers to changing one’s thoughts about a situation to change one’s emotional response. Suppression refers to the act of inhibiting one’s emotional response or expression (i.e., keeping a “poker face,” Gross & John, 2003, p. 349). Meta-analytic work has demonstrated positive associations between reappraisal and mental health, whereas suppression has shown negative associations to mental health (Gross & John, 2003; Hu et al., 2014). ER is a transdiagnostic factor with relevance not only to stress but also to a range of mental health disorders (Aldao et al. 2016; Gross, 1999; Lazarus, 1966; Sheppes et al., 2015), and is a modifiable psychological construct targeted in multiple psychological interventions (Sloan et al., 2017). ER is also crucial in parenting (Hajal & Paley, 2020; Rutherford et al., 2015). Because of its relevance to stress, mental health disorders, and caregiving, as well as its modifiability in interventions, ER is an important construct to investigate during pregnancy.

Two studies to date have investigated ER and stress during pregnancy. These studies, which used the same sample of pregnant women, found that greater ER difficulties were associated with recent life stress, health-related life stress, and chronic and episodic life stress (Kaliush et al., 2021; Lin et al., 2019). A few related studies have also examined links between ER and other mental health domains in expectant mothers. Specifically, greater difficulties with ER have been associated with pregnancy-specific anxiety, general anxiety, depressive symptoms, borderline personality pathology, and self-injurious thoughts and behaviors (Lin et al., 2019; McDonald et al., 2021). Higher levels of rumination, considered a harmful ER strategy, were associated with insomnia in pregnant women (Kalmbach et al., 2020). Greater levels of suppression and lower levels of reappraisal have also been linked to pregnancy-specific anxiety (Basharpoor & Taherifard 2019). An examination of cognitive ER strategies showed that blaming others and rumination were associated with depressive and anxiety symptoms, and catastrophizing was associated with anxiety symptoms among pregnant women (Ghorbani-Marghmaleki et al., 2019). Finally, longitudinal research has shown that maternal prenatal ER predicted both pre- and postnatal depression and anxiety symptoms (Cao et al., 2018; Coo et al., 2020).

Though the above studies have begun to demonstrate the importance of prenatal ER for maternal stress and mental health, more research is needed. In particular, examinations of ER and stress during pregnancy have thus far focused on overall difficulties in ER and on domains of life stress (Lin et al. 2019; Kaliush et al., 2021). Additional examination of ER and stress during pregnancy is important because of the risks for increased stress and psychopathology during the perinatal period (Glover, 2014). Stress may be a more accessible construct than depression or anxiety, given the stigma often associated with perinatal depression and anxiety (Byatt et al., 2012). In this regard, perceived stress, referring to one’s subjective experience of stress or appraisals of events as stressful, relative to life stress or objective counts of stressors, may be a stronger predictor of mental and physical symptomology (Cohen et al., 1983). Therefore, it is particularly beneficial to understand the role of ER in perceived stress during pregnancy. In addition, understanding the use of specific ER strategies, such as suppression and reappraisal, and their role in perceived stress among expectant parents would have clinical utility but has yet to be studied. Prior research investigating ER strategies of reappraisal and suppression has also demonstrated that the ratio between suppression and reappraisal—rather than focusing on each strategy in isolation—provides distinct information (Cai et al., 2018; Pines et al., 2018). For example, Cai and colleagues (2018) found that this ratio, but neither strategy on its own, had a significant correlation with anxiety in a youth sample. Examining this ratio may yield further clinically useful information in terms of understanding whether expecting parents tend toward one strategy more than the other, and the effects of using one strategy more than the other. Another research gap is that there are no studies on ER in expectant fathers. Paternal ER is important to understand because distinct effects of paternal versus maternal prenatal factors have been demonstrated (Gao et al., 2021; Hughes et al., 2020), and because fathers have often been overlooked in parenting research (Cabrera et al., 2018).

The current study aimed to address these knowledge gaps by: a) investigating the role of two ER strategies, reappraisal and suppression, in the perceived stress of expectant mothers and fathers, b) examining the relative use of ER strategies, using the ratio of suppression to reappraisal, and its role in perceived stress during pregnancy, and c) evaluating whether expectant mothers and fathers differ in their ER strategies and perceived stress. Our specific hypotheses were: Hypothesis a) reappraisal would be associated with lower perceived stress, and suppression with greater perceived stress; Hypothesis b) tendency to use suppression more than reappraisal (i.e., higher scores for the ratio of suppression to reappraisal) would be associated with greater perceived stress; and Hypothesis c) while mothers would report greater perceived stress, due to the physical and psychological changes in pregnancy, given the absence of literature in this area, we did not make a directional hypothesis regarding differences in the use of ER strategies between mothers and fathers. Overall, this study sought to expand knowledge on ER during pregnancy for both maternal and paternal perceived stress, yielding information germane to prenatal intervention efforts for expectant mothers and fathers.

Materials and Method

Participants and Procedure

The sample included 83 expectant parents in the third trimester of pregnancy (M=36.7 weeks, SD=2.24, range=28–39 weeks). Demographic information can be found in Table 1. Parents were recruited from the local community in a city in the Northeastern United States (U.S.) and completed measures in English using Qualtrics during in-person lab visits as part of a larger study on the transformative experience of pregnancy. Inclusion criteria were that participants must be adults during their own or their partner’s singleton pregnancy. Exclusion criteria included non-English language speaking, severe mental illness preventing participation, history of head injury with loss of consciousness, or history of seizures. Recruitment methods included flyers posted around the community and in prenatal clinics. Individuals interested in participating completed a phone screen with a research assistant who explained the study, determined eligibility based on inclusion/exclusion criteria, and scheduled the study visits if the participant was interested (with or without their partner). Pregnant women (n=51) were enrolled in the study alone or with their partner; 31 partners were male and one female. Informed consent procedures were followed, and all participants provided written consent. This study was approved by Yale School of Medicine’s Human Investigations Committee (HIC# 1608018314).

Table 1.

Participant demographics and descriptive statistics for main study variables

Whole sample
(N = 83)		 Mothers
(n = 52)		 Fathers
(n = 31)
M (SD) or
N. (%)		 M (SD) or
N. (%)		 M (SD) or
N. (%)
Age 30.00 (6.68) 32.03 (7.36) 28.79 (5.99)a
Race/Ethnicity
 Black or African American 31 (37.3%) 20 (38.5%) 11 (35.5%)
 White 29 (34.9%) 18 (34.6%) 11 (35.5%)
 Hispanic/Latinx 12 (14.5%) 7 (13.5%) 5 (16.1%)
 Asian or Asian American 3 (3.6%) 2 (3.8%) 1 (3.2%)
 Mixed Race or Other 8 (9.6%) 5 (9.6%) 3 (9.7%)
Years of Education 13.94 (3.51) 13.87 (2.80) 14.07 (4.50)
Relationship Status
 Single 12 (14.5%) 8 (15.4%) 4 (12.9%)
 In a Relationship 31 (37.3%) 18 (34.6%) 13 (41.9%)
 Married 39 (47.0%) 25 (48.1%) 14 (45.2%)
 Widowed 1 (1.2%) 1 (1.9%) 0
Parity
 Primiparous 47 (56.6%) 30 (57.7%) 17 (54.8%)
 Multiparous 36 (43.4%) 22 (42.3%) 14 (45.2%)
Perceived Stress (PSS) 23.21 (6.83) 23.08 (6.95) 23.42 (6.74)
Reappraisal (ERQ-R) 4.93 (1.37) 5.04 (1.38) 4.75 (1.36)
Suppression (ERQ-S) 3.43 (1.53) 3.27 (1.47) 3.69 (1.63)
ERQ-Ratio (ERQ-S/ERQ-R) .75 (.37) .69 (.33) .84 (.42)b
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Note.

a

Mothers and father significantly differed in age, when controlling for couple ID, F(1, 80)=4.53, p=.04.

b

Mothers and fathers significantly differed in ERQ-Ratio scores, when controlling for age, years of education, and couple ID, F(1, 78)=4.74, p=.03.

Mothers and fathers did not significantly differ on any other variable.

Measures

Perceived Stress Scale (PSS)

Parents completed the 14-item PSS, a self-report measure assessing the extent to which participants viewed situations in their lives as stressful over the last month (Cohen et al., 1983). Response options are presented in a Likert-type scale ranging from 0—Never to 4—Very often. Items are summed for a total score, with higher scores representing higher levels of perceived stress. The PSS is widely used, including among parents during the perinatal period (Grande et al., 2021; Russell et al., 2021). Reliability and construct validity of the measure have been demonstrated (Cohen et al., 1983, Cohen & Williamson, 1988). This measure was created in English and first validated with U.S. samples (Cohen et al., 1983). Internal consistency in the present sample was α=.68.

Emotion Regulation Questionnaire (ERQ)

Parents completed the ERQ, a self-report measure of ER strategies (Gross & John, 2003) that includes 10 items with Likert-type response options from 1—Strongly disagree to 7—Strongly agree. The measure yields two scales: Reappraisal (ERQ-R) and Suppression (ERQ-S). Items for each scale were averaged, with higher scores indicative of greater use of that strategy. The ERQ was developed in English and first validated with U.S. samples (Gross & John, 2003). The ERQ has also been previously used among parents during the perinatal period (Basharpoor & Taherifard, 2019; Grande et al., 2021; Liu et al., 2018). An ERQ ratio score was also calculated by dividing ERQ-S by ERQ-R, based on prior research (Cai et al., 2018; Pines et al., 2018). Scores above 1 reflect greater use of suppression relative to reappraisal. Internal consistency values in the present study were α=.81 (ERQ-S) and α=.89 (ERQ-R).

Data Analytic Strategy

Analyses were conducted in SPSS version 26. Due to the nesting of some participants within couples, we first evaluated whether a multilevel modeling (MLM) approach was necessary by testing unconditional models to estimate variance components and calculate intraclass correlation coefficients (ρ). A separate unconditional model was tested for main study variables PSS, ERQ-R, ERQ-S, and ERQ-Ratio. If the ρ value was over .10, this suggested significant variability in scores from that measure due to clustering of individuals within couples, necessitating inclusion of the clustering structure within the model using MLM. If ρ values were below .10, this suggested that clustering did not need to be accounted for and instead a fixed effects approach could be used. Intraclass correlation values from unconditional models for ERQ-R (ρ=.044), ERQ-S (ρ=0.00), and ERQ-Ratio (ρ=0.00) were below .10. However, for the PSS, the intraclass correlation coefficient was ρ=.165. To account for this variability in PSS due to clustering within couples, we used MLM to conduct all analyses that included the PSS, by testing conditional models with individuals (level 1) nested within couples (level 2), estimating random effects (intercept only) due to couple in addition to fixed effects of predictors and covariates when applicable. Maximum likelihood estimation was used, and an unstructured covariance matrix was specified. In analyses where PSS was not included, we used a fixed effects approach but entered couple ID as a covariate.

First, bivariate associations between main study variables (ERQ-R, ERQ-S, ERQ-Ratio, and PSS) and continuous demographic variables (age, years of education) were tested. Pearson’s partial correlations, controlling for couple ID, were used to evaluate associations among continuous variables other than the PSS. Bivariate associations with the PSS were evaluated with multilevel conditional models. Next, bivariate associations between dichotomous demographic variables (sex, parity, relationship status) and continuous outcome variables were tested using analysis of covariance with couple ID covaried. Sex was coded as 1=Male, 2=Female, Parity as 1=Primiparous, 2=Multiparous, and Relationship Status as 0=Single or Widowed, 1=In a relationship or married. Demographic variables that demonstrated significant associations to main study variables in bivariate analysis were included as covariates in further analysis. Second, an MLM approach was used to test regression models between ERQ subscales and PSS scores. Two conditional models were tested, both including random effects of intercept to account for clustering. In the first model, fixed effects were estimated for relevant covariates and both ERQ-Reappraisal and ERQ-Suppression. In the second model, fixed effects were estimated for relevant covariates and the ERQ-Ratio. Two separate regression models were tested (rather than one) to avoid collinearity between the ERQ-Ratio and the two individual ERQ subscales, and to align with prior investigation of the ERQ-Ratio which examined the ratio in its own models (e.g., Cai et al., 2018). Third, sex differences between mothers and fathers were tested using analysis of covariance (ANCOVA) for ERQ-R, ERQ-S, and ERQ-Ratio, controlling for couple ID and relevant covariates. An MLM approach was also used to evaluate sex differences on the PSS.

There was one same-sex couple in the sample. Results did not differ when we conducted analyses with and without this couple; therefore, they were included in all analyses. Both partners in this couple were in the mothers group when evaluating differences between mothers and fathers. Race/ethnicity variables were examined as covariates, and results were unchanged; they were not included in final analyses to reduce the number of independent variables.

Results

Descriptive and Bivariate Statistics

Descriptive statistics are reported in Table 1. Mothers and fathers significantly differed in age (F(1, 80)=4.53, p=.04), but did not differ in other demographic variables (all p>.59). Bivariate associations between continuous variables are reported in Table 2. Significant associations were observed between age and reappraisal such that older age was associated with greater use of reappraisal (r=.23, p=.04). Higher level of education was significantly associated with lower levels of suppression (r=−.31, p=.005) and lower use of suppression relative to reappraisal (r=−.40, p<.001). Greater use of reappraisal was associated with greater use of suppression (r=.23, p=.04). Higher suppression to reappraisal ratio scores were associated negatively with reappraisal (r=−.48, p<.001) and positively with suppression (r=.70, p<.001). For associations with PSS scores, values are standardized fixed effects estimates from conditional models to account for random intercept effects. Higher level of education was significantly associated with lower levels of perceived stress (β=−.294, p=.007). Greater perceived stress was significantly associated with lower levels of reappraisal (β=−.258, p=.017), higher levels of suppression (β=.213, p=.047), and higher use of suppression relative to reappraisal (β=.334, p=.002). Based on significant associations between parent age and years of education and main study variables, both age and years of education were included in further analysis as covariates. Analysis testing bivariate associations between dichotomous variables (sex, parity, relationship status) and main study variables (PSS, ERQ-R, ERQ-S, ERQ-Ratio) indicated no significant associations (all p ≥ .082); these variables were not included in further analyses as covariates.

Table 2.

Bivariate associations between continuous demographic and main study variables

1 2 3 4 5
1. Age —
2. Years of Education 0.302** —
3. Reappraisal (ERQ-R) 0.226* 0.130 —
4. Suppression (ERQ-S) −0.086 −0.307** 0.231* —
5. ERQ-Ratio −0.200 −0.396*** −0.483*** 0.704*** —
6. Perceived Stress (PSS) −0.134 −0.294** −0.258* 0.213* 0.334**
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Note. Values among variables 1–5 are partial Pearson correlations conditioned on couple ID to account for individuals participating in couples. Values for variable 6, PSS, are standardized fixed effects estimates from multilevel conditional models accounting for random intercept effects due to clustering of individuals within couples.

*

p < .05,

**

p < .01,

***

p < .001

Role of ERQ Strategies in Perceived Stress among Expectant Parents

In the first model (Table 3), suppression was significantly associated with perceived stress (β=.223, p=.044) over and above age, level of education, and random intercept effects, such that greater suppression was associated with greater levels of perceived stress. The association between reappraisal and perceived stress was also significant (β=−.295, p=.007), such that greater reappraisal was associated with lower levels of perceived stress. In the second model (Table 3), the ERQ ratio of suppression to reappraisal scores was significantly associated with stress (β=.265, p=.019) over and above covariates and random intercept effects, with greater use of suppression relative to reappraisal significantly associated with greater levels of perceived stress.

Table 3.

Fixed effects between emotion regulation strategies and perceived stress among expectant parents, controlling for covariates

DV = Perceived Stress (PSS) 95% CI
B SE β df t p Lower Upper
Intercept 28.080 3.900 61.142 7.199 <.001 20.281 35.879
Age 0.012 0.109 .011 65.935 0.106 0.916 −0.206 0.230
Years of Education −0.374 0.215 −.192 71.374 −1.737 0.087 −0.803 0.055
Suppression (ERQ-S) 0.995 0.485 .223 80.491 2.051 0.044 0.029 1.960
Reappraisal (ERQ-R) −1.466 0.531 −.295 82.811 −2.761 0.007 −2.523 −0.410
DV = Perceived Stress (PSS) 95% CI
B SE β df t p Lower Upper
Intercept 28.918 3.970 60.828 7.284 <.001 20.980 36.857
Age −0.025 0.110 −.024 66.314 −0.227 0.821 −0.244 0.194
Years of Education −0.356 0.222 −.183 71.329 −1.602 0.114 −0.799 0.087
ERQ-Ratio 4.894 2.039 .265 78.897 2.400 0.019 0.835 8.954
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Note.

Models were calculated with a multilevel modeling approach using conditional models. Each model includes fixed effects of predictors (shown in table) and random effects of intercept to account for clustering of some individuals within couples. ERQ-R, -S, and -Ratio scores were grand mean centered. ERQ-Ratio was examined in its own model to avoid collinearity with ERQ-R and ERQ-S and in keeping with prior research (Cai et al., 2018).

Sex Differences in Emotion Regulation and Stress among Expectant Parents

ANCOVA results (Table 1) for ERQ-R, ERQ-S, and ERQ-Ratio scores, when controlling for couple ID, age, and years of education, revealed no significant sex differences for ERQ-R (F(1, 78)=2.03, p=.16, d=.21) or ERQ-S (F(1,78)=1.70, p=.20, d=.27). However, there was a significant difference in ERQ-Ratio (F(1, 78)=4.74, p=.03, d=.40), with mothers endorsing a lower suppression to reappraisal ratio (M=.69, SD=.33) relative to fathers (M=.84, SD=.42). Results from the conditional multilevel model testing differences in PSS scores when controlling for age, years of education, and intercept of random effects revealed no significant differences between mothers and fathers (F(1, 43.81)=.27, p=.61, d=.05).

Discussion

Stress during pregnancy can increase physical and mental health risks for parents and offspring. Use of certain emotion regulation (ER) strategies in expectant parents may decrease prenatal stress and help to protect against adverse outcomes. However, there is a dearth of research focused on ER during pregnancy. No studies have yet examined links between ER strategies and perceived stress during pregnancy or have examined ER in expectant fathers. The current study began addressing these gaps by evaluating associations between ER strategies (reappraisal, suppression, and the relative use of suppression over reappraisal) and perceived stress in expectant parents. Findings indicated that greater suppression and lower reappraisal independently predicted greater perceived stress in expectant parents, and higher use of suppression relative to reappraisal also predicted greater perceived stress. Expectant mothers and fathers did not differ in perceived stress or in use of reappraisal and suppression. However, expectant mothers and fathers significantly differed in relative use of ER strategies, with fathers having a higher suppression-to-reappraisal ratio than mothers.

The finding that expectant fathers and mothers did not significantly differ in perceived stress is important for highlighting pregnancy as a time of potential stress for fathers alongside mothers. Though maternal prenatal stress carries additional risks in terms of fetal programming effects, expectant fathers’ stress may worsen their own mental health, exacerbate stress in expectant mothers, and may uniquely impact infant outcomes (Braren et al., 2020; Darwin et al., 2017; Divney et al., 2016; Gao et al. 2021). Our findings point to the importance of screening for elevated stress or other affective symptoms among both expectant parents, and are further evidence of the importance of perinatal mental health in expecting fathers, which is often overlooked relative to maternal perinatal mental health (Baldoni & Giannotti, 2020; Mangialavori et al., 2020; Walsh et al., 2020; Widarsson et al., 2012). While the incidence of perinatal depression and anxiety is higher in expectant mothers than fathers (Rollè et al., 2017), perinatal affective problems in fathers may present differently than for mothers. Baldoni and Giannotti (2020) discuss how men may demonstrate perinatal depression behaviorally via externalizing problems or addictions, or as anxiety or illness behavior. Because fathers may be less likely to endorse depression, assessing perceived stress may help to gain valuable insight into paternal perinatal mental health.

Similarly, reported use of reappraisal and suppression as individual ER strategies did not differ between expectant mothers and fathers. Both mothers and fathers reported more frequent use of reappraisal than suppression. However, fathers’ ratios of suppression to reappraisal were significantly higher than mothers’ ratios. Focusing on the ER ratio considers that individuals tend to use multiple ER strategies (Aldao & Nolen-Hoeksema, 2012; Cai et al., 2018). The current finding reveals that expectant fathers engage in reappraisal (typically associated with better mental health and well-being) relative to suppression (typically associated with greater mental health difficulties and lower well-being) less often than expectant mothers (Gross & John, 2003). This finding somewhat aligns with previous work in which men reported greater levels of suppression than women, which is thought to stem from social norms that encourage emotional expression more in women and suggest that men should control or inhibit their emotions (Chaplin, 2015; Gross & John, 2003).

While the present results are important for providing initial data on ER skills in expectant parents, future work should include multi-method assessments of ER, such as laboratory tasks or biological markers of ER, to examine real-time ER in addition to perceived usage of ER strategies. It is also important for future work to consider the measurement of ER during pregnancy. The neurobiological and psychological changes during the transition to parenthood may affect ER during this period (Rutherford et al., 2015), meaning that perinatal-specific measures of ER may be warranted.

An additional unique contribution of this study was in providing data on the associations between ER skills and perceived stress in expectant parents. The specific links between ER strategies and perceived stress in expectant parents had yet to be studied. Results provide the validation that in the prenatal period, ER skills operated in the expected directions with perceived stress (Gross & John, 2003; Hu et al., 2014): greater use of reappraisal was associated with lower levels of perceived stress, and greater use of suppression was associated with higher levels of perceived stress. While these results consider the independent use of each strategy, this study further evaluated the joint impact of use of reappraisal and suppression on stress during pregnancy using the ERQ-Ratio, demonstrating that the more parents use suppression relative to reappraisal, the higher their perceived stress. Therefore, prenatal perceived stress may be reduced by considering expectant parents’ relative use of these strategies and encouraging replacement of suppression with reappraisal.

The present results have direct clinical implications in underlining that changing ER may be one way of reducing perceived stress in expectant parents. Pregnancy presents a critical opportunity for intervention when parents are making regular healthcare visits and when bolstering ER may have both proximal and distal impacts in terms of parent-child health and caregiving (Hajal & Paley, 2020; Paley & Hajal, 2021; Rutherford et al., 2015). Because ER is a common target across multiple psychological interventions (Sloan et al., 2017), there are many possibilities for incorporating ER skill building into existing prenatal interventions or for adapting existing evidence-based approaches to the prenatal period. Indeed, interventions that address ER such as Dialectical Behavior Therapy, mindfulness interventions, and mentalization-based interventions all have adaptations for the perinatal period (e.g., Lucena et al., 2020; Markin, 2013; Wilson & Donachie, 2018), and there is evidence that prenatal intervention with pregnant women can significantly reduce perceived stress and improve affect regulation (Vieten & Astin, 2008). There is a need to expand the evaluation and implementation of prenatal mental health interventions. For instance, integrated care, including mental health screening, consultation, referral, and even brief intervention in obstetric care settings, is an important and growing area of work (Lomonaco-Haycraft et al., 2018; Moore Simas et al., 2018; Poleshuck & Woods, 2014; Terrazas et al., 2018). Screening for high levels of perceived stress in integrated perinatal care settings may be an important adjunct to screening for depression and anxiety, as well as developing brief skill-building interventions that focus on emotion regulation. Mental health screening and interventions during pregnancy should include the non-pregnant parent (Baldoni & Giannotti, 2020). Moreover, there is significant evidence that maternal and paternal perinatal mental health affect each other (Baldoni et al., 2020; Da Costa et al., 2017; Paulson & Bazemore, 2010), suggesting that it would be maximally beneficial for both parents to receive mental health support where indicated. From a broader public health perspective, informing expectant parents about the potential increase in stress and/or mental health symptoms that may arise during pregnancy for both partners, as well as strategies for managing these concerns and when to seek help, is paramount.

Limitations

Limitations of the current study include that it used only self-report data; therefore, shared method variance may be affecting the strength of observed associations. Second, some mothers participated as a couple with their partner, and some did not. Because of this, paternal and maternal comparisons were group comparisons and not within-couple comparisons. Third, data were collected at one timepoint and cannot speak to effects over time of ER on stress. Due to the cross-sectional nature of data, it is also possible that perceived stress affects use of ER strategies (i.e., greater stress leads to greater suppression and less reappraisal), rather than the opposite. In this study, we focused on perceived stress as the dependent variable because it overlaps with mental health variables such as depression and anxiety (Cohen et al., 1983), yet may be more accessible for parents to endorse compared to symptoms of psychopathology, in the context of perinatal mental health screening. Prior research has shown that emotion dysregulation often precedes the development of psychopathology (Crowell et al., 2015), and further, ER during the prenatal period predicts both concurrent and longitudinal mental health symptoms in mothers (Cao et al., 2018; Coo et al., 2020). Therefore, ER may be conceptualized as a predictor of perceived stress. Nevertheless, future work should examine the direction of effects between perceived stress and ER during the perinatal period. A final limitation is that this study lacked a control group of non-pregnant women and their partners, and therefore we cannot say conclusively that our findings are specific to the prenatal period. Future research would also benefit from testing these associations simultaneously in a group of expectant parents and a matched control group of non-parents.

Conclusion

ER during pregnancy is understudied—and even more so in expectant fathers—but may play a role in prenatal stress, which carries well-documented physical and mental health risks for parents and offspring. This study provided novel data demonstrating that ER strategies and perceived stress are related in expected directions during pregnancy among expectant mothers and fathers. Further, perceived stress levels did not differ among fathers and mothers, suggesting that efforts to reduce stress during pregnancy should include both partners. In particular, boosting cognitive reappraisal skills while reducing emotional suppression in expectant parents may help to decrease perceived stress.

Acknowledgements

We would like to thank all the parents who participated. This work was supported by the BIAL Foundation, NIDA R01 DA050636, NIMH R01 MH113669, and NIMH T32 MH18268.

Footnotes

Disclosure of Interest

The authors report no conflicts of interest.

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