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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
  1. Terri A Levine1,2,
  2. Ruth E Grunau3,4,
  3. Ricardo Segurado5,
  4. Sean Daly6,
  5. Michael P Geary7,
  6. Mairead M Kennelly8,
  7. Keelin O’Donoghue9,
  8. Alyson Hunter10,
  9. John J Morrison11,
  10. Gerard Burke12,
  11. Patrick Dicker13,
  12. Elizabeth C Tully14,
  13. Fergal D Malone14,
  14. Fiona A Alderdice1,15,
  15. Fionnuala M McAuliffe16
  1. 1 School of Nursing and Midwifery, Queen’s University Belfast, Belfast, Northern Ireland
  2. 2 Newborn Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
  3. 3 Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
  4. 4 Child and Family Research Institute, Vancouver, British Columbia, Canada
  5. 5 UCD CSTAR and School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
  6. 6 Department of Obstetrics and Gynaecology, Coombe Women and Infants University Hospital, Dublin, Ireland
  7. 7 Department of Obstetrics and Gynaecology, Rotunda Hospital, Dublin, Ireland
  8. 8 University College Dublin Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland
  9. 9 Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Cork, Ireland
  10. 10 Department of Obstetrics and Gynaecology, Royal Jubilee Maternity Hospital, Belfast, Northern Ireland
  11. 11 Department of Obstetrics and Gynaecology, National University of Ireland, Galway, Ireland
  12. 12 Department of Obstetrics and Gynaecology, Mid-Western Regional Maternity Hospital, Limerick, Ireland
  13. 13 Department of Epidemiology and Public Health, Royal College of Surgeons in Ireland, Dublin, Ireland
  14. 14 Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Dublin, Ireland
  15. 15 National Perinatal Epidemiology Unit, Oxford University, Oxford, UK
  16. 16 UCD Perinatal Research Centre, Obstetrics and Gynaecology, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
  1. Correspondence to Dr Fiona A Alderdice; f.a.alderdice{at}qub.ac.uk

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.

  • doppler ultrasound
  • small for gestational age
  • pregnancy-specific stress
  • perinatal mental health
  • umbilical artery
  • middle cerebral artery

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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Footnotes

  • Contributors TAL made substantial contributions to the analysis and interpretation of the data for this manuscript, drafted the initial manuscript, revised it critically for important intellectual content, approved the final version for publication and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. REG, FAA and FMMcA made substantial contributions to the analysis and interpretation of the data for this manuscript, revised the manuscript critically for important intellectual content, approved the final version for publication and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. FAA and FMMcA also made substantial contributions to the conception and design of the work and the acquisition of the data for this manuscript. RS made substantial contributions to the analysis and interpretation of the data for this manuscript, revised it critically for important intellectual content, approved the final version for publication and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SD, MPG, MMK, KO’D, AH, JJM, GB, PD, ECT and FDM made substantial contributions to the conception and design of the work and the acquisition of the data for this manuscript, revised it critically for important intellectual content, approved the final version for publication and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding TAL held a PhD studentship from Queen’s University Belfast in Northern Ireland, UK. The PORTO study was conducted by the Perinatal Ireland Research Consortium, a nationwide collaborative research network comprising of the seven largest academic obstetric centers in Ireland. The study was funded by the Health Research Board (HRB).

  • Competing interests None declared.

  • Ethics approval Institutional Review Boards at all participating centres.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The authors welcome requests for any unpublished data associated with this study.

  • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with 'BMJ Publishing Group'. This only affected the full text version, not the PDF. We have since corrected theseerrors and the correct publishers have been inserted into the references.

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