Does Antenatal Maternal Psychological Distress Affect Placental Circulation in the Third Trimester?

Abstract

IntroductionSome types of antenatal maternal psychological distress may be associated with reduced fetal growth and birthweight. A stress-mediated reduction in placental blood flow has been suggested as a mechanism. Previous studies have examined this using ultrasound-derived arterial resistance measures in the uterine (UtA) and umbilical (UA) arteries, with mixed conclusions. However, a reduction in placental volume blood flow may occur before changes in arterial resistance measures are seen. Fetoplacental volume blood flow can be quantified non-invasively in the umbilical vein (UV). Our objective was to study whether specific types of maternal psychological distress affect the placental circulation, using volume blood flow quantification in addition to arterial resistance measures.MethodsThis was a prospective observational study of 104 non-smoking pregnant women (gestational age 30 weeks) with uncomplicated obstetric histories. Psychological distress was measured by General Health Questionnaire-28 (subscales anxiety and depression) and Impact of Event Scale-22 (subscales intrusion, avoidance and arousal). UtA and UA resistance measures and UV volume blood flow normalized for fetal abdominal circumference, were obtained by Doppler ultrasound.ResultsIES intrusion scores above the mean were associated with a reduction in normalized UV volume blood flow (corresponding to –0.61 SD; P = 0.003). Adjusting for UA resistance increased the strength of this association (difference –0.66 SD; P<0.001). Other distress types were not associated with UV volume blood flow. Maternal distress was not associated with arterial resistance measures, despite adjustment for confounders.ConclusionsIntrusive thoughts and emotional distress regarding the fetus were associated with reduced fetoplacental volume blood flow in third trimester. Uterine and umbilical artery resistance measures were not associated with maternal distress. Our findings support a decrease in fetoplacental blood flow as a possible pathway between maternal distress and reduced fetal growth.

Prenatal stress and hemodynamics in pregnancy: a systematic review

“…Seven of the studies assessed healthy, medically low-risk pregnant women (Helbig et al, 2013;Kent et al, 2002;Mendelson et al, 2011;Roos et al, 2015;Sjostrom et al, 1997;Teixeira et al, 1999;Vythilingum et al, 2010), two assessed medically high-risk pregnant women (Caliskan et al, 2009;Helbig et al, 2011), and Harville et al (2008) included both high-and low-risk participants. Two studies specifically assessed pregnant women with existing psychiatric diagnoses (Maina et al, 2008;Monk et al, 2012).…”

“…One study (Caliskan et al, 2009) failed to provide exclusion criteria, and two studies failed to describe the study sample for key characteristics (Kent et al, 2002;Teixeira et al, 1999). Six studies (Caliskan et al, 2009;Helbig et al, 2011;Helbig et al, 2013;Kent et al, 2002;Teixeira et al, 1999;Vythilingum et al, 2010) were cross-sectional, with participants assessed at varying gestational ages, which can make it more difficult to assess acute versus chronic stress as well as changes in blood flow over time. All but one (Harville et al, 2008) study had small sample sizes, which can make it difficult to detect minor effects and does not allow conclusions about clinical significance.…”

“…Five studies explicitly excluded participants on the basis of a pre-existing psychiatric diagnosis (Helbig et al, 2011;Helbig et al, 2013;Maina et al, 2008;Mendelson et al, 2011;Monk et al, 2012), and seven did not (Caliskan et al, 2009;Harville et al, 2008;Kent et al, 2002;Roos et al, 2015;Sjostrom et al, 1997;Teixeira et al, 1999;Vythilingum et al, 2010).…”

“…Although three studies (Helbig et al, 2013;Maina et al, 2008;Sjostrom et al, 1997) listed reasons why participants were lost to follow-up, none adequately described or compared key characteristics in participants who completed the study and those who did not.…”

“…Standardized outcome measures decrease measurement bias and make comparability across studies less problematic but increase the risk of subjective response bias, and the choice of stress measures varied considerably. Only three studies (Helbig et al, 2011;Helbig et al, 2013;Mendelson et al, 2011) addressed pregnancyspecific stress. Four studies (Harville et al, 2008;Maina et al, 2008;Monk et al, 2012;Sjostrom et al, 1997) included a clinical interview to assess maternal psychological state, while eight (Caliskan et al, 2009;Helbig et al, 2011;Helbig et al, 2013;Kent et al, 2002;Mendelson et al, 2011;Roos et al, 2015;Teixeira et al, 1999;Vythilingum et al, 2010) relied on self-report measures.…”