Norwegian Resource Centre for Women's Health, Oslo University Hospital, Oslo, Norway ; Department of Obstetrics, Oslo University Hospital, Oslo, Norway.
Norwegian Resource Centre for Women's Health, Oslo University Hospital, Oslo, Norway ; Department of Health, Nutrition and Management, Oslo and Akershus University College of Applied Sciences, Oslo, Norway.
PLoS One. 2014 Jan 27;9(1):e86597. doi: 10.1371/journal.pone.0086597. eCollection 2014.
Antenatal maternal psychological distress may be associated with reduced placental circulation, which could lead to lower birthweight. Studies investigating this in humans show mixed results, which may be partially due to type, strength and timing of distress. In addition, the arterial vascular resistance measures often used as outcome measures do not detect smaller changes in placental volume blood flow. We aimed to investigate the effect of a specific stressor, with increased levels of stress early in pregnancy, on the fetoplacental volume blood flow in third trimester.
This was a prospective observational study of 74 pregnant women with a congenital malformation in a previous fetus or child. Psychological distress was assessed twice, around 16 and 30 weeks' gestation. Psychometric measures were the General Health Questionnaire-28 (subscales anxiety and depression), Edinburgh Postnatal Depression Scale, and Impact of Event Scale-22 (subscales intrusion, avoidance, and arousal). Placental circulation was examined at 30 weeks, using Doppler ultrasonography, primarily as fetoplacental volume blood flow in the umbilical vein, normalized for abdominal circumference; secondarily as vascular resistance measures, obtained from the umbilical and the uterine arteries.
Maternal distress in second but not third trimester was associated with increased normalized fetoplacental blood flow (P-values 0.006 and 0.013 for score > mean for depression and intrusion, respectively). Post-hoc explorations suggested that a reduced birthweight/placental weight ratio may mediate this association. Psychological distress did not affect vascular resistance measures in the umbilical and uterine arteries, regardless of adjustment for confounders.
In pregnant women with a previous fetus or child with a congenital malformation, higher distress levels in second trimester were associated with third trimester fetoplacental blood flow that was higher than expected for the size of the fetus. The results do not support placental blood flow reduction as a pathway between maternal distress and reduced birthweight.
产前产妇心理困扰可能与胎盘循环减少有关，这可能导致出生体重降低。研究表明，人类中存在混合结果，这可能部分归因于困扰的类型、强度和时间。此外，通常用作结果测量的动脉血管阻力测量并不能检测到胎盘体积血流的较小变化。我们旨在研究特定应激源的影响，即在妊娠早期增加应激水平，对妊娠晚期胎儿胎盘体积血流的影响。
这是一项对 74 名前一胎或前一胎孩子有先天畸形的孕妇进行的前瞻性观察研究。心理困扰在妊娠 16 周和 30 周左右进行了两次评估。心理测量学指标包括一般健康问卷-28（焦虑和抑郁子量表）、爱丁堡产后抑郁量表和事件影响量表-22（闯入、回避和唤醒子量表）。使用多普勒超声检查在 30 周时检查胎盘循环，主要是脐静脉的胎儿胎盘体积血流，按腹围归一化；其次是从脐动脉和子宫动脉获得的血管阻力测量值。
仅在第二孕期而非第三孕期时，产妇的困扰与增加的归一化胎儿胎盘血流有关（抑郁和闯入评分>平均值的分数分别为 P 值 0.006 和 0.013）。事后探索表明，出生体重/胎盘重量比降低可能介导这种关联。无论是否调整混杂因素，心理困扰都不会影响脐动脉和子宫动脉的血管阻力测量值。
在有先天畸形前一胎或前一胎孩子的孕妇中，第二孕期较高的困扰水平与第三孕期胎儿胎盘血流有关，该血流高于胎儿大小的预期。结果不支持胎盘血流减少作为产妇困扰与出生体重降低之间的途径。
