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Arruda Correia ML, Peixoto Filho FM, Gomes Júnior SC, de Jesus GR. Effects of osteopathic manipulative treatment on maternal-fetal hemodynamics in third trimester pregnant women: A prospective study. PLoS One 2024; 19:e0300514. [PMID: 38507460 PMCID: PMC10954147 DOI: 10.1371/journal.pone.0300514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/24/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVE To evaluate the maternal-fetal hemodynamic effects after osteopathic manipulative treatment by measuring vital signs and Doppler velocimetry in third-trimester pregnant women. MATERIALS AND METHODS This is a prospective study with pregnant women undergoing outpatient follow-up and hospitalized in a ward at Instituto Fernandes Figueira/Fiocruz, between August 2021 to August 2022, during the SARS-CoV-2 pandemic. This study was registered in REBEC under Register Number RBR-9q7kvg and approved by the ethics committee under number 32216620.0.0000.5269. The study population was composed of 51 pregnant women between 28 and 40 weeks of gestation, over 18 years of age, allocated in a single group. Pregnancies with multiple fetuses, malformations, premature rupture of the membrane, and active labor were excluded. The procedures evaluated maternal-fetal hemodynamics using three consecutive measures of ultrasound examination with Doppler velocimetry, and three maternal vital signs measured by an electronic blood pressure monitor. RESULTS Most vital signs changed after osteopathic treatment. However, only the systolic blood pressure (109.92 ±14.42 to 110.71±12.8, p = 0.033), diastolic blood pressure (79.8±11.54 to 77.57±9.44, p = 0.018) and heart rate (87.59±11.93 to 81.12±10.26, p = 0.000) in the sitting position, systolic blood pressure (110.75±13.26 to 108.59±13.07; p = 0.034) in the supine, and heart rate (83.22±11.29 to 80.39±11.0; p = 0.013) in left lateral decubitus reached statistical significance. The oximetry measures (98.55±0.64 to 98.67±0.68; p = 0.098) stayed stable during all three positions. All artery values remained stable after treatment, and no statistically significant difference was recorded in the artery results. CONCLUSION Responses to osteopathic treatment in women in the third trimester of pregnancy did not affect uteroplacental and fetoplacental circulation. However, some maternal vital signs had statistically significant results, with a decrease in diastolic blood pressure and heart rate, and an increase in systolic blood pressure in the sitting position, a decrease of heart rate in the left lateral decubitus position, and systolic blood pressure in the supine position. All the results observed were maintained in the normal parameters. The study responses attest to the safety of using the osteopathic manipulative treatment for the fetus and for pregnant women with comorbidities.
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Ticona DM, Huanco D, Ticona-Rendón MB. Impact of unplanned pregnancy on neonatal outcomes: findings of new high-risk newborns in Peru. Int Health 2024; 16:52-60. [PMID: 36942842 PMCID: PMC10759294 DOI: 10.1093/inthealth/ihad018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Unplanned pregnancy is a significant public health problem, especially in low- to middle-income countries. The objective of this study was to determine the neonatal outcomes associated with unplanned pregnancy in a public hospital in southern Peru. METHODS A cross-sectional analytical study was conducted from June to August 2021 among 306 mothers and their newborns selected by convenience sampling. After obtaining informed consent, mothers were surveyed during their postpartum hospitalization about their pregnancy intentions. Unintended pregnancy was considered when it was mistimed or unwanted. Neonatal outcomes were assessed by reviewing medical records prior to discharge, evaluating the presence of low birth weight, insufficient birth weight, prematurity, respiratory distress syndrome, sepsis and neonatal mortality. Association was measured in terms of prevalence ratio (PR) and beta coefficient and respective 95% CIs, crude and adjusted for variables that obtained a value of p<0.20 in the crude model (maternal age, education and parity). RESULTS The overall unplanned pregnancies rate was 65%, of which 40.5% were mistimed pregnancies and 24.5% unwanted pregnancies. Unplanned and mistimed pregnancies were significantly associated with insufficient birth weight [adjusted prevalence ratio (aPR)=2.14; 95% CI 1.01 to 4.56 and aPR=2.43; 95% CI 1.09 to 5.39, respectively] and unwanted pregnancies were significantly associated with preterm birth (aPR=3.49; 95% CI 1.01 to 12.11). Furthermore, adjusted analysis showed that birth weight and gestational age were lower in unplanned, mistimed and unwanted pregnancies. CONCLUSIONS Unplanned pregnancy was associated with lower birth weight and shorter gestational age of newborns. These data collected in a public hospital in a developing country may have significant implications today. If pregnancy intention is not included as a neonatal risk factor, insufficient birth weight and preterm birth could increase because a higher proportion of births will be unplanned.
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Affiliation(s)
| | - Diana Huanco
- Universidad Nacional Jorge Basadre Grohmann, Faculty of Health Sciences, 23003, Tacna, Peru
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Pan WL, Lin LC, Kuo LY, Chiu MJ, Ling PY. Effects of a prenatal mindfulness program on longitudinal changes in stress, anxiety, depression, and mother-infant bonding of women with a tendency to perinatal mood and anxiety disorder: a randomized controlled trial. BMC Pregnancy Childbirth 2023; 23:547. [PMID: 37525110 PMCID: PMC10388457 DOI: 10.1186/s12884-023-05873-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/25/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Stress is a risk factor for poor physical and mental health, affecting new mothers' ability, especially those with perinatal mood and anxiety disorders, to maintain their everyday lives. Over the past 50 years, global incidences of depression and anxiety disorders have increased, reaching pandemic levels. These incidences represent major public health issues that are challenging to detect and treat. Mindfulness programs are viable for reducing stress, anxiety, and depression. The present study evaluates mindfulness intervention effects on stress, anxiety, depression, and mother-infant bonding. METHODS We collected data on 102 women participating in a prenatal mindfulness program between July 2021 and March 2022; they were parallel and randomly assigned to experimental or control groups. The intervention group received an 8-week course in a prenatal mindfulness program, and the control group received usual standard prenatal care. The self-reported stress, pregnancy-related anxiety, and depression were assessed before and after the intervention and at 36 weeks of gestation. At 2 and 4 months postpartum, all participants provided self-reported their levels of stress, depression, and quality of mother-infant bonding. RESULTS Compared to the control group, the experimental group that received the prenatal mindfulness intervention experienced reduced prenatal stress, anxiety, and depression and reduced postnatal stress and depression. Despite this, there was no significant difference between the groups in terms of the quality of mother-infant bonding. CONCLUSIONS Mindfulness prenatal programs are convenient and effective methods of decreasing stress, anxiety, and depression during the perinatal period. Based on our findings, prenatal mindfulness may play a role in mitigating mood and anxiety disorders and should be considered in future approaches to preventing psychological distress. TRIAL REGISTRATION NUMBER This trial has been prospectively registered at ClinicalTrials.gov (NCT04693130) and the first registration date was 12/24/2020.
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Affiliation(s)
- Wan-Lin Pan
- School of Nursing, National Taipei University of Nursing and Health Sciences, No.365, Ming-Te Road, Peitou District, Taipei, Taiwan.
| | - Li-Chiu Lin
- Department of Nursing, HungKuang University, Taichung, Taiwan
| | - Li-Yen Kuo
- Department of Thanatology and Health Counseling, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Mu-Jung Chiu
- Department of Nursing, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Pei-Ying Ling
- Department of Obstetrics and Gynecology, Taiwan Adventist Hospital, Taipei, Taiwan
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Jorge TF, Nomura RMY. Effects of maternal anxiety on fetal and maternal circulation. Rev Assoc Med Bras (1992) 2023; 69:410-414. [PMID: 36820770 PMCID: PMC10004293 DOI: 10.1590/1806-9282.20221011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 12/10/2022] [Indexed: 02/22/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the association between maternal anxiety in the third trimester and changes in fetal and maternal circulation assessed by Doppler velocimetry. METHODS This is a prospective, cross-sectional study. The inclusion criteria were good health, a singleton pregnancy, maternal age between 18 and 40 years, and gestational age between 34 and 40 weeks. Doppler measurements included mean uterine artery pulsatility index, fetal middle cerebral artery pulsatility index, peak of systolic velocity, umbilical artery, and umbilical vein. The Beck Anxiety Inventory questionnaire, validated for the Brazilian population, with 21 self-reported items, was applied. RESULTS The study included 34 pregnant women, and 6 (17.7%) presented a total Beck Anxiety Inventory score showing moderate or severe maternal anxiety. The mean maternal age was 28.1 years (SD 5.7 years); the mean gestational age at interview was 36.5 weeks (SD 1.8 weeks), and the mean Beck Anxiety Inventory total score was 12.3 (SD 9.8). The group with moderate or severe anxiety, compared to the group with minimal or mild anxiety, presented an association with lower maternal age (median 21.5 vs. 29.5 years, p=0.019), lower fetal umbilical vein blood flow (median 189.4 vs. 249.5 mL/min, p=0.047), and lower umbilical vein-corrected blood flow (median 68.5 vs. 84.9 mL/kg/min, p=0.038). CONCLUSION Maternal anxiety may affect fetal circulation patterns in late pregnancy and is associated with reduced blood flow in the fetal umbilical vein. The underlying physiopathology needs further investigation.
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Affiliation(s)
- Tiago Ferreira Jorge
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Obstetrics - São Paulo (SP), Brazil
| | - Roseli Mieko Yamamoto Nomura
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Obstetrics - São Paulo (SP), Brazil
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Roche D, Rafferty A, Holden S, Killeen SL, Kennelly M, McAuliffe FM. Maternal Well-Being and Stage of Behaviour Change during Pregnancy: A Secondary Analysis of the PEARS Randomised Controlled Trial. Int J Environ Res Public Health 2022; 20:34. [PMID: 36612357 PMCID: PMC9819687 DOI: 10.3390/ijerph20010034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
We aimed to determine whether early pregnancy well-being was associated with the stage of behaviour change during an antenatal lifestyle intervention using a secondary analysis of data from the Pregnancy Exercise and Nutrition Research Study (PEARS). Pregnant women (n = 277) with well-being data in early pregnancy were included. Maternal well-being was measured using the World Health Organisation Five-Item Well-Being Index. The intervention consisted of a mobile health (mHealth) phone application, supported by antenatal education and exercise, to prevent gestational diabetes in a population with overweight. Stage of behaviour change was measured in late pregnancy using a five-stage classification. Ordinal logistic regression was used to examine if well-being, the study group, or their interaction, were related to behaviour change. Maternal well-being (OR 1.03, 95% CI 1.01, 1.04, p < 0.01) and the study group (OR 2.25, 95% CI 1.44, 3.51, p < 0.01) both significantly influenced the positive stage of behaviour change. The probability of being at stage 5 increased from 43 to 92% as well-being increased from 0 to 100% and was higher in the intervention (53%) compared to the control (34%) group (p ≤ 0.01 (8.65, 29.27). This study demonstrates the potential importance of well-being in enabling women to engage with a healthy lifestyle, and the role that mHealth technology has in facilitating beneficial behaviour change.
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Affiliation(s)
- Doireann Roche
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, D02 YH21 Dublin, Ireland
| | - Anthony Rafferty
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, D02 YH21 Dublin, Ireland
| | - Sinead Holden
- UCD School of Mathematics and Statistics, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Sarah Louise Killeen
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, D02 YH21 Dublin, Ireland
| | - Maria Kennelly
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, D02 YH21 Dublin, Ireland
| | - Fionnuala M. McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, D02 YH21 Dublin, Ireland
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Kornfield SL, Riis VM, McCarthy C, Elovitz MA, Burris HH. Maternal perceived stress and the increased risk of preterm birth in a majority non-Hispanic Black pregnancy cohort. J Perinatol 2022; 42:708-713. [PMID: 34400775 PMCID: PMC8847548 DOI: 10.1038/s41372-021-01186-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/06/2021] [Accepted: 07/30/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine whether perceived stress is associated with preterm birth (PTB) and to investigate racial differences in stress and PTB. STUDY DESIGN A secondary analysis of a prospective cohort study of 1911 women with singleton pregnancies examined responses to psychosocial stress questionnaires at 16-20 weeks of gestation. RESULTS High perceived stress (19%) and PTB (10.8%) were prevalent in our sample (62% non-Hispanic Black). Women with PTB were more likely to be Black, have chronic hypertension (cHTN), pregestational diabetes, and higher BMI. Women with high perceived stress had more PTBs than those with lower stress (15.2% vs. 9.8%), and stress was associated with higher odds of PTB (aOR: 1.55, 95% CI: 1.09-2.19). CONCLUSION The significant association between high perceived stress and PTB suggests that prenatal interventions to reduce maternal stress could improve the mental health of pregnant women and may result in reduced rates of PTB.
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Affiliation(s)
- Sara L Kornfield
- Center for Women's Behavioral Wellness, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Valerie M Riis
- Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Clare McCarthy
- Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Michal A Elovitz
- Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Heather H Burris
- Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Caparros-Gonzalez RA, Lynn F, Alderdice F, Peralta-Ramirez MI. Cortisol levels versus self-report stress measures during pregnancy as predictors of adverse infant outcomes: a systematic review. Stress 2022; 25:189-212. [PMID: 35435113 DOI: 10.1080/10253890.2022.2059348] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Systematically review existing evidence to (1) identify the association between self-report stress and cortisol levels measured during pregnancy; and, (2) assess their association with adverse infant outcomes to determine which is the better predictor. A systematic review was conducted in accordance with PRISMA guidelines. Search terms focused on pregnancy, psychological stress and cortisol. Nine electronic databases were searched, in addition to reference lists of relevant papers. Eligibility criteria consisted of studies that included measurement of self-reported psychological stress, cortisol and assessed their associations with any infant-related outcome. Further limits included studies published in English or Spanish with human female participants. A meta-regression was not feasible due to differences in study samples, measurement tools employed, types of cortisol assessed and outcomes reported. A narrative synthesis was provided. 28 studies were eligible for inclusion. Convergent validity between self-report measures and cortisol was reported by three studies (range r = 0.12-0.41). Higher levels of self-report stress were significantly associated with intrauterine growth restriction (fetal biparietal diameter, low fetal head circumference, abdominal circumference), low gestational age at birth, low anthropometric measures (birth length, head circumference, length of the neonate), poor infant neurodevelopment (cognitive development) and potentially pathogenic gut microbiota (Clostridiaceae Clostridium, Haemophilus) in six studies. Higher cortisol levels were significantly associated with intrauterine growth restriction (fetal biparietal diameter, low fetal head circumference, abdominal circumference), low gestational age at birth, low infant birth weight, poor infant neurodevelopment (attention scores on the Network Neurobehavioral Scale) and low levels of potentially protective gut microbiota (Lactobacillus, Slackia and Actinobaculum) in 13 studies. Of the studies that assessed which type of measure was a better predictor of infant outcomes (n = 6), there was agreement that cortisol levels were statistically better at predicting adverse outcomes than self-reported stress. Self-report stress measures appear to be modest predictors of adverse infant outcomes in comparison to cortisol. A number of methodological limitations need to be addressed in future studies to help understand the relationship between cortisol and self-reported stress and how they are related to adverse infant outcomes.
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Affiliation(s)
- Rafael A Caparros-Gonzalez
- Faculty of Health Sciences, Department of Nursing, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Fiona Lynn
- Medical Biology Center, School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Fiona Alderdice
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Kaya S, Kaya B. Evaluation of Fetal Renal Artery Doppler Indices in Pregnancies Complicated with Preeclampsia. Gynecol Obstet Invest 2021; 86:502-508. [PMID: 34788761 DOI: 10.1159/000519954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 09/27/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Preeclampsia, characterized by endothelial dysfunction, is associated with maternal and fetal Doppler alterations. This study aimed to evaluate fetal renal artery Doppler indices in pregnancies complicated with preeclampsia and compare them with normotensive pregnancies. DESIGN This cross-sectional study enrolled 46 pregnancies complicated with preeclampsia between weeks 24 and 37 of gestation as the study group and 48 normotensive pregnancies as the control group. MATERIALS AND METHODS The abdominal aorta, its bifurcation, and the renal arteries were visualized in the coronal view of the fetal abdomen using color Doppler. Renal artery Doppler indices were measured after arising from the abdominal aorta. The angle of insonation was ≤30° from the direction of blood flow, and the sample volume was 2 mm. Fetal renal artery pulsatility index, resistance index, systolic/diastolic ratio, and peak systolic velocity (PSV) were measured. All Doppler measurements were performed in the absence of fetal movements. Moreover, demographic characteristics and the perinatal outcome data of patients were recorded. RESULTS The values of fetal renal artery pulsatility and resistance indices were found to be significantly lower in the study group than those in the control group (p < 0.001 and p = 0.013, respectively). The fetal renal artery systolic/diastolic ratio and PSV values were also significantly lower in the study group compared with those in the control group (p = 0.007 and p < 0.001, respectively). Renal artery pulsatility and resistance indices were negatively correlated with mean arterial pressure (r = -0.381, p < 0.001 and r = -0.267, p = 0.009, respectively). The renal artery systolic/diastolic ratio was also significantly negatively correlated with the mean arterial pressure (r = -0.257, p = 0.013). LIMITATIONS The main limitations of this study are its cross-sectional design and the small number of participants. Another limitation of the study is that preeclamptic pregnancies complicated with fetal growth restriction were not included. CONCLUSION The observed decrease in fetal renal artery Doppler impedance may be caused by the unique response of the fetal renal artery to the factors involved in the etiopathogenesis of preeclampsia than other fetal peripheral vessels. These changes in fetal renal artery indices in pregnancies complicated with preeclampsia could be taken into account in the assessment of fetal health.
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Affiliation(s)
- Serdar Kaya
- Department of Maternal-Fetal Medicine, Health Sciences University, Bagcilar Education and Research Hospital, Istanbul, Turkey
| | - Basak Kaya
- Department of Maternal-Fetal Medicine, Istanbul Medipol University Hospital, Istanbul, Turkey
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Yılmaz M, Değirmenci F, Yılmaz DV. A psychosocial examination of feelings and thoughts about pregnancy: A qualitative study. Midwifery 2021; 103:103106. [PMID: 34352598 DOI: 10.1016/j.midw.2021.103106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 04/15/2021] [Accepted: 05/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND during pregnancy, which is a developmental period, there are risks that may cause pathological changes when physical, mental and social adaptation is not achieved. During antenatal appointments, it is possible to provide necessary care for pregnant women at the right time by screening for risks that threaten health. In addition to physical risk factors, psychosocial risk factors that can have significant effects on the health of pregnant women should also be included in antenatal appointments. A woman's inability to meet her needs or difficulties encountered in psychosocial areas, such as mental health, family relations, social life and job status during pregnancy, may result in mental and social problems as well as physical problems. Insufficient social support, job loss and family communication problems can leave pregnant women vulnerable to stress and cause many pregnancy complications, such as preterm labor. When problems in these areas cannot be detected at an early stage, they can threaten the life of the woman and the fetus. As such, knowledge of the specific feelings and thoughts of pregnant women from a psychosocial perspective will be useful in the evaluation of psychosocial risk factors. PURPOSE to determine the feelings and thoughts of pregnant women from a psychosocial perspective. METHOD this study used a qualitative descriptive approach to investigate pregnancy-related feelings and thoughts in a sample of 23 healthy pregnant women. Data were collected using a personal information form and a semi-structured interview form. The interviews, which were conducted using the semi-structured interview form and individual in-depth interviews, were recorded on a voice recorder. A thematic approach was used to analyze the data. RESULTS according to the results, the mean age of the pregnant women was 30.39 (standard deviation 4.03) years, 73.9% were university graduates and 78.3% were multiparous. Three main themes ('Pregnancy perception', 'Emotions in pregnancy' and 'Psychosocial dimension of pregnancy') and eight subthemes emerged from the data analysis. For 'Pregnancy perception', the subtheme was 'Meaning of pregnancy'. For 'Emotions in pregnancy', the subthemes were 'Emotional status (mood) in pregnancy' and 'Fear in pregnancy'. For 'Psychosocial dimension of pregnancy', the subthemes were 'Reflections of pregnancy on social life', 'Reflections of pregnancy on body image', 'Reflections of pregnancy on sexual life', 'Reflections of pregnancy on marital relationship' and 'Reflections of pregnancy on working life'. CONCLUSIONS in order to protect and maintain the health of the mother and fetus during pregnancy, it is recommended that women should be provided with the best physical and psychosocial care within the context of social and cultural structure, not only in this period but in every stage of their lives.
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Affiliation(s)
- Mualla Yılmaz
- Department of Mental Health Nursing, Mersin University Faculty of Nursing, Mersin, Turkey
| | - Filiz Değirmenci
- Department of Obstetrics and Gynaecology Nursing, Mersin University Faculty of Nursing, Mersin 33343, Turkey.
| | - Duygu Vefikuluçay Yılmaz
- Department of Obstetrics and Gynaecology Nursing, Mersin University Faculty of Nursing, Mersin 33343, Turkey
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10
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Moog NK, Nolvi S, Kleih TS, Styner M, Gilmore JH, Rasmussen JM, Heim CM, Entringer S, Wadhwa PD, Buss C. Prospective association of maternal psychosocial stress in pregnancy with newborn hippocampal volume and implications for infant social-emotional development. Neurobiol Stress 2021; 15:100368. [PMID: 34355050 PMCID: PMC8319845 DOI: 10.1016/j.ynstr.2021.100368] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/30/2021] [Accepted: 07/15/2021] [Indexed: 02/06/2023] Open
Abstract
Maternal psychosocial stress during pregnancy can impact the developing fetal brain and influence offspring mental health. In this context, animal studies have identified the hippocampus and amygdala as key brain regions of interest, however, evidence in humans is sparse. We, therefore, examined the associations between maternal prenatal psychosocial stress, newborn hippocampal and amygdala volumes, and child social-emotional development. In a sample of 86 mother-child dyads, maternal perceived stress was assessed serially in early, mid and late pregnancy. Following birth, newborn (aged 5–64 postnatal days, mean: 25.8 ± 12.9) hippocampal and amygdala volume was assessed using structural magnetic resonance imaging. Infant social-emotional developmental milestones were assessed at 6- and 12-months age using the Bayley-III. After adjusting for covariates, maternal perceived stress during pregnancy was inversely associated with newborn left hippocampal volume (β = −0.26, p = .019), but not with right hippocampal (β = −0.170, p = .121) or bilateral amygdala volumes (ps > .5). Furthermore, newborn left hippocampal volume was positively associated with infant social-emotional development across the first year of postnatal life (B = 0.01, p = .011). Maternal perceived stress was indirectly associated with infant social-emotional development via newborn left hippocampal volume (B = −0.34, 95% CIBC [-0.97, −0.01]), suggesting mediation. This study provides prospective evidence in humans linking maternal psychosocial stress in pregnancy with newborn hippocampal volume and subsequent infant social-emotional development across the first year of life. These findings highlight the importance of maternal psychosocial state during pregnancy as a target amenable to interventions to prevent or attenuate its potentially unfavorable neural and behavioral consequences in the offspring. Maternal perceived stress predicted smaller neonatal left hippocampal volume (HCV). Neonatal left HCV was positively associated with infant social-emotional function. Variation in HCV may mediate maternal stress-related effects on child mental health.
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Affiliation(s)
- Nora K Moog
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Medical Psychology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Saara Nolvi
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Medical Psychology, Augustenburger Platz 1, 13353, Berlin, Germany.,Turku Institute for Advanced Studies, Department of Psychology and Speech-Language Pathology, University of Turku, Finland
| | - Theresa S Kleih
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Medical Psychology, Augustenburger Platz 1, 13353, Berlin, Germany.,Institute of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Martin Styner
- Departments of Psychiatry and Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - John H Gilmore
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jerod M Rasmussen
- Development, Health, and Disease Research Program, Departments of Pediatrics, Psychiatry and Human Behavior, Obstetrics and Gynecology, and Epidemiology, University of California, Irvine, School of Medicine, Irvine, CA, USA
| | - Christine M Heim
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Medical Psychology, Augustenburger Platz 1, 13353, Berlin, Germany.,Department of Biobehavioral Health, Pennsylvania State University, College of Health and Human Development, University Park, PA, USA
| | - Sonja Entringer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Medical Psychology, Augustenburger Platz 1, 13353, Berlin, Germany.,Development, Health, and Disease Research Program, Departments of Pediatrics, Psychiatry and Human Behavior, Obstetrics and Gynecology, and Epidemiology, University of California, Irvine, School of Medicine, Irvine, CA, USA.,Department of Pediatrics, University of California, Irvine, School of Medicine, Orange, CA, USA
| | - Pathik D Wadhwa
- Development, Health, and Disease Research Program, Departments of Pediatrics, Psychiatry and Human Behavior, Obstetrics and Gynecology, and Epidemiology, University of California, Irvine, School of Medicine, Irvine, CA, USA.,Department of Pediatrics, University of California, Irvine, School of Medicine, Orange, CA, USA.,Departments of Psychiatry and Human Behavior, Obstetrics and Gynecology, and Epidemiology, University of California, Irvine, School of Medicine, Orange, CA, USA
| | - Claudia Buss
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Medical Psychology, Augustenburger Platz 1, 13353, Berlin, Germany.,Development, Health, and Disease Research Program, Departments of Pediatrics, Psychiatry and Human Behavior, Obstetrics and Gynecology, and Epidemiology, University of California, Irvine, School of Medicine, Irvine, CA, USA.,Department of Pediatrics, University of California, Irvine, School of Medicine, Orange, CA, USA
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Liset R, Grønli J, Henriksen RE, Henriksen TEG, Nilsen RM, Pallesen S. Sleep, evening light exposure and perceived stress in healthy nulliparous women in the third trimester of pregnancy. PLoS One 2021; 16:e0252285. [PMID: 34081723 DOI: 10.1371/journal.pone.0252285] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 05/12/2021] [Indexed: 12/25/2022] Open
Abstract
Objective Sleep disturbances are common in pregnancy, and the prevalence increases during the third trimester. The aim of the present study was to assess sleep patterns, sleep behavior and prevalence of insomnia in pregnant women in the third trimester, by comparing them to a group of non-pregnant women. Further, how perceived stress and evening light exposure were linked to sleep characteristics among the pregnant women were examined. Methods A total of 61 healthy nulliparous pregnant women in beginning of the third trimester (recruited from 2017 to 2019), and 69 non-pregnant women (recruited in 2018) were included. Sleep was monitored by actigraphy, sleep diaries and the Bergen Insomnia Scale. The stress scales used were the Relationship Satisfaction Scale, the Perceived Stress Scale and the Pre-Sleep Arousal Scale. Total white light exposure three hours prior to bedtime were also assessed. Results The prevalence of insomnia among the pregnant women was 38%, with a mean score on the Bergen Insomnia Scale of 11.2 (SD = 7.5). The corresponding figures in the comparing group was 51% and 12.3 (SD = 7.7). The pregnant women reported lower sleep efficiency (mean difference 3.8; 95% CI = 0.3, 7.3), longer total sleep time derived from actigraphy (mean difference 59.0 minutes; 95% CI = 23.8, 94.2) and higher exposure to evening light (mean difference 0.7; 95% CI = 0.3, 1.2), compared to the non-pregnant group. The evening light exposure was inversely associated with total sleep time derived from actigraphy (B = -8.1; 95% CI = -14.7, -1.5), and an earlier midpoint of sleep (B = -10.3, 95% CI = -14.7, -5.9). Perceived stressors were unrelated to self-reported and actigraphy assessed sleep. Conclusion In healthy pregnant participants sleep in the third trimester was preserved quite well. Even so, the data suggest that evening light exposure was related to shorter sleep duration among pregnant women.
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Haq SU, Bhat UA, Kumar A. Prenatal stress effects on offspring brain and behavior: Mediators, alterations and dysregulated epigenetic mechanisms. J Biosci 2021. [DOI: 10.1007/s12038-021-00153-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Gerson KD, Mccarthy C, Ravel J, Elovitz MA, Burris HH. Effect of a Nonoptimal Cervicovaginal Microbiota and Psychosocial Stress on Recurrent Spontaneous Preterm Birth. Am J Perinatol 2021; 38:407-413. [PMID: 33032329 PMCID: PMC8026761 DOI: 10.1055/s-0040-1717098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE While select cervicovaginal microbiota and psychosocial factors have been associated with spontaneous preterm birth, their effect on the risk of recurrence remains unclear. It is also unknown whether psychosocial factors amplify underlying biologic risk. This study sought to determine the effect of nonoptimal cervicovaginal microbiota and perceived stress on the risk of recurrent spontaneous preterm birth. STUDY DESIGN This was a secondary analysis of a prospective pregnancy cohort, Motherhood and Microbiome. The Cohen's Perceived Stress Scale (PSS-14) was administered and cervical swabs were obtained between 16 and 20 weeks of gestation. PSS-14 scores ≥30 reflected high perceived stress. We analyzed cervicovaginal microbiota using 16S rRNA sequencing and classified microbial communities into community state types (CSTs). CST IV is a nonoptimal cervicovaginal microbial community characterized by anaerobes and a lack of Lactobacillus. The final cohort included a predominantly non-Hispanic Black population of women with prior spontaneous preterm birth who had recurrent spontaneous preterm birth or term birth and had stress measurements (n = 181). A subanalysis was performed in the subset of these women with cervicovaginal microbiota data (n = 74). Multivariable logistic regression modeled adjusted associations between CST IV and recurrent spontaneous preterm birth, high stress and recurrent spontaneous preterm birth, as well as high stress and CST IV. RESULTS Among the 181 women with prior spontaneous preterm birth, 45 (24.9%) had high perceived stress. We did not detect a significant association between high stress and recurrent spontaneous preterm birth (adjusted odds ratio [aOR] 1.67, 95% confidence interval [CI]: 0.73-3.85). Among the 74 women with prior spontaneous preterm birth and cervicovaginal microbiota analyzed, 29 (39.2%) had CST IV; this proportion differed significantly among women with recurrent spontaneous preterm birth (51.4%) compared with women with term birth (28.2%) (p = 0.04). In models adjusted for race and marital status, the association between CST IV and recurrent spontaneous preterm birth persisted (aOR 3.58, 95% CI: 1.25-10.24). There was no significant interaction between stress and CST IV on the odds of spontaneous preterm birth (p = 0.328). When both stress and CST IV were introduced into the model, their associations with recurrent spontaneous preterm birth were slightly stronger than when they were in the model alone. The aOR for stress with recurrent spontaneous preterm birth was 2.02 (95% CI: 0.61-6.71) and for CST IV the aOR was 3.83 (95% CI: 1.30-11.33). Compared to women with neither of the two exposures, women with both high stress and CST IV had the highest odds of recurrent spontaneous preterm birth (aOR = 6.01, 95% CI: 1.002-36.03). CONCLUSION Among a predominantly non-Hispanic Black cohort of women with a prior spontaneous preterm birth, a nonoptimal cervicovaginal microbiota is associated with increased odds of recurrent spontaneous preterm birth. Adjustment for perceived stress may amplify associations between CST IV and recurrent spontaneous preterm birth. Identification of modifiable social or behavioral factors may unveil novel nonpharmacologic interventions to decrease recurrent spontaneous preterm birth among women with underlying biologic risk. KEY POINTS · CST IV, a nonoptimal microbiota, is associated with increased odds of recurrent spontaneous preterm birth.. · Adjustment for perceived stress amplified associations between CST IV and recurrent spontaneous preterm birth.. · Identification of modifiable psychosocial factors may unveil novel nonpharmacologic interventions to decrease recurrent preterm birth..
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Affiliation(s)
- Kristin D. Gerson
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Clare Mccarthy
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jacques Ravel
- Department of Microbiology and Immunology, Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Michal A. Elovitz
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Heather H. Burris
- Department of Pediatrics, University of Pennsylvania, Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Caparros-Gonzalez RA, Torre-Luque ADL, Romero-Gonzalez B, Quesada-Soto JM, Alderdice F, Peralta-Ramírez MI. Stress During Pregnancy and the Development of Diseases in the offspring: A Systematic-Review and Meta-Analysis. Midwifery 2021; 97:102939. [PMID: 33647755 DOI: 10.1016/j.midw.2021.102939] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 01/21/2021] [Accepted: 02/04/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The goal of this systematic-review and meta-analysis was to assess whether high maternal stress during pregnancy is associated with the development of pediatric pathology. DESIGN Epidemiological peer-reviewed studies published in English or Spanish assessing associations between maternal stress during pregnancy and psychiatric and medical diseases were selected. PARTICIPANTS We retrieved 73,024 citations; 42 studies meeting inclusion criteria were assessed. Overall sample included 65,814,076 women. FINDINGS Overall odds ratio for the development of a medical disease was OR=1.24 (CI95=1.11, 1.39), Z=3.85, p<.01. Overall odds ratio for psychiatric disorders was OR=1.28 (CI95=1.06, 1.56), Z=2.54, p<.02. Multivariate meta-analysis showed a significant coefficient for autism spectrum disorder studies, B=0.42, SE=0.16, Z=2.67, p<.01. We found a significant overall effect size for autism spectrum disorder (OR=1.45 [CI95=1.24, 1.70], Z=4.69, p<.01). In terms of medical diseases, studies including obesity and infantile colic presented a significant overall effect size, as OR=1.20 (CI95=1.03, 1.39), Z=2.41, p<.02. The highest effect size was found regarding the first trimester (B=1.62, SE=0.16, Z=9.90, p<.01). KEY CONCLUSIONS We concluded that exposure to high levels of stress during pregnancy are associated with autism spectrum disorder, obesity, and infantile colic in offspring. IMPLICATIONS FOR PRACTICE Maternal stress during pregnancy should be addressed to tackle its potential impact in health across the life span.
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Affiliation(s)
| | | | - Borja Romero-Gonzalez
- Mind, Brain, and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain
| | | | - Fiona Alderdice
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
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Slaughter-Acey JC, Brown TN, Keith VM, Dailey R, Misra DP. A tale of two generations: Maternal skin color and adverse birth outcomes in Black/African American women. Soc Sci Med 2020; 265:113552. [PMID: 33277068 PMCID: PMC7781157 DOI: 10.1016/j.socscimed.2020.113552] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/17/2020] [Accepted: 11/23/2020] [Indexed: 01/03/2023]
Abstract
We examined how sociopolitical context (marked by generational cohort) and maternal skin color interacted to influence preterm delivery (PTD) rates in sample of Black women. Data were from 1410 Black women, ages 18-45 years, residing in Metropolitan Detroit, MI enrolled (2009-2011) in the Life-course Influences on Fetal Environments (LIFE) Study. Because we hypothesized that generational differences marked by changes in the sociopolitical context would influence exposure to racism, we categorized women into two cohorts by maternal birth year: a) Generation X, 1964-1983 and b) Millennial, 1984-1993. Descriptive results showed similar PTD rates by generational cohort, Generation X: 16.3% vs. Millennials: 16.1%. Yet, within each generation, PTD rates varied by women's skin tone (categorized: light, medium, and dark brown). Poisson regression models confirmed a significant interaction between generational cohort and maternal skin tone predicting PTD (P = 0.001); suggesting a salubrious association between light brown skin tone (compared to medium and dark) and PTD for Generation X. However, Millennials with medium and dark brown skin experienced lower PTD rates than their light Millennial counterparts. Research should consider sociopolitical context and the salience of skin tone bias when investigating racial health disparities, including those in perinatal health.
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Affiliation(s)
- Jaime C Slaughter-Acey
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
| | - Tony N Brown
- Department of Sociology, Rice University, Houston, TX, USA
| | - Verna M Keith
- Department of Sociology, University of Alabama Birmingham, Birmingham, AL, USA
| | - Rhonda Dailey
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Dawn P Misra
- Department of Epidemiology & Biostatistics, Michigan State University, East Lansing, MI, USA
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16
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Bayrak M, Sancak A. Association between antenatal maternal anxiety and fetal middle cerebral artery Doppler depends on fetal gender. J Matern Fetal Neonatal Med 2020; 34:818-823. [PMID: 31969035 DOI: 10.1080/14767058.2020.1716331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objective: Several studies have demonstrated that antenatal maternal anxiety (AMA) during pregnancy is associated with an increased risk of abnormal fetal Doppler parameters and adverse perinatal outcomes. Despite these studies, the evidence of the association between them remains inconclusive due in part to the methodological limitations of existing studies. Hence, in the present study, we established strict criteria and excluded patients who may have moderate or confounding variables to investigate the relationship between AMA and fetal Doppler findings and adverse perinatal outcomes.Methods: This was a cross-sectional study of 160 healthy nulliparous pregnant women (gestational age 31-33 weeks) with uncomplicated obstetric histories, who underwent Doppler flow studies on uterine, umbilical and fetal middle cerebral artery (MCA). Maternal anxiety was measured by STAI-State and STAI-Trait inventory.Results: Statistical analyses revealed that STAI-Trait anxiety was associated with lower MCA pulsatility index at 31-33 weeks gestational age and lower birth weight for the female fetus. There were no significant differences in the birth weight of boys of mothers with high anxiety and without high anxiety.Conclusions: The adaptation of the fetus to this hostile environment as AMA differs by gender. Adaptation for the female fetus means the "brain sparing effect" and reduced birth weight. The findings emphasize the potential importance of maternal psychological wellbeing during pregnancy for fetal development.
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Affiliation(s)
- Mehmet Bayrak
- Department of Obstetrics and Gynecology, Uludag University Hospital, Bursa, Turkey
| | - Arzu Sancak
- Department of Psychiatry, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
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Nowland TL, van Wettere WHEJ, Plush KJ. Allowing sows to farrow unconfined has positive implications for sow and piglet welfare. Appl Anim Behav Sci 2019; 221:104872. [DOI: 10.1016/j.applanim.2019.104872] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Mustonen P, Karlsson L, Kataja EL, Scheinin NM, Kortesluoma S, Coimbra B, Rodrigues AJ, Sousa N, Karlsson H. Maternal prenatal hair cortisol is associated with prenatal depressive symptom trajectories. Psychoneuroendocrinology 2019; 109:104383. [PMID: 31400561 DOI: 10.1016/j.psyneuen.2019.104383] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/17/2019] [Accepted: 07/17/2019] [Indexed: 11/15/2022]
Abstract
UNLABELLED Maternal prenatal cortisol levels have been inconsistently associated with self-reports of prenatal psychological distress (PD). Previous research has linked hair cortisol concentration (HCC) evaluating cumulatively the previous months with cross-sectional PD measures that usually cover the past week(s), which may lead to misleading conclusions on their relations. We aimed to investigate how maternal HCC relates to cumulative PD measures across pregnancy. METHODS Subjects (N = 595) were drawn from the FinnBrain Birth Cohort Study. Maternal HCC was measured from hair samples collected at gestational week (gwk) 24 (HCC1, n = 467) and at delivery (HCC2, n = 222). As HCC1 and HCC2 comprised mostly of different subjects, they were considered as independent populations. Maternal PD assessments at gwks 14, 24, and 34 were the Edinburgh Postnatal Depression Scale (EPDS), the anxiety subscale of the Symptom Checklist (SCL-90), the Pregnancy-Related Anxiety Questionnaire -Revised2 (PRAQ-R2), and a daily hassles scale. Cumulative PD comprised of the mean scores of two consecutive assessments (mean1 = gwks 14 and 24; mean2 = gwks 24 and 34). In addition, EPDS and SCL scores were modelled by using growth mixture modelling to identify symptom trajectory categories. Regression models were adjusted for age, body mass index, education and use of selective serotonin/serotonin-norepinephrine reuptake inhibitor medication. RESULTS In the adjusted regression model, higher HCC2 was related to the "consistently elevated" prenatal depressive symptoms trajectory in comparison to "consistently low" (β =.71, p =.021) and "low and increasing" (β =.82, p = .011) symptom trajectories. Additionally, the cumulative mean (mean 1) of daily hassles in relationships was associated with HCC1 (β = 0.25, p = .004). General or pregnancy-related anxiety symptoms were unrelated to HCC after adjustment for the covariates. CONCLUSIONS The assessment of cumulative or trajectory measures of PD can reveal important associations with maternal prenatal HCC, even though the associations are generally weak. Of the different dimensions of PD, prenatal trajectories of depressive symptoms were most consistently linked with end-pregnancy HCC levels.
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Affiliation(s)
- Paula Mustonen
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Finland; Department of Child Psychiatry, University of Turku and Turku University Hospital, Turku, Finland.
| | - Linnea Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Finland; Department of Child Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - Eeva-Leena Kataja
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Finland; Department of Child Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - Noora M Scheinin
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Finland; Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - Susanna Kortesluoma
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Finland; Institute of Biomedicine, University of Turku, Finland
| | - Bárbara Coimbra
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Ana João Rodrigues
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Hasse Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Finland; Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
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Fallon B, Filippelli J, Joh-Carnella N, Milne E, Carradine J. Promoting Protective Factors in Environments of Risk for Young Children: An Organizing Framework for Practice, Policy, and Research. Gender and the Genome 2018. [DOI: 10.1177/2470289718820843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Early childhood is an important developmental period, which lays the foundation for future learning, behaviour, physical and mental health and gene expression. The most vulnerable children in society are often referred to and receive services from the child welfare system because of a concern of abuse and neglect and/or a poor developmental trajectory. This paper presents an organizing framework for how the child welfare system, in concert with allied partners, can support interventions for young children and families by acknowledging its crucial role in improving their development and well-being. The framework is informed by research amassed from numerous disciplines, including child welfare, development, neuroscience, neurobiology and epigenetics. Although the notions of protection and well-being are central considerations in child welfare legislation in Ontario, Canada, the operationalization of wellbeing has proven challenging in child welfare practice, policy and research. The framework proposes ten key indicators and priorities for identifying and promoting optimal child development. Findings from the 2013 cycle of the Ontario Incidence Study of Reported Child Abuse and Neglect (OIS-2013), the only provincial source of aggregated child welfare investigation data, are presented to articulate the divide between the environmental context of a population of at-risk children and the conditions that both protect children and increase the likelihood that they will thrive in adulthood. This paper argues there are different points of entry and intervention across sectors and provides a foundation for further discussion on how to promote well-being for society's most vulnerable children.
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Affiliation(s)
- Barbara Fallon
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Joanne Filippelli
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | | | - Elizabeth Milne
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Jessica Carradine
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
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Abstract
Objectives Studies examining risk factors for preterm birth (PTB) such as psychosocial stress are often focused on women with a history of PTB; however, most preterm babies are born to women with no history of preterm birth. Our objective was to determine if the relationship between psychosocial stress and PTB is altered by parity. Non-Hispanic black (NHB) women have increased psychosocial stress and PTB; therefore, we further aimed to determine if race alters the relationship between psychosocial stress, parity, and PTB. Methods We performed a secondary analysis of the Healthy Pregnancy, Healthy Baby Study comparing pregnant women who were primiparous (first pregnancy), multiparous with history of preterm birth, or multiparous with history of term birth. Perceived stress, perceived racism, interpersonal support, John Henryism and self-efficacy were measured using validated instruments. Logistic regression was used to model the effect of psychosocial stress on PTB stratified by parity and race. Results The analysis entire cohort included 1606 subjects, 426 were primiparous, 268 had a history of presterm birth, and 912 had a history of term birth. In women with a history of term birth, higher self-efficacy was associated with lower odds of spontaneous PTB, and this association was amplified in NHB women. In women with a history of spontaneous PTB, John Henryism Active Coping was associated with lower odds of spontaneous PTB in the index pregnancy. Conclusions for Practice The relationship between psychosocial stress and PTB may be mediated by parity and race.
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Affiliation(s)
- Sarahn Wheeler
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, DUMC Box 3967, Durham, NC, 27710, USA.
| | - Pamela Maxson
- Clinical and Translational Science Institute, Duke University School of Medicine, Durham, NC, USA
| | - Tracy Truong
- Department of Biostatistics and Bioinformatics, Biostatistics Core, Duke University of Medicine, Durham, NC, USA
| | - Geeta Swamy
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, DUMC Box 3967, Durham, NC, 27710, USA
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Huizink AC, de Rooij SR. Prenatal stress and models explaining risk for psychopathology revisited: Generic vulnerability and divergent pathways. Dev Psychopathol 2018; 30:1041-62. [PMID: 30068410 DOI: 10.1017/S0954579418000354] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The present review revisits three hypothesized models that potentially could explain how prenatal maternal stress influences fetal development, birth outcomes, and subsequent developmental psychopathology. These models were mostly based on animal models, and new evidence for these models from human studies is evaluated. Furthermore, divergent trajectories from prenatal exposure to adversities to offspring affected outcomes are reviewed, including the comparison of studies on prenatal maternal stress with research on maternal substance use and maternal malnutrition during pregnancy. Finally, new directions in research on the mechanism underlying prenatal stress effects on human offspring is summarized. While it is concluded that there is abundant evidence for the negative associations between prenatal maternal stress and offspring behavioral, brain, and psychopathological outcomes in humans, there is no consistent evidence for specific mechanisms or specific outcomes in relation to stress exposure in utero. Rather, principles of multifinality and equifinality best describe the consequences for the offspring, suggesting a generic vulnerability and different pathways from prenatal adversities to developmental psychopathology, which complicates the search for underlying mechanisms. New and promising directions for research are provided to get a better understanding of how prenatal stress gets under the skin to affect fetal development.
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Vujović M, Sovilj M, Jeličić L, Stokić M, Plećaš D, Plešinac S, Nedeljković N. Correlation between maternal anxiety, reactivity of fetal cerebral circulation to auditory stimulation, and birth outcome in normotensive and gestational hypertensive women. Dev Psychobiol 2017; 60:15-29. [PMID: 29091282 DOI: 10.1002/dev.21589] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 09/10/2017] [Indexed: 12/17/2022]
Abstract
This study investigated the correlation between maternal anxiety and blood flow changes through the fetal middle cerebral artery (MCA) after defined acoustic stimulation in 43 normotensive (C) and 40 gestational hypertensive (GH) subjects. Neonatal outcomes (gestational age at birth, Apgar score, birth weight) in the C and GH groups were analyzed. State (STAI-S) and trait (STAI-T) anxiety was assessed using Spielberger's questionnaire. The MCA blood flow was assessed once between 28 and 41 weeks of gestation using color Doppler ultrasound before and after application of defined acoustic stimulus. Relative size of the Pulsatility index (Pi) change (RePi) was calculated. The general hypotheses were: (1) women in GH group would have higher anxiety; (2) higher anxiety correlates with higher RePi change and poorer neonatal outcome; (3) fetuses from the GH group would have poorer neonatal outcome. Subjects from the GH group had higher STAI-T and RePi compared to the C group. A positive correlation between RePi and STAI-S, STAI-T, and systolic/diastolic blood pressure was found in both groups. There were more preterm deliveries in the GH group compared to the C group. A significant effect of STAI-T on body weight was observed in the C and GH group. There was a predictive effect of STAI-T and RePi on the C group, and STAI-S, STAI-T, diastolic blood pressure, and RePi on the GH group in terms of neonatal body weight. This study demonstrates an association between antenatal anxiety in GH women and increased fetal cerebral circulation in response to defined auditory stimulation.
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Affiliation(s)
- Marina Vujović
- Institute for Experimental Phonetics and Speech Pathology, Belgrade, Serbia
| | - Mirjana Sovilj
- Institute for Experimental Phonetics and Speech Pathology, Belgrade, Serbia.,Life Activities Advancement Center, Belgrade, Serbia
| | - Ljiljana Jeličić
- Institute for Experimental Phonetics and Speech Pathology, Belgrade, Serbia.,Life Activities Advancement Center, Belgrade, Serbia
| | - Miodrag Stokić
- Institute for Experimental Phonetics and Speech Pathology, Belgrade, Serbia.,Life Activities Advancement Center, Belgrade, Serbia
| | - Darko Plećaš
- Clinical Center of Serbia, Medical Faculty, University Clinic for Obstetrics and Gynecology, University of Belgrade, Belgrade, Serbia
| | - Snežana Plešinac
- Clinical Center of Serbia, Medical Faculty, University Clinic for Obstetrics and Gynecology, University of Belgrade, Belgrade, Serbia
| | - Nadežda Nedeljković
- Faculty of Biology, Department for General Physiology and Biophysics, University of Belgrade, Belgrade, Serbia
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Soltani F, Maleki A, Shobeiri F, Shamsaei F, Ahmadi F, Roshanaei G. The limbo of motherhood: Women's experiences of major challenges to cope with the first pregnancy. Midwifery 2017; 55:38-44. [PMID: 28923536 DOI: 10.1016/j.midw.2017.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/27/2017] [Accepted: 08/27/2017] [Indexed: 12/25/2022]
Abstract
INTRODUCTION pregnancy is a unique health experience which is influenced by various factors, particularly culture and social context. AIM OF STUDY to explore women's perception regarding major challenges of adaptation with first pregnancy based on culture and social context. DESIGN a qualitative content analysis was used for data gathering and analysis. Data were collected through unstructured in-depth interviews. SETTING the study was conducted in public health clinics in Hamadan city, an urban area in southwest of Iran from July to December 2016. PARTICIPANTS nineteen healthy primigravidas were recruited using a purposive sampling method and interviewed in the third trimester of pregnancy. FINDINGS the two main categories extracted: imposing the motherhood role on oneself and negative feelings toward pregnancy. The feeling of being in limbo during pregnancy suggests that the everyday experiences of the participants were filled with challenges and short-term tensions, fears, and limitations of pregnancy overwhelmed the participants with negative feelings. As a result, they experienced doubt due to their inexperience in the acceptance of the responsibility of pregnancy and motherhood. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE one of the challenges of adaptation to pregnancy is the experience of negative feelings toward physiological changes and sense of uncertainty toward accepting motherhood responsibilities. Thus, the provision of suitable interventions during the prenatal period to reduce negative feelings and improve women's self-sufficiency in adaptation to pregnancy seems necessary.
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Affiliation(s)
- Farzaneh Soltani
- Mother and Child Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Azam Maleki
- Mother and Child Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Fatemeh Shobeiri
- Mother and Child Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Farshid Shamsaei
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Fazlollah Ahmadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Ghodratollah Roshanaei
- Department of Biostatistics, Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
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Levine TA, Grunau RE, Segurado R, Daly S, Geary MP, Kennelly MM, O’Donoghue K, Hunter A, Morrison JJ, Burke G, Dicker P, Tully EC, Malone FD, Alderdice FA, McAuliffe FM. Pregnancy-specific stress, fetoplacental haemodynamics, and neonatal outcomes in women with small for gestational age pregnancies: a secondary analysis of the multicentre Prospective Observational Trial to Optimise Paediatric Health in Intrauterine Growth Restriction. BMJ Open 2017; 7:e015326. [PMID: 28637734 PMCID: PMC5734406 DOI: 10.1136/bmjopen-2016-015326] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/12/2017] [Accepted: 04/24/2017] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To examine associations between maternal pregnancy-specific stress and umbilical (UA PI) and middle cerebral artery pulsatility indices (MCA PI), cerebroplacental ratio, absent end diastolic flow (AEDF), birthweight, prematurity, neonatal intensive care unit admission and adverse obstetric outcomes in women with small for gestational age pregnancies. It was hypothesised that maternal pregnancy-specific stress would be associated with fetoplacental haemodynamics and neonatal outcomes. DESIGN This is a secondary analysis of data collected for a large-scale prospective observational study. SETTING This study was conducted in the seven major obstetric hospitals in Ireland and Northern Ireland. PARTICIPANTS Participants included 331 women who participated in the Prospective Observational Trial to Optimise Paediatric Health in Intrauterine Growth Restriction. Women with singleton pregnancies between 24 and 36 weeks gestation, estimated fetal weight <10th percentile and no major structural or chromosomal abnormalities were included. PRIMARY AND SECONDARY OUTCOME MEASURES Serial Doppler ultrasound examinations of the umbilical and middle cerebral arteries between 20 and 42 weeks gestation, Pregnancy Distress Questionnaire (PDQ) scores between 23 and 40 weeks gestation and neonatal outcomes. RESULTS Concerns about physical symptoms and body image at 35-40 weeks were associated with lower odds of abnormal UAPI (OR 0.826, 95% CI 0.696 to 0.979, p=0.028). PDQ score (OR 1.073, 95% CI 1.012 to 1.137, p=0.017), concerns about birth and the baby (OR 1.143, 95% CI 1.037 to 1.260, p=0.007) and concerns about physical symptoms and body image (OR 1.283, 95% CI 1.070 to 1.538, p=0.007) at 29-34 weeks were associated with higher odds of abnormal MCA PI. Concerns about birth and the baby at 29-34 weeks (OR 1.202, 95% CI 1.018 to 1.421, p=0.030) were associated with higher odds of AEDF. Concerns about physical symptoms and body image at 35-40 weeks were associated with decreased odds of neonatal intensive care unit admission (OR 0.635, 95% CI 0.435 to 0.927, p=0.019). CONCLUSIONS These findings suggest that fetoplacental haemodynamics may be a mechanistic link between maternal prenatal stress and fetal and neonatal well-being, but additional research is required.
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Affiliation(s)
- Terri A Levine
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, Northern Ireland
- Newborn Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Ruth E Grunau
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Ricardo Segurado
- UCD CSTAR and School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Sean Daly
- Department of Obstetrics and Gynaecology, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Michael P Geary
- Department of Obstetrics and Gynaecology, Rotunda Hospital, Dublin, Ireland
| | - Mairead M Kennelly
- University College Dublin Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Keelin O’Donoghue
- Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Cork, Ireland
| | - Alyson Hunter
- Department of Obstetrics and Gynaecology, Royal Jubilee Maternity Hospital, Belfast, Northern Ireland
| | - John J Morrison
- Department of Obstetrics and Gynaecology, National University of Ireland, Galway, Ireland
| | - Gerard Burke
- Department of Obstetrics and Gynaecology, Mid-Western Regional Maternity Hospital, Limerick, Ireland
| | - Patrick Dicker
- Department of Epidemiology and Public Health, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Elizabeth C Tully
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fergal D Malone
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fiona A Alderdice
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, Northern Ireland
- National Perinatal Epidemiology Unit, Oxford University, Oxford, UK
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, Obstetrics and Gynaecology, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
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Rakers F, Rupprecht S, Dreiling M, Bergmeier C, Witte OW, Schwab M. Transfer of maternal psychosocial stress to the fetus. Neurosci Biobehav Rev 2017; 117:S0149-7634(16)30719-9. [PMID: 28237726 DOI: 10.1016/j.neubiorev.2017.02.019] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 02/14/2017] [Accepted: 02/20/2017] [Indexed: 12/18/2022]
Abstract
Psychosocial maternal stress experienced during different vulnerable periods throughout gestation is thought to increase the individual's risk to develop neuropsychiatric, cardiovascular and metabolic disease in later life. Cortisol has generally been identified as the major mediator of maternal stress transfer to the fetus. Its lipophilic nature allows a trans-placental passage and thus excessive maternal cortisol could persistently impair the development of the fetal hypothalamic-pituitary-adrenal axis (HPAA). However, cortisol alone cannot fully explain all effects of maternal stress especially during early to mid pregnancy before maturation of the fetal HPAA has even begun and expression of fetal glucocorticoid receptors is limited. This review focuses on mediators of maternal fetal stress transfer that in addition to cortisol have been proposed as transmitters of maternal stress: catecholamines, cytokines, serotonin/tryptophan, reactive-oxygen-species and the maternal microbiota. We propose that the effects of psychosocial maternal stress on fetal development and health and disease in later life are not a consequence of a single pathway but are mediated by multiple stress-transfer mechanisms acting together in a synergistic manner.
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Affiliation(s)
- Florian Rakers
- Hans Berger Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany.
| | - Sven Rupprecht
- Hans Berger Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany.
| | - Michelle Dreiling
- Hans Berger Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany.
| | - Christoph Bergmeier
- Hans Berger Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany.
| | - Otto W Witte
- Hans Berger Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany.
| | - Matthias Schwab
- Hans Berger Department of Neurology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany.
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Dusitkasem S, Herndon BH, Somjit M, Stahl DL, Bitticker E, Coffman JC. Comparison of Phenylephrine and Ephedrine in Treatment of Spinal-Induced Hypotension in High-Risk Pregnancies: A Narrative Review. Front Med (Lausanne) 2017; 4:2. [PMID: 28164084 PMCID: PMC5247437 DOI: 10.3389/fmed.2017.00002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 01/06/2017] [Indexed: 11/13/2022] Open
Abstract
Purpose To compare maternal and fetal effects of intravenous phenylephrine and ephedrine administration during spinal anesthesia for cesarean delivery in high-risk pregnancies. Source An extensive literature search was conducted using the US National Library of Medicine, MEDLINE search engine, Cochrane review, and Google Scholar using search terms “ephedrine and phenylephrine,” “preterm and term and spinal hypotension,” “preeclampsia and healthy parturients,” or “multiple and singleton gestation and vasopressor.” Society of Obstetric Anesthesia and Perinatology meeting abstracts for the past 4 years were also searched for relevant studies. Principle findings Both phenylephrine and ephedrine can be safely used to counteract hypotension after spinal anesthesia in patients with uteroplacental insufficiency, pregnancy-induced hypertension, and in non-elective cesarean deliveries. Vasopressor requirements before delivery in high-risk cesarean sections are reduced compared to healthy parturients. Among the articles reviewed, there were no statistically significant differences in umbilical arterial pH, umbilical venous pH, incidence of fetal acidosis, Apgar scores, or maternal hypotension when comparing maternal phenylephrine and ephedrine use. Conclusion From the limited existing data, phenylephrine and ephedrine are both appropriate selections for treating or preventing hypotension induced by neuraxial blockade in high-risk pregnancies. There is no clear evidence that either medication is more effective at maintaining maternal blood pressure or has a superior safety profile in this setting. Further investigations are required to determine the efficacy, ideal dosing regimens, and overall safety of phenylephrine and ephedrine administration in high-risk obstetric patients, especially in the presence uteroplacental insufficiency.
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Affiliation(s)
- Sasima Dusitkasem
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Blair H Herndon
- Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Monsicha Somjit
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Srinagarin Hospital, Khonkaen University, Khon Kaen, Thailand
| | - David L Stahl
- Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Emily Bitticker
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA; University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - John C Coffman
- Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
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Arranz Betegón Á, García M, Parés S, Montenegro G, Feixas G, Padilla N, Camacho A, Goberna J, Botet F, Gratacós E. A Program Aimed at Reducing Anxiety in Pregnant Women Diagnosed With a Small-for-Gestational-Age Fetus: Evaluative Findings From a Spanish Study. J Perinat Neonatal Nurs 2017; 31:225-235. [PMID: 28737543 DOI: 10.1097/jpn.0000000000000270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The objective of this study was to evaluate the effect of anxiety-reducing techniques including music therapy, sophrology, and creative visualization in pregnant women with a fetus diagnosed as small for gestational age and improved fetal and neonatal weight. This was a quasi-experimental study with a nonrandomized clinical trial design. We compared 2 groups of pregnant women with a fetus diagnosed as small for gestational age with no abnormalities on Doppler studies. The control group (n = 93) received standard care, and the intervention group (n = 65), in addition to standard care, underwent a program of 6 sessions led by a midwife or nurse who taught anxiety-reduction techniques. The State-Trait Anxiety Inventory (STAI) including trait and state subscales were completed by both groups at the start of the study, and only the STAI-State subscale was completed again at the end of the study. Comparisons between the 2 groups regarding fetal weight and centile and maternal STAI scores were performed using the t test and the χ test. There were no significant differences in the STAI-Trait scores between the 2 groups. There were statistically significant differences in the intervention group's STAI-State score percentiles between the start and the end of the study, being lower at the end of the study (P < .001). There were significant differences between the 2 groups in fetal weight trajectory on the basis of fetal weight: the intervention group had a larger weight gain (P < .005). The program designed to reduce anxiety in pregnant women was effective at reducing anxiety in the women in the intervention group, leading to a favorable fetal weight trajectory in this group.
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Affiliation(s)
- Ángela Arranz Betegón
- BCNatal (Hospital Clínic de Barcelona and Hospital Sant Joan de Déu), Barcelona, Spain (Drs Arranz Betegón, Botet, and Gratacós and Mss García, Parés, Montenegro, Feixas, and Camacho); Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden (Dr Padilla); Department of Public Health, Mental Health and Perinatal Nursing, University of Barcelona, Barcelona, Spain (Dr Goberna); and IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBERER), Barcelona, Spain (Drs Botet and Gratacós)
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