13 research outputs found

    Circulatory outcome measures.

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    <p>Data are given as median (interquartile range), <i>n</i> (%), or mean ± SD.</p><p>bpm, beats per minute; Q<sub>UV</sub>, umbilical vein volume blood flow; Q<sub>UVAC</sub>, umbilical vein volume blood flow normalized for fetal abdominal circumference; PI, pulsatility index.</p

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

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    <div><p>Introduction</p><p>Some 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.</p> <p>Methods</p><p>This 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.</p> <p>Results</p><p>IES intrusion scores above the mean were associated with a reduction in normalized UV volume blood flow (corresponding to –0.61 SD; <i>P</i> = 0.003). Adjusting for UA resistance increased the strength of this association (difference –0.66 SD; <i>P</i><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.</p> <p>Conclusions</p><p>Intrusive 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.</p> </div

    Linear regression exploring the role of birthweight/placental weight ratio on the association between distress measures and ln-transformed normalized umbilical vein blood flow.

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    <p>Results from linear regression analyses showing associations between ordinal and dichotomous distress measures at 16 weeks gestational age and ln-transformed umbilical vein blood flow normalized for fetal abdominal circumference (Ln-Q<sub>UVAC</sub>, ml/min/cm) at 30 weeks, with adjustment for birthweight/placental weight ratio.</p>a<p>Distress measures n = 65, Bw/Pw ratio n = 61.</p>b<p>B, regression coefficient; Bw/Pw, birthweight/placental weight.</p><p>GHQ, General Health Questionnaire; IES, Impact of Event Scale; T1, assessment at around 16 weeks gestational age.</p

    Psychological ordinal distress scores at 16 and 30 weeks of gestational age.

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    a<p>Missing n = 1 (missing set of questionnaires).</p>b<p>n = 72 (1 missing set of questionnaires; 1 page of questionnaire left blank).</p><p>EPDS, Edinburgh Postnatal Depression Scale; GHQ, General Health Questionnaire; IES, Impact of Event Scale.</p

    Maternal and infant characteristics (<i>n = </i>104).

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    <p>Data are given as mean ± SD, median (interquartile range) or <i>n</i> (%).</p>*<p>One pregnancy-induced hypertension at 30 week assessment, all others later onset.</p

    Associations between second trimester psychological distress scores at 16 weeks and third trimester normalized umbilical vein volume blood flow (n = 65).

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    a<p>Correlations (Spearman's correlation coefficient) between ordinal psychological distress scores at 16 weeks of gestational age and umbilical vein volume blood flow (Q<sub>UVAC</sub>, normalized for fetal abdominal circumference, ml/min/cm) at 30 weeks.</p>b<p>Mann-Whitney <i>U</i> test comparing Q<sub>UVAC</sub> (median, interquartile range) at 30 weeks of gestational age for women scoring below <i>vs.</i> above the mean for psychological distress at 16 weeks.</p>c<p>Missing n = 1 (page of questionnaire left blank).</p><p>EPDS, Edinburgh Postnatal Depression Scale; GHQ, General Health Questionnaire; IES, Impact of Event Scale; IQR, inter-quartile range; Q<sub>UVAC</sub>, umbilical vein volume blood flow normalized for fetal abdominal circumference (ml/min/cm); r<sub>s</sub>, Spearman's rank correlation coefficient.</p

    Psychological distress scores at 30 weeks of gestational age (<i>n</i> = 104).

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    <p>Psychometric scores and prevalence of different levels of psychological distress in the study population.</p>*<p>For choice of cut-off levels for psychological distress, see methods.</p

    Determinants of normalized umbilical vein volume blood flow, with continuous or dichotomized distress score (<i>n = </i>96).

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    <p>Results from univariate and multiple linear regression showing associations between distress measure IES intrusion and umbilical vein volume blood flow normalized for fetal abdominal size (Q<sub>UVAC</sub>; ml/min/cm). IES intrusion scores are continuous in section A, and dichotomized at the mean in section B.</p>*<p>Maternal age does not fulfill criteria of P<0.10 for continued inclusion into this regression model, but is retained for easier comparison with section A.</p><p>B, regression coefficient; β, standardized regression coefficient; IES, Impact of Event Scale; UA, umbilical artery; PI, pulsatility index.</p

    Associations between non-psychometric covariates and normalized umbilical vein volume blood flow (<i>n</i> = 96).

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    <p>Results from univariate linear regression with normalized umbilical vein volume blood flow (Q<sub>UVAC</sub>; ml/min/cm) as outcome variable.</p><p>B, regression coefficient; BMI, body mass index; bpm, beats per minute; PI, pulsatility index.</p

    Maternal psychological responses during pregnancy after ultrasonographic detection of structural fetal anomalies: A prospective longitudinal observational study

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    <div><p>In this longitudinal prospective observational study performed at a tertiary perinatal referral centre, we aimed to assess maternal distress in pregnancy in women with ultrasound findings of fetal anomaly and compare this with distress in pregnant women with normal ultrasound findings. Pregnant women with a structural fetal anomaly (n = 48) and normal ultrasound (n = 105) were included. We administered self-report questionnaires (General Health Questionnaire-28, Impact of Event Scale-22 [IES], and Edinburgh Postnatal Depression Scale) a few days following ultrasound detection of a fetal anomaly or a normal ultrasound (T1), 3 weeks post-ultrasound (T2), and at 30 (T3) and 36 weeks gestation (T4). Social dysfunction, health perception, and psychological distress (intrusion, avoidance, arousal, anxiety, and depression) were the main outcome measures. The median gestational age at T1 was 20 and 19 weeks in the group with and without fetal anomaly, respectively. In the fetal anomaly group, all psychological distress scores were highest at T1. In the group with a normal scan, distress scores were stable throughout pregnancy. At all assessments, the fetal anomaly group scored significantly higher (especially on depression-related questions) compared to the normal scan group, except on the IES Intrusion and Arousal subscales at T4, although with large individual differences. In conclusion, women with a known fetal anomaly initially had high stress scores, which gradually decreased, resembling those in women with a normal pregnancy. Psychological stress levels were stable and low during the latter half of gestation in women with a normal pregnancy.</p></div
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