Article

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

ABSTRACT 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.

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Available from: Vivette Glover, Mar 20, 2014
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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 · 2.26 Impact Factor
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    • "Little is understood about the mechanisms that may underlie fetal programming by prenatal stress in humans. One early suggestion was a decrease in blood flow to the fetus [58]. It is not clear, however, if the decrease observed in that study would be clinically significant, and others have failed to replicate the original finding [59]. "
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    ABSTRACT: Care for the emotional state of pregnant women remains a neglected aspect of obstetric medicine. Many prospective studies have shown that, if a mother is depressed, anxious, or stressed while pregnant, this increases the risk for her child having a wide range of adverse outcomes, including emotional problems, symptoms of attention deficit hyperactivity disorder, or impaired cognitive development. Although genetics and postnatal care clearly affect these outcomes, evidence for an additional prenatal causal component is substantial. Prenatal anxiety or depression may contribute 10-15% of the attributable load for emotional and behavioural outcomes. The Nurse Family Partnership remains the only intervention that starts in pregnancy and has been shown to have long-term benefits for the behaviour of the child. Several other interventions, however, are likely to be helpful. Depression, anxiety, and stress during pregnancy are frequently undetected by health professionals, and untreated. Programmes to help with this should eventually improve child outcome.
    Best practice & research. Clinical obstetrics & gynaecology 09/2013; 28(1). DOI:10.1016/j.bpobgyn.2013.08.017 · 3.00 Impact Factor
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    • "Risks for intrauterine growth restriction were also increased by 45% [20]. The biological pathways that have been suggested to explain this include the dysregulation of the hypothalamic–pituitary–adrenal axis, increased uterine artery resistance in response to perceived stress, which leads to placental hypofusion , immune activation characteristic of depression, or both [23] [25] [26]. Later studies, however, have failed to confirm the hypothesised relation between maternal stress and increased uterine artery resistance [27]. "
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    ABSTRACT: Depression, anxiety, or both, during pregnancy are common complications during the perinatal period, with 15-20% of women experiencing depression at some point during their pregnancy. Considerable evidence suggests that untreated or undertreated maternal Axis I mood disorders can increase the risk for preterm birth, low birth weight, and alter neurobehavioral development in utero. Serotonin reuptake inhibitor antidepressants are often considered for antenatal therapy, with the goal of improving maternal mental health during pregnancy. Treatment with a serotonin-reuptake inhibitor, however, does not guarantee remission of depression, and in-utero serotonin reuptake inhibitor exposure has also been linked to increased risks for adverse infant outcomes. In this chapter, evidence linking serotonin reuptake inhibitor use with an increased risk for postnatal adaptation syndrome, congenital heart defects, and neonatal persistent pulmonary hypertension is reviewed. Management decisions should include attention to the continuum of depression symptoms, from subclinical to severe major depressive disorder and the long-term developmental risks that might also be associated with pre- and postnatal exposure.
    Best practice & research. Clinical obstetrics & gynaecology 09/2013; 28(1). DOI:10.1016/j.bpobgyn.2013.09.001 · 3.00 Impact Factor
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