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

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dc.contributor.author Levine, Terri A.
dc.contributor.author Grunau, Ruth E.
dc.contributor.author Segurado, Ricardo
dc.contributor.author Daly, Sean
dc.contributor.author Geary, Michael P.
dc.contributor.author Kennelly, Mairead M.
dc.contributor.author O'Donoghue, Keelin
dc.contributor.author Hunter, Alyson
dc.contributor.author Morrison, John J.
dc.contributor.author Burke, Gerard J.
dc.contributor.author Dicker, Patrick
dc.contributor.author Tully, Elizabeth C.
dc.contributor.author Malone, Fergal D.
dc.contributor.author Alderdice, Fiona A.
dc.contributor.author McAuliffe, Fionnuala M.
dc.date.accessioned 2017-09-26T11:39:19Z
dc.date.available 2017-09-26T11:39:19Z
dc.date.issued 2017
dc.identifier.citation Levine, T. A., Grunau, R. E., Segurado, R., Daly, S., Geary, M. P., Kennelly, M. M., O’Donoghue, K., Hunter, A., Morrison, J. J., Burke, G., Dicker, P., Tully, E. C., Malone, F. D., Alderdice, F. A. and McAuliffe, F. M. (2017) '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, 7(6). (12pp). doi: 10.1136/bmjopen-2016-015326 en
dc.identifier.volume 7
dc.identifier.issued 6
dc.identifier.issn 2044-6055
dc.identifier.uri http://hdl.handle.net/10468/4787
dc.identifier.doi 10.1136/bmjopen-2016-015326
dc.description.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. en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher BMJ Publishing Group en
dc.relation.uri http://bmjopen.bmj.com/content/7/6/e015326
dc.rights © 2017, the Authors (or their employer(s) unless otherwise stated in the text of the article). All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ en
dc.rights.uri http://creativecommons.org/licenses/by-nc/4.0/
dc.subject Middle cerebral artery en
dc.subject Corticotropin releasing hormone en
dc.subject Intimate partner violence en
dc.subject Prenatal distress questionnaire en
dc.subject Maternal psychological distress en
dc.subject Cerebroplacental doppler ratio en
dc.subject Nitric oxide synthase en
dc.subject Blood flow en
dc.subject Placental resistance en
dc.subject Birth outcomes en
dc.title 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 en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Keelin O'Donoghue, Obstetrics and Gynaecology, University College Cork, Cork, Ireland. +353-21-490-3000 Email: k.odonoghue@ucc.ie en
dc.internal.availability Full text available en
dc.description.version Published Version en
dc.internal.wokid WOS:000406391200144
dc.contributor.funder Health Research Board
dc.description.status Peer reviewed en
dc.identifier.journaltitle BMJ Open en
dc.internal.IRISemailaddress k.odonoghue@ucc.ie en
dc.identifier.articleid e015326


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© 2017, the Authors (or their employer(s) unless otherwise stated in the text of the article). All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ Except where otherwise noted, this item's license is described as © 2017, the Authors (or their employer(s) unless otherwise stated in the text of the article). All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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