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.authorLevine, Terri A.
dc.contributor.authorGrunau, Ruth E.
dc.contributor.authorSegurado, Ricardo
dc.contributor.authorDaly, Sean
dc.contributor.authorGeary, Michael P.
dc.contributor.authorKennelly, Mairead M.
dc.contributor.authorO'Donoghue, Keelin
dc.contributor.authorHunter, Alyson
dc.contributor.authorMorrison, John J.
dc.contributor.authorBurke, Gerard J.
dc.contributor.authorDicker, Patrick
dc.contributor.authorTully, Elizabeth C.
dc.contributor.authorMalone, Fergal D.
dc.contributor.authorAlderdice, Fiona A.
dc.contributor.authorMcAuliffe, Fionnuala M.
dc.contributor.funderHealth Research Board
dc.date.accessioned2017-09-26T11:39:19Z
dc.date.available2017-09-26T11:39:19Z
dc.date.issued2017
dc.description.abstractObjectives 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.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.articleide015326
dc.identifier.citationLevine, 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-2016-015326en
dc.identifier.doi10.1136/bmjopen-2016-015326
dc.identifier.issn2044-6055
dc.identifier.issued6
dc.identifier.journaltitleBMJ Openen
dc.identifier.urihttps://hdl.handle.net/10468/4787
dc.identifier.volume7
dc.language.isoenen
dc.publisherBMJ Publishing Groupen
dc.relation.urihttp://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.urihttp://creativecommons.org/licenses/by-nc/4.0/
dc.subjectMiddle cerebral arteryen
dc.subjectCorticotropin releasing hormoneen
dc.subjectIntimate partner violenceen
dc.subjectPrenatal distress questionnaireen
dc.subjectMaternal psychological distressen
dc.subjectCerebroplacental doppler ratioen
dc.subjectNitric oxide synthaseen
dc.subjectBlood flowen
dc.subjectPlacental resistanceen
dc.subjectBirth outcomesen
dc.titlePregnancy-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 restrictionen
dc.typeArticle (peer-reviewed)en
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