Stress in the first trimester

Fetus to Mom: You're Stressing Me Out!

Dr. Calvin Hobel, a perinatologist in Los Angeles, has spent much of his career trying to document the effects of stress on pregnancy and to figure out how best to get pregnant women to relax. Not only does he see the importance clinically, but he's reminded of it daily.

Beginning with his 45-minute commute to Cedars Sinai Medical Center, Dr. Hobel watches women putting on makeup in their cars, wolfing down bites of breakfast ... and the clincher? Pregnant women who come to yoga classes to learn how to relax have to take a breather -- to answer cell phones they just couldn't leave behind.

Stress is such a familiar part of women's lives that many just squeeze a pregnancy right into all the hubbub. Even if women wonder whether it's bad for their developing fetuses, it's often hard to get a straight answer, mainly because most doctors don't know how much stress is too much -- or for whom.

But researchers, including Hobel, are getting closer to unlocking the mystery.

For one thing, a growing number of studies are confirming what used to be considered just an old wives' tale -- that stress really isn't good for pregnant women. It not only increases the risk of pre-term labor, but possibly a host of other problems for babies after birth.

Even more important -- and clearly more difficult to discern -- researchers are close to being able to predict who's most susceptible to stress and at highest risk for complications, such as pre-term birth. In fact, some say it won't be long before health-care providers have the tools to head off these problems before it's too late.

"Stress is a silent disease," says Dr. Hobel, director of maternal-fetal medicine at Cedars Sinai and a professor of obstetrics/gynecology and pediatrics at University of California, Los Angeles (UCLA). "Pregnant women need to be educated in recognizing when they have stress, the consequences and some of the simple things they can do to make a difference."

Throw Out the 'Blueprint'

Developmental biologists once thought fetuses were conceived with a "blueprint" from their parents' genes. As long as you gave the growing fetus the right nutrients and avoided harmful substances, this blueprint would develop into a healthy baby. That's not what experts believe anymore, says Dr. Pathik Wadhwa, assistant professor of behavioral science, obstetrics and gynecology at University of Kentucky College of Medicine.

"This view has more or less been completely turned upside down," says Dr. Wadhwa, who is co-editing a special issue of scientific papers on pregnancy and stress to be published in Health Psychology next year. "At each stage of development, the organism uses cues from its environment to decide how best to construct itself within the parameters of its genes."

Stress is an example of how a fetus responds to stimuli in the womb and adapts physiologically. "When the mother is stressed, several biological changes occur, including elevation of stress hormones and increased likelihood of intrauterine infection," Dr. Wadhwa says. "The fetus builds itself permanently to deal with this kind of high-stress environment, and once it's born may be at greater risk for a whole bunch of stress-related pathologies. "

Pre-term births and low birth weight are among the most recognized effects of maternal stress during pregnancy, established over nearly two decades of animal and human research. Recent studies by Dr. Wadhwa and colleagues suggest that women who experience high levels of psychological stress are significantly more likely to deliver pre-term. Typically, one in 10 women delivers pre-term (before 37 weeks).

Pre-term babies are susceptible to a range of complications later, including chronic lung disease, developmental delays, learning disorders and infant mortality. There's even compelling evidence from epidemiological studies and animal research that babies who experience stress in utero are more likely to develop chronic health problems as adults, such as heart disease, high blood pressure and diabetes.

Most recently, some studies are suggesting that stress in the womb can affect a baby's temperament and neurobehavioral development. Infants whose mothers experienced high levels of stress while pregnant, particularly in the first trimester, show signs of more depression and irritability. In the womb, they also are slower to "habituate" or tune out repeated stimuli -- a skill that, in infants, is an important predictor of IQ.

"Who you are and what you're like when you're pregnant will affect who that baby is," says Janet DiPietro, a developmental psychologist at Johns Hopkins University. "Women's psychological functioning during pregnancy -- their anxiety level, stress, personality -- ultimately affects the temperament of their babies. It has to ... the baby is awash in all the chemicals produced by the mom."

The Womb Is a Busy Place

So, how does a mom's stress get passed onto their fetus? Researchers aren't exactly sure which stress responses play the largest role, but it's clear that when a pregnant woman experiences anxiety, their body produces chemicals that affect the baby, too. Their nervous system, for instance, stimulates the release of epinephrine and norepinephrine, stress hormones that constrict blood vessels and reduce oxygen to the uterus.

Since a very significant decrease in blood flow is probably necessary to compromise development of the fetus, Dr. Wadhwa says that another stress response is more likely to affect fetal growth and pre-term labor. That is, when pregnant women experience stress, particularly in the first trimester, the placenta increases production of corticotropin-releasing hormone (CRH), which regulates the duration of pregnancy and fetal maturation.

CRH is one of the most exciting recent scientific discoveries that could explain why women go into labor when they do. Called the "placental clock," CRH levels measured in the mother's blood early in pregnancy -- between 16 and 20 weeks -- can predict the onset of labor months later. Those with the highest levels will likely deliver prematurely, and those with lowest levels are apt to deliver past their due dates.

And it appears that stressful events occurring during the first trimester are most critical in signaling early labor. "That's very important because it used to be thought exactly the opposite -- that women become fragile as term approaches. Indeed, our data suggests that women become psychologically stronger," says Dr. Curt Sandman, professor and vice chairman of the department of psychiatry at University of California, Irvine.

Monitoring CRH levels and managing stress that early in pregnancy may have important implications in reducing pre-term delivery, says Dr. Christine Dunkel-Schetter, a professor of psychology at UCLA. Dr. Dunkel-Schetter is working on two studies (one with Drs. Wadhwa, Hobel and Sandman) to determine who is at highest risk for pre-term birth and what types of stresses are the biggest contributors.

"It appears we will be able to show that stress in pregnant women early in pregnancy leads to an early rise in CRH, which then leads to an early delivery," she says. "What we can't do yet is diagnose which women are most at risk. But we're close, and very soon it will be appropriate for women to be asking their doctors if their level of stress should be assessed systematically."

What's Too Much .

.. and for Whom?

Tiffanie Pomerance of Los Angeles remembers when she was admitted to the hospital during her first pregnancy after a sonogram found that her cervix had started to dilate at 19 weeks. Doctors stitched her up but she started having severe contractions and was hospitalized. Everyone, including her husband and family, was worried.

"We just sat in the hospital room staring at the fetal monitor, looking at how many contractions I was having. We all thought I was going to lose the pregnancy," says Pomerance, 32. Her mother finally covered the monitor with a towel when Dr. Hobel explained that worries would exacerbate her condition. Sure enough, she started to notice that contractions got worse when she was more anxious.

In hindsight, Pomerance says her hectic lifestyle as a speech therapist -- working 12-hour days, dividing her time between three nursing homes and grabbing lunch while standing -- probably contributed to her problem in the first place. She slowed down considerably with her second pregnancy. Fortunately, she carried both babies to 35 weeks.

Like most women, Pomerance had no idea how much stress could put her over the edge. "I was under your everyday type of stress. I thought that I would do it all, plus work out every day at the gym. Now I tell anyone who's pregnant to slow down a bit."

That's what makes health providers so reluctant to emphasize the connection between stress and pregnancy problems. They say a lot of the differences come down to women's personalities and how they cope with stress. Besides, who wants to lay even more guilt and anxiety on a woman who is already stressed?

Dr. Dunkel-Schetter says she's hoping to nail down the biggest predictors of stress and devise a questionnaire that women could take, along with the blood test to measure CRH levels, to determine who's at highest risk. She says it appears that women who are constantly anxious or fearful may be most susceptible to problems during pregnancy.

"Stress can be lots of things," she says. "What you'll see in the literature (are) these lists of life events -- 'Did somebody die? Did you lose your job?' But those events are not what's leading to early delivery. What I see in our work that's leading to early delivery is being a generally anxious person ... for instance, a lot of fear about the pregnancy and delivery."

But she says it's a continuum. "Low levels of anxiety we all know and feel -- sometimes more, sometimes less," says Dr. Dunkel-Schetter. "The highest level is somebody who has panic attacks or is extremely fearful of many things, and it's probably the case that the higher you are on this continuum, the more risk to your physiology in pregnancy."

Personality traits that might account for some women being better able to handle stress include optimism, self-esteem, a feeling of control over one's life, emotional suppression or expression, and hostility, says Dr. Wadhwa.

So, What's a Mother To Do?

Dr. Hobel worked in France with one of the first obstetricians to successfully reduce pre-term births. The program he devised included work leaves as early as 24 weeks into the pregnancy and nurse-midwife home visits to help women handle psychosocial stress. He started a similar program for 12,000 women in Los Angeles in the 1980s; pre-term births dropped 21% at a time when pre-term birth rates were increasing in the city and nationally.

"I think our whole approach to comprehensive prenatal care today is sort of messed up -- a lot of the focus is on the wrong things," says Dr. Hobel. "We measure a woman's blood pressure, her uterine size, listen to the baby's heart tones, but no one asks how things are going with her life."

The big question, he says, is finding the right interventions. He and Dr. Dunkel-Schetter believe some of those components include the usual methods to reduce stress, including biofeedback, guided imagery and yoga. But what may be equally important are a woman's support network and providing enough information about prenatal care and the pregnancy to ward off worries.

And it's clearly a matter of teaching women how to relax, a foreign concept for many. "No one is telling them that they should look at what they're doing," says Dr. Hobel. It might mean taking Wednesdays off and work Saturdays instead, just to break the fatigue of a week's work; or making sure to take time for breakfast and frequent meals.

"Sure, I think there are some super women that can deal with stress, but if you really study them, you'll recognize that they've got some built-in mechanisms, something about the way they're dealing with their lives, that makes a difference," says Dr. Hobel. "Pregnancy itself is a real stress on the body."

Dr. James McGregor, a professor of obstetrics at the University of Colorado Health Sciences Center, uses another type of test to predict pre-term labor. It's a saliva test that measures another hormone, estriol, which can give up to three-weeks notice of the onset of labor. He's even called employers when it indicates a patient needs to kick back a little.

Sometimes, he says, it's hard to persuade pregnant women themselves that they may need to slow down if they're feeling stressed. "Actually everybody knows it, but we kind of deny it," says Dr. McGregor. "Stress comes under the heading of an old wives' tale, but in this case, it happens to be true."

What Is Your Stress Level?

Here are some questions to assess your level of stress during pregnancy, developed by Dr. Calvin Hobel, director of maternal-fetal medicine at Cedars Sinai Medical Center in Los Angeles. For each question, answer "yes," "sometimes" or "no." If you answer "sometimes" or "yes" to three or more questions, says Dr. Hobel, you may have sufficient stress to warrant some form of counseling or intervention. Consult your health-care provider.

I feel tense.
I feel nervous.
I feel worried.
I feel frightened.
I have trouble dealing with problems.
Things are not going well.
I cannot control things in my life.
I am worried that my baby is abnormal.
I am concerned that I may lose my baby.
I am concerned that I will have a difficult delivery.
I am concerned that I will be unable to pay my bills.
I live apart from my partner or spouse.
I have extra-heavy homework.
I have problems at work.
Have you and your partner or spouse had any problems?
Have you been threatened with physical harm?

Stress and pregnancy

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KEY POINTS

Stress is a common feeling during pregnancy. Physical discomforts and other changes in your daily life can cause stress during pregnancy.
Some types of stress may cause serious health problems, like high blood pressure, and lead to problems like premature birth.
Learn about ways to help manage some stresses in your life like talking to your health care provider and asking your partner, friends or family for help.

How can stress affect your pregnancy?

Feeling stressed is common during pregnancy because pregnancy is a time of many changes. Your family life, your body and your emotions are changing. You may welcome these changes, but they can add new stresses to your life.

High levels of stress that continue for a long time may cause health problems, like high blood pressure and heart disease. During pregnancy, stress can increase the chances of having a premature baby (born before 37 weeks of pregnancy) or a low-birthweight baby (weighing less than 5 pounds, 8 ounces). Babies born too soon or too small are at increased risk for health problems.

What causes stress during pregnancy?

The causes of stress are different for every woman, but here are some common causes during pregnancy:

You may be dealing with the discomforts of pregnancy, like morning sickness, constipation, being tired or having a backache.
Your hormones are changing, which can cause your mood to change. Mood swings can make it harder to handle stress.
You may be worried about what to expect during labor and birth or how to take care of your baby.
If you work, you may have to manage job tasks and prepare your team for when you take maternity leave.
You may worry about how you eat, drink and feel and how these things affect your baby.

What types of stress can cause pregnancy problems?

Stress is not all bad. When you handle it right, a little stress can help you take on new challenges. Regular stress during pregnancy, such as work deadlines, probably don’t add to pregnancy problems.

However, serious types of stress during pregnancy may increase your chances of certain problems, like premature birth. Most women who have serious stress during pregnancy can have healthy babies. But talk to your health care provider if you have these types of stress:

Negative life events. These are things like divorce, serious illness or death in the family, or losing a job or home.
Catastrophic events. These include earthquakes, hurricanes or terrorist attacks.
Long-lasting stress. This type of stress can be caused by having problems with money, being abused, being homeless or having serious health problems.
Depression or anxiety. Depression is a medical condition that causes feelings of sadness and a loss of interest in things you like to do. It can affect how you feel, think and act and can interfere with your daily life. It needs treatment to get better. Anxiety is a feeling of worry or fear of things that may happen. Both conditions may make it hard to take care of yourself and your baby. Depression and anxiety are common and treatable so talk to your provider if you feel depressed or anxious. If you have these conditions before pregnancy, talk to your provider before stopping or starting any medications. Quitting suddenly can cause serious problems for you and your baby. If you need to stop taking medicine or switch medicines, your health care provider can help you make changes safely.
Neighborhood stress. Some women may have stress from living in a neighborhood with poverty and crime.
Racism. Some women may face stress from racism during their lives. This may help explain why African-American women in the United States are more likely to have premature and low-birthweight babies than women from other racial or ethnic groups.
Pregnancy-related stress. Some women may feel serious stress about pregnancy. They may be worried about pregnancy loss, the health of their baby or about how they’ll cope with labor and birth or becoming a parent. If you feel this way, talk to your health care provider.

How does stress cause pregnancy problems?

We don’t completely understand the effects of stress on pregnancy. But certain stress-related hormones may play a role in causing certain pregnancy complications. Serious or long-lasting stress may affect your immune system, which protects you from infection. This can increase the chances of getting an infection of the uterus. This type of infection can cause premature birth.

Other ways stress can cause pregnancy problems include:

Normal pregnancy discomforts, like trouble sleeping, body aches and morning sickness may feel even worse with stress
You may have problems eating, like not eating enough or eating too much. This can make you underweight or cause you to gain too much weight during pregnancy. It also may increase your risk of having gestational diabetes and preterm labor.
Stress may lead to high blood pressure during pregnancy. This puts you at risk of a serious high blood pressure condition called preeclampsia, premature birth and having a low-birthweight infant.
Stress also may affect how you respond to certain situations. Some women deal with stress by smoking cigarettes, drinking alcohol or taking street drugs, which can lead to serious health problems in you and you baby.

Many women worry that stress may lead to miscarriage, the death of a baby before 20 weeks of pregnancy. While extra stress isn't good for your overall health, there's no evidence that stress causes miscarriage.

How can post-traumatic stress disorder affect pregnancy?

Post-traumatic stress disorder (also called PTSD) is a disorder that develops when you have problems after you experience a shocking, scary or dangerous event. These events may include rape, abuse, a natural disaster, a terrorist attack or the death of a loved one. People with PTSD may have:

Serious anxiety
Flashbacks of the event
Nightmares
Physical responses (like a racing heartbeat or sweating) when reminded of the event

Women who have PTSD may be more likely than women without it to have a premature or low-birthweight baby. They also are more likely than other women to have risky health behaviors, such as smoking cigarettes, drinking alcohol, abusing medications or taking street drugs. Doing these things can increase the chances of having pregnancy problems. If you think you may have PTSD, talk to your provider or a mental health professional. Treatments for PTSD include medications and therapy.

Can high levels of stress in pregnancy affect your baby’s health later in life?

Some studies show that high levels of stress in pregnancy may cause certain problems during childhood, like having trouble paying attention or being afraid. It’s possible that stress also may affect your baby’s brain development or immune system.

How can you reduce stress during pregnancy?

Here are some ways to help you reduce stress:

Know that the discomforts of pregnancy are only temporary. Ask your provider about how to handle these discomforts.
Stay healthy and fit. Eat healthy foods, get plenty of sleep and exercise (with your provider’s OK). Exercise can help reduce stress and also helps prevent common pregnancy discomforts.
Cut back on activities you don’t need to do. For example, ask your partner to help with chores around the house.
Try relaxation activities, like prenatal yoga or meditation. They can help you manage stress and prepare for labor and birth.
Take a childbirth education class so you know what to expect during pregnancy and when your baby arrives. Practice the breathing and relaxation methods you learn in your class.
If you’re working, plan ahead to help you and your employer get ready for your time away from work. Use any time off you may have to get extra time to relax.

The people around you may help with stress relief too. Here are some ways to reduce stress with the help of others:

Have a good support network, which may include your partner, family and friends. Or ask your provider about resources in the community that may be helpful.
Figure out what’s making you stressed and talk to your partner, a friend, family or your provider about it.
If you think you may have depression or anxiety talk to your provider right away. Getting treatment early is important for your health and your baby’s health.
Ask for help from people you trust. Accept help when they offer. For example, you may need help cleaning the house, or you may want someone to go with you to your prenatal visits.

Last reviewed: October, 2019

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Pregnancy stress threatens the health of the unborn child - DW - 11/07/2013

Vladimir Fradkin

November 7, 2013

It is well known that severe stress is harmful. Now scientists have taken up the question of how the stress experienced by the mother during pregnancy affects the health of the child.

https://p.dw.com/p/1ADc4

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Pregnancy, even if it is not the first, in itself, of course, is a fair amount of stress. But even if this were not so, hardly any woman manages to avoid the stress caused by various events of everyday life for all nine months. And therefore, almost any expectant mother asks the question: how will the stress she experiences affect the child? Can the fear, pain, grief, irritation, or arousal of the mother be transmitted to the fetus in the womb?

Maternal stress hormone in fetal blood

Not only can they be transmitted, but they must be transmitted, although, of course, still not fully, doctors say. The placenta contains a number of hormones designed to protect the fetus from the harmful effects of cortisol, the mother's stress hormone. But it still penetrates into the blood of the embryo. True, there its concentration is about 10 times lower than the maternal one, however, it is also enough to have a significant effect on the fetal body.

And not just significant, but long-term, often even permanent. This conclusion was reached by a group of doctors led by Professor Matthias Schwab (Matthias Schwab) from the Hans Berger Neurological Clinic at the University Hospital of Jena. The scientists reported the results of their research at the 21st annual session of the German Somnological Society, which took place in Wiesbaden.

“Antenatal stress leads to a long-term increase in fetal cortisol levels and accelerates brain maturation,” says Prof. Schwab, who heads the Intrauterine Brain Development and Later Life Programming of Disease Working Group. “For this reason, the stress experienced by the mother during pregnancy , is a serious risk factor that increases the likelihood of a child developing later depression and other pathologies.

Dreaming of a lamb in the womb of a sheep

Professor Schwab and his colleagues conducted their experiments on sheep, since in these animals the course of pregnancy and the formation of the embryo have a significant similarity with the same processes in humans. Pregnant - that is, pregnant - sheep, the researchers injected betamethasone, a synthetic glucocorticoid drug related to cortisol, which is often prescribed to women with the threat of premature birth. This drug speeds up the development of the lungs in the fetus, which increases the chances of a premature baby to survive. Betamethasone was administered to pregnant sheep at a stage corresponding in pregnant women to the period between the 25th and 32nd weeks.

At the same time, scientists monitored the intrauterine brain activity of embryos using electroencephalography. It turned out that betamethazole accelerates the maturation of not only the lungs, but also the brain, says Professor Schwab: “This is evidenced, first of all, by the early appearance of dreams. Usually, the formation of dreams occurs in the last third of pregnancy, and this development occurs very gradually. And betamethasone literally includes there is some kind of toggle switch in the brain, and dreams are formed in 2-4 days. "

Brain development inhibits cell growth and division

Another consequence of the introduction of the hormone was an abnormally frequent alternation of the phases of REM and non-REM sleep. This fragmentation of sleep, if it becomes permanent, indicates a high risk of developing depression later in life and, according to Professor Schwab, is often diagnosed in newborns whose mothers experienced severe stress during pregnancy.

The problem is that the premature maturation of brain structures occurs due to a slowdown in cell division and body growth, the scientist says. This is confirmed by other doctors. "Children given injections to accelerate lung maturation showed a very significant increase in stress axis activity and had a markedly lower birth weight," says Thorsten Braun, a gynecologist at the Charité University Hospital in Berlin.

Therapy with betamethasone is fraught with behavioral disorders

In Germany, 8 to 10 percent of pregnant women receive betamethasone. The fact that this drug reduces mortality among premature babies by 31 percent has long been scientifically proven. However, animal experiments have shown that taking the drug also causes long-term side effects - in particular, hypertension - and also contributes to the development of cardiovascular diseases and diabetes in later life.

As for a person, here scientists have identified, first of all, an increased risk of developing depression and behavioral abnormalities. Recently, Professor Schwab and his colleagues examined 40 eight-year-old children who had previously undergone intrauterine therapy with betamethasone. Comparing the test results of these children with the test results of children in the control group revealed significant differences, the scientist emphasizes: ". Electroencephalography also showed that these children could not relax before testing, and could not concentrate during testing.

No reason to panic

Apparently, the increased content of the stress hormone in the blood at the stage of intrauterine development leads to the fact that the body of the embryo gets used to this situation and begins to perceive it as the norm. "These babies are already programmed in the womb to produce too much of the stress hormone later in life," says Professor Schwab.

The Dutch colleagues of the German scientist - doctors at the University of Tilburg - found that maternal stress affects the fetus most negatively between the 12th and 22nd weeks of pregnancy: its consequences make themselves felt even 20 years later.

But still, one should not panic, says Professor Schwab: “Stress during pregnancy is a completely normal thing. And injections of betamethasone, this hormonal accelerator of lung development, are an important and necessary therapy if there are indications for it. You just need to keep in mind that An elevated level of stress hormone in the blood of the embryo seems to play a more important role in the development of later diseases than has been previously believed.

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Stress during pregnancy - how to deal with it | Mamovedia

Everyone knows that pregnancy is a period of many changes. Your body, emotions and the life of your family are changing. Of course, the expectant mother is happy with these changes, but with them, experiences can be added, and if a woman is very impressionable, then experiences can turn into stress.

Unfortunately, the feeling of stress is not uncommon during pregnancy, and if you experience it constantly, it brings some discomfort and negative consequences. As a result, sleep problems, headaches, loss of appetite, or, on the contrary, overeating begin. If a woman is under stress for a long time, this can seriously affect her health and, as a result, provoke high blood pressure or heart disease. The impact of stress on a woman's body during pregnancy can provoke preterm labor (before 37 weeks) or the birth of a child with a low birth weight, because babies born too early or too small are at increased risk and health problems.

What can cause stress during pregnancy?

There are many different reasons, these are physiological, hormonal changes in a woman's body, and psychological and emotional stress on the body can also be attributed here.

Here are some of the main causes of pregnancy stress:

discomfort during pregnancy (nausea, constipation, fatigue or back pain)
hormonal changes, which can lead to a change in your mood
anxiety about your health, baby, or fears of childbirth itself
emotional and psychological stress at work

But life goes on and should not stop just because you pregnant.

Symptoms of stress

We all experience stress in one way or another every day (news, traffic jams, doing important work) of course this will not negatively affect our health and will not cause problems with pregnancy. But you should see a specialist if you experience the following symptoms:

Permanent insomnia
Sloveness, indifference to everything, apathy
decrease or absence of appetite
Frequent heartbeat
Tremor (trembling of the limbs)
Nervousness

In this case you have a more serious type of stress that you have a more serious type of stress can lead to certain health problems, so you should consult a doctor.

Effects of pregnancy stress

In fact, women do not fully understand the effects of stress on pregnancy. In this condition, a special hormone rises - glucocorticoid, which is associated with the work of the placenta and can affect genes, as a result of which the consequences can be very serious. Prolonged stress can affect the immune system that protects you from infection.

* These include: fear, autism, fears and phobias, enuresis, the development of diabetes, problems with adaptation.

As you can see, the consequences can be serious, so try to avoid stress at all costs.

Control methods co stress om during pregnancy

Know that pregnancy is a period when you should be carried in your arms, you should not be upset about every occasion and take everything to heart.