Stress and preterm birth: biological and vascular mechanisms affecting the feto‐placental circulation and the length of gestation

Najafzadeh, Afrooz

doi:10.1002/sono.12073

Cited by 5 publications

(5 citation statements)

References 37 publications

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“…One possible explanation for this result is the saturation of maternal stress-induced response. Maternal stress may induce a response, such as hypothalamic-pituitary adrenal (HPA) axis dysfunction 32,33 or inflammatory immune response 34 which activates a mechanism leading to PTB and this response saturates and plateau once stress hits the level of depression.…”

Section: Discussionmentioning

confidence: 99%

Timing of selective serotonin reuptake inhibitor use and risk for preterm birth and related adverse events

Hwang

Roper

Piekos

et al. 2023

Preprint

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PurposeThere is uncertainty around the safety of SSRIs for treating depression during pregnancy. We aimed 1) to address confounding by indication, as well as socioeconomic and environmental factors associated with depression and 2) evaluate associations of timing of SSRI exposure in pregnancy with the risk of preterm birth and related outcomes (small for gestational age and low birthweight) among women with depression before pregnancy.MethodsWe conducted propensity score-adjusted regression to calculate odds ratios (OR) of preterm birth, small for gestational age, and low birth weight. We accounted for maternal/pregnancy characteristics, pre-pregnancy comorbidity/depression severity, social vulnerability, rural health disparity, and pre-natal depression severity. We additionally conducted a drug-specific analysis and assessed the impact of other classes of antidepressants within our cohort of interest.ResultsAmong women with a history of depression, we identified women with indication of depression ≤ 180 days before pregnancy (n=6,408). Women with no SSRI order during pregnancy (n=3,122) constituted the unexposed group (no SSRI exposure group). The late SSRI exposure group consisted of women with an SSRI order after the first trimester (n=2,596). The early-only SSRI exposure group consisted of women with SSRI orders only in the first trimester (n=691). Late SSRI exposure group had an increased risk of preterm birth of OR=1.7 ([1.3,2.2], p<0.0001), and low birth weight of OR = 1.7 ([1.3,2.4], p<0.001), relative to the no SSRI exposure group.ConclusionsThese findings suggest associations between preterm birth/low birthweight and SSRI exposure is dependent on exposure timing during pregnancy. Small for gestational age is not associated with SSRI exposure.

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Section: Discussionmentioning

confidence: 99%

Timing of selective serotonin reuptake inhibitor use and risk for preterm birth and related adverse events

Hwang

Roper

Piekos

et al. 2023

Preprint

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“…Pregnancy-related stress is a predictor of preterm birth [ 1 ]. The resistance to placental blood flow mediated by the hypothalamic-pituitary-adrenal axis response to high-level maternal stress was proposed as the probable reason for the increase in preterm deliveries [ 16 ]. A statistically significant association between maternal anxiety, mental distress, psychiatric disorder, and Doppler velocimetry of umbilical and uterine arteries was not clearly established [ 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…Despite extensive research about the association between maternal psychological stress and Doppler findings indicative of fetoplacental compromise, there exists a knowledge gap that prevents arriving at a definitive conclusion because of substantial methodological differences across studies [16]. The recent COVID-19 pandemic documented the occurrence of maternal psychological stress [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

The Impact of COVID-19-Related Psychological Stress on Fetoplacental Circulation: A Doppler Scan of Umbilical Vessels in Third-Trimester Antenatal Women

Gowtham,

Gugapriya,

Umredkar

et al. 2023

Cureus

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Introduction: The placenta is an important organ of pregnancy. A multitude of physiological and pathological factors influence blood flow in the placenta during pregnancy. However, the fetal effects of maternal psychological stress were inconclusive. The recent COVID-19 pandemic had unprecedented economic, social, and psychological effects. The effect of COVID-19-induced psychological stress in antenatal women and its resultant fetal impact were studied by observing the Doppler waveforms of the uterine and umbilical arteries. Methods: The cross-sectional study was conducted on 26 healthy third-trimester antenatal women who satisfied pre-set inclusion and exclusion criteria. A pandemic-related pregnancy stress scale (PREPS) was used to evaluate the stress in pregnant women and categorize it into mild, moderate, and severe levels. The Doppler ultrasound of the uterine and umbilical vessels was done along with a routine growth scan in the third trimester of pregnancy. The arterial waveforms, Pulsatility index (PI) of uterine and umbilical arteries, umbilical vein blood flow, and biometric parameters of the fetus were recorded and analyzed. Results: Seventeen of the 26 participants were found to be moderately stressed. Among the three dimensions of the PREPS tool, the perinatal infection stress dimension was expressed predominantly. A strong expression of the positive affirmation dimension was seen in antenatal women. The mean Pulsatility index in the mild, moderate, and severe groups was 0.74, 0.93, and 0.63, respectively. The association between the PREPS score and the Pulsatility index of the umbilical artery alone was found to be significant at p=0.02. Conclusion: The COVID-19 pandemic caused moderate to severe levels of psychological stress in pregnant women. The statistically significant association between the PREPS score and the umbilical artery PI indicates possible fetoplacental compromise, suggesting the need for cognitive therapy to manage psychological stress in antenatal women.

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“…[5][6][7] Although the mechanism of the association between prenatal stress and perinatal outcomes is still unknown, prenatal stress may be associated with the hypothalamicpituitary-adrenal axis and maternal-placental-fetal neuroendocrine system activity. 8,9 Cortisol could increase the placental corticotropinreleasing hormone concentration level, and a rise in this hormone level may contribute to the onset of labor, leading to preterm birth and low birth weight. 10,11 In addition, retrospective cohort studies reported that stress events reduce the secondary sex ratio, which is the ratio of male to female newborns at birth.…”

Section: Introductionmentioning

confidence: 99%

“…Severe stress, including natural disasters and life events, has been reported to adversely affect perinatal outcomes, such as preterm birth and low birth weight 5–7 . Although the mechanism of the association between prenatal stress and perinatal outcomes is still unknown, prenatal stress may be associated with the hypothalamic–pituitary–adrenal axis and maternal–placental–fetal neuroendocrine system activity 8,9 . Cortisol could increase the placental corticotropin‐releasing hormone concentration level, and a rise in this hormone level may contribute to the onset of labor, leading to preterm birth and low birth weight 10,11 .…”

Section: Introductionmentioning

confidence: 99%

Association between earthquakes and perinatal outcomes: A systematic review and meta‐analysis

Wada,

Watanabe,

Yamamoto

et al. 2024

Intl J Gynecology & Obste

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BackgroundEvidence for the association between earthquakes and adverse perinatal outcomes is limited.ObjectivesTo evaluate the association between earthquakes and perinatal outcomes including preterm birth and low birth weight.Search StrategyWe searched studies using MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, World Health Organization International Clinical Trials Platform Search Portal, and ClinicalTrials.gov on February 9, 2023.Selection CriteriaWe included before‐and‐after studies that evaluated the associations between earthquakes and perinatal outcomes in women living in affected areas.Data Collection and AnalysisTwo independent reviewers extracted data. We calculated the pooled odds ratio (OR) with the random‐effects model. We analyzed outcomes in subgroups of Asians and others. We evaluated the certainty of evidence with the Grading of Recommendations Assessment, Development and Evaluation system.Main ResultsWe included 2 607 405 women in 13 studies. Earthquakes may not increase preterm birth (nine studies, 1 761 760 participants: OR 1.10, 95% confidence interval [CI] 0.98–1.24, low certainty of evidence) or low birth weight (seven studies, 1 753 891 participants: OR 1.10, 95% CI 0.94–1.28, low certainty of evidence). Subgroup analyses showed that earthquakes may be associated with an increase of preterm birth among populations in Asia (OR 1.44, 95% CI 1.07–1.95), but this was not evident in others (OR 0.93, 95% CI 0.83–1.05).ConclusionsPerinatal outcomes might not change after earthquakes. Further research on the association between earthquakes and perinatal outcomes, combined with an assessment of the characteristics of the region, is needed.

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Stress and preterm birth: biological and vascular mechanisms affecting the feto‐placental circulation and the length of gestation

Cited by 5 publications

References 37 publications

Timing of selective serotonin reuptake inhibitor use and risk for preterm birth and related adverse events

Timing of selective serotonin reuptake inhibitor use and risk for preterm birth and related adverse events

The Impact of COVID-19-Related Psychological Stress on Fetoplacental Circulation: A Doppler Scan of Umbilical Vessels in Third-Trimester Antenatal Women

Association between earthquakes and perinatal outcomes: A systematic review and meta‐analysis

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