Abstract
IntroductionSome types of antenatal maternal psychological distress may be associated with reduced fetal growth and birthweight. A stress-mediated reduction in placental blood flow has been suggested as a mechanism. Previous studies have examined this using ultrasound-derived arterial resistance measures in the uterine (UtA) and umbilical (UA) arteries, with mixed conclusions. However, a reduction in placental volume blood flow may occur before changes in arterial resistance measures are seen. Fetoplacental volume blood flow can be quantified non-invasively in the umbilical vein (UV). Our objective was to study whether specific types of maternal psychological distress affect the placental circulation, using volume blood flow quantification in addition to arterial resistance measures.MethodsThis was a prospective observational study of 104 non-smoking pregnant women (gestational age 30 weeks) with uncomplicated obstetric histories. Psychological distress was measured by General Health Questionnaire-28 (subscales anxiety and depression) and Impact of Event Scale-22 (subscales intrusion, avoidance and arousal). UtA and UA resistance measures and UV volume blood flow normalized for fetal abdominal circumference, were obtained by Doppler ultrasound.ResultsIES intrusion scores above the mean were associated with a reduction in normalized UV volume blood flow (corresponding to –0.61 SD; P = 0.003). Adjusting for UA resistance increased the strength of this association (difference –0.66 SD; P<0.001). Other distress types were not associated with UV volume blood flow. Maternal distress was not associated with arterial resistance measures, despite adjustment for confounders.ConclusionsIntrusive thoughts and emotional distress regarding the fetus were associated with reduced fetoplacental volume blood flow in third trimester. Uterine and umbilical artery resistance measures were not associated with maternal distress. Our findings support a decrease in fetoplacental blood flow as a possible pathway between maternal distress and reduced fetal growth.
Highlights
Some types of antenatal maternal psychological distress may be associated with reduced fetal growth and birthweight
Impact of Event Scale (IES) intrusion scores above the mean were associated with a reduction in normalized umbilical vein (UV) volume blood flow
Maternal distress was not associated with arterial resistance measures, despite adjustment for confounders
Summary
Some types of antenatal maternal psychological distress may be associated with reduced fetal growth and birthweight. A reduction in placental volume blood flow may occur before changes in arterial resistance measures are seen. Our objective was to study whether specific types of maternal psychological distress affect the placental circulation, using volume blood flow quantification in addition to arterial resistance measures. Psychological distress has been suspected of causing reduced fetal growth and birthweight, human studies have not shown consistent results [4,6,7]. This may due to the considerable methodological challenges and variations involved [5,6,8]. While the effect size may not be of clinical relevance, it represents a physiological event and may be part of the complex interplay between the maternal environment, the placenta, and the developing fetus
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