Association between maternal anxiety in pregnancy and increased uterine artery resistance index: Cohort based study

Centre for Fetal Care, Division of Paediatrics, Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, London W6 0XG.
BMJ Clinical Research (Impact Factor: 14.09). 01/1999; 318(7177):153-7. DOI: 10.1136/bmj.318.7177.153
Source: PubMed


To investigate whether maternal anxiety in the third trimester is associated with an increased uterine artery resistance index. Design: Cohort based study.
100 pregnant women, with a mean gestation of 32 weeks.
Self rating Spielberger questionnaire for state anxiety and trait anxiety, and uterine blood flow waveform patterns as assessed by colour Doppler ultrasound.
A significant association was found between uterine artery resistance index and scores for both Spielberger state anxiety and trait anxiety (rs=0.31, P<0.002 and 0.28 P<0.005 respectively). Women with state anxiety scores >40 (n=15) had a higher mean uterine resistance index than those with scores </= 40 (mean difference with mean resistance index 24%, 95% confidence interval 12% to 38%; P<0.0001). Similarly, women with trait anxiety scores >40 (n=32) had a higher mean resistance index than those with scores </= 40, although to a lesser extent. The presence of notches in the waveform pattern produced by uterine artery blood flow was found in 4/15 (27%) women with high state anxiety scores compared with 4/85 (5%) with low anxiety scores (P<0.02).
This study shows an association between maternal anxiety in pregnancy and increased uterine artery resistance index. It suggests a mechanism by which the psychological state of the mother may affect fetal development, and may explain epidemiological associations between maternal anxiety and low birth weight. The influence of maternal anxiety may be one mechanism by which the intrauterine environment contributes to later disease in offspring.


Available from: Vivette Glover, Mar 20, 2014
    • "Anxiety during pregnancy is associated with several adverse maternal and child outcomes, such as postpartum depression (Ahluwalia et al., 2004; Heron et al., 2004; Skouteris et al., 2009), preterm birth, low birth weight (Littleton et al., 2007; O'Donnell et al., 2011; Teixeira et al., 1999), and subsequent developmental and mental health challenges in children (Buss et al., 2011; Davis and Sandman, 2012; Kingston et al., 2012; Loomans et al., 2012). Available data suggest that PrA may be more strongly associated with maternal and child outcomes than general anxiety or depressive symptoms are and may predict these outcomes more accurately (Blair et al., 2011; Kramer et al., 2009; Lobel et al., 2008). "

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    • "Less directly, antenatal anxiety may affect fetal development by altering the barrier enzyme Placental 11b- hydroxysteroid dehydrogenase type 2 (HSD11B2) 11bHSD2 leading to fetuses' increased exposure to glucocorticoids [30]. Alternatives to an HPA axis-mediated mechanism, such as restricted uterine blood flow [31] and/or immunological mechanisms [32], could affect fetuses' development and health, as well. Based on the literature reviewed, we hypothesized that males carried by anxious mothers would weigh the same or more than males in the control group both in utero and at birth, whereas females carried by anxious mothers would weigh less than female controls [17]. "
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    ABSTRACT: To test for gender-differences in the relation between mothers' antenatal anxiety and infants' body weight during gestation, at birth, and at 1-month of age. Two hundred and twelve randomly-recruited women were divided into two groups: Controls (n=105) and Anxious Group (n=107) based on a standard cut-off of the Beck Anxiety Inventory. Outcome measures were Fetal Weight derived from biometrics obtained from an ultrasound scan in the 3rd trimester and infants' weight at birth and at 1-month of age, both obtained from medical records. Multivariate analyses showed main effects of Gender on infants' birth weight (P=.001) and on infants' weight at 1-month of age (P=.004), but no main effects of Anxiety Group at any time-point. Gender x Anxiety Group interactions at all three time points (Fetal weight: P=.05; Birth weight: P=.03; 1-month of age: P=.10) reflected gender differences (males>females) among infants in the anxious group, but not among controls. Distinct trends regarding same sex comparisons across groups (Control vs. Anxiety) were in line with predictions (male controls<male anxious; female controls>females anxious). Controlling for Postpartum Anxiety and Antenatal and Postpartum Depression in the models did not affect primary results. Gender differences in fetal and birth weight were more substantial among infants of anxious mothers than among controls due to the seemingly accelerated growth of "anxious" males and the diminution of weight among "anxious" females. Copyright © 2015 Elsevier Inc. All rights reserved.
    Journal of psychosomatic research 07/2015; DOI:10.1016/j.jpsychores.2015.07.006 · 2.74 Impact Factor
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    • "Of those studies that have shown interactions, these were mainly found later in pregnancy [1] [2]. For example, women with features of state and trait anxiety have been found to have significantly increased uterine artery RI during the third trimester [2]. State and trait anxiety respectively refer to transitory perceived apprehension associated with certain stimuli, and a relatively stable personality characteristic of anxiety proneness [9]. "
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    ABSTRACT: Although a number of studies have found significant associations between maternal psychological distress, anxiety and changes in fetoplacental blood flow, findings remain inconsistent. A recent pilot study by our group highlighted some of these inconsistencies. In the current study, we expanded this pilot analysis to include psychological distress, anxiety and a range of antenatal variables, with the aim of identifying predictors of fetoplacental blood flow.Methods Healthy pregnant women (n =148) underwent Doppler flow studies on uterine, umbilical and fetal arteries; as well as assessments of distress, anxiety and other antenatal variables (e.g. perceived social support, resilience, nicotine and alcohol use) in each trimester.ResultsStepwise regression analyses found that state anxiety was associated with lower mid-cerebral artery pulsatility index at trimester 3.LimitationsSubjects were recruited from selected midwife obstetric units in the same health district, so the generalizability of our results may be limited. While most subjects received Doppler assessment at trimester 2 and 3, only approximately half of our sample was assessed at trimester 1.Conclusion The finding that anxiety is associated with increased blood flow to the fetal brain during trimester 3 of pregnancy, coincide with previous work. The findings emphasize a growing appreciation of the potential importance of psychological well-being during pregnancy for infant development. However, as associations were small and variable, further research using multivariate models to determine the precise mechanisms underlying these associations would be warranted.
    Comprehensive Psychiatry 11/2014; 57. DOI:10.1016/j.comppsych.2014.11.011 · 2.25 Impact Factor
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