Prenatal stress and hemodynamics in pregnancy: a systematic review

Abstract

Purpose: Maternal prenatal stress is associated with preterm birth, intrauterine growth restriction, and developmental delay. However, the impact of prenatal stress on hemodynamics during pregnancy remains unclear. This systematic review was conducted in order to assess the quality of the evidence available to date regarding the relationship between prenatal stress and maternal-fetal hemodynamics. Methods:The PubMed/Medline, EMBASE, PsycINFO, Maternity and Infant Care, Trip, Cochrane Library, and CINAHL databases were searched using the search terms pregnancy; stress; fetus; blood; Doppler; ultrasound. Studies were eligible for inclusion if prenatal stress was assessed with standardized measures, hemodynamics was measured with Doppler ultrasound, and methods were adequately described. A specifically designed data extraction form was used. The methodological quality of included studies was assessed using wellaccepted quality-appraisal guidelines.Results: Of 2,532 studies reviewed, 12 met the criteria for inclusion. Six reported that prenatal stress significantly affects maternal or fetal hemodynamics; six found no significant association between maternal stress and circulation. Significant relationships between prenatal stress and uterine artery RI and PI, umbilical artery RI, PI, and S/D ratio, fetal MCA PI, cerebroplacental ratio, and umbilical vein volume blood flow were found. Conclusions:To date, there is limited evidence that prenatal stress is associated with changes in circulation. More carefully designed studies with larger sample sizes, repeated assessments across gestation, tighter control for confounding factors, and measures of pregnancy-specific stress will clarify this relationship.

Comparison of Phenylephrine and Ephedrine in Treatment of Spinal-Induced Hypotension in High-Risk Pregnancies: A Narrative Review

“…Moreover, an association between prenatal stress and changes in Doppler waveform parameters remain inconclusive due to the methodological limitations of available studies (27). Further investigations are necessary to clarify the effect of vasopressors on uteroplacental blood flow and fetal well-being in these high-risk settings.…”

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

“…The overall sample size and sample sizes at each time point in the current study are also relatively large within the context of the available literature on prenatal stress and fetoplacental Doppler velocimetry. 12 Moreover, because this was an SGA sample, it was possible to examine associations between maternal stress and abnormal Doppler findings, while most studies to date have reported statistically but not clinically significant associations with continuous outcomes. None of the 12 studies reporting associations between prenatal stress and Doppler ultrasound also reported neonatal outcomes.…”

“… 7–11 Although evidence links pregnancy-specific stress and fetal and infant outcomes, potential mechanistic pathways such as fetoplacental haemodynamics remain relatively unexplored. A recent systematic review reported 12 studies of prenatal stress and haemodynamics in pregnancy as measured by Doppler ultrasound; 12 only three measured pregnancy-specific stress. 13–15 There is therefore an evidence gap regarding potential associations between pregnancy-specific stress and fetoplacental haemodynamics.…”

Effect of a Nonoptimal Cervicovaginal Microbiota and Psychosocial Stress on Recurrent Spontaneous Preterm Birth

“…[16][17][18][19][20][21][22][23][24][25][26] While precise mechanisms remain unknown, it has been postulated that stress influences hormonal pathways leading to changes in host immune response, thereby affecting the cervicovaginal ecosystem. [27][28][29][30] These findings raise questions as to whether stress may promote colonization of the cervicovaginal space with a nonoptimal microbiota in pregnancy.…”