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

Helbig, Anne; Kaasen, Anne; Malt, Ulrik Fredrik; Haugen, Guttorm
Journal article, Peer reviewed
(c) 2014 helbig et al. this is an open-access article distributed under the terms of the creative commons attribution license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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URI
https://hdl.handle.net/10642/2465
Date
2014
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  • HV - Institutt for sykepleie og helsefremmende arbeid [1565]
Original version
Helbig, A., Kaasen, A., Malt, U.F. & Haugen,G. (2014). Maternal psychological distress and placental circulation in pregnancies after a previous offspring with congenital malformation. PLoS ONE, 9(1). doi:10.1371/journal.pone.0086597   http://dx.doi.org/10.1371/journal.pone.0086597
Abstract
Introduction: 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.
Publisher
Public Library of Science

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