Maternal psychological distress and placental circulation in pregnancies after a previous offspring with congenital malformation.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Norwegian Resource Centre for Women's Health, Oslo University Hospital, Oslo, Norway ; Department of Obstetrics, Oslo University Hospital, Oslo, Norway.
Anne
A
Helbig
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.
Anne
A
Kaasen
Department of Neuropsychiatry and Psychosomatic Medicine, Oslo University Hospital, Oslo, Norway ; Institute of Clinical Medicine, University of Oslo, Norway.
Ulrik Fredrik
UF
Malt
Department of Obstetrics, Oslo University Hospital, Oslo, Norway ; Institute of Clinical Medicine, University of Oslo, Norway.
Guttorm
G
Haugen
D000013:Congenital Abnormalities / Q000523:psychology*; D005260:Female; D006801:Humans; D009035:Mothers / Q000523:psychology*; D021041:Placental Circulation / Q000502:physiology*; D011247:Pregnancy; D011446:Prospective Studies; D011594:Psychometrics; D013315:Stress, Psychological / Q000503:physiopathology*; D011795:Surveys and Questionnaires; D014463:Ultrasonography; D014655:Vascular Resistance / Q000502:physiology