Psychological distress after recent detection of fetal malformation: short-term effect on second-trimester uteroplacental and fetoplacental circulation

Abstract

We examined the short-term effect of severe maternal psychological distress on the placental circulation in second trimester in a prospective observational study. In 86 pregnant women with a newly detected fetal malformation, and 98 women with normal ultrasound findings, distress was assessed using the Impact of Event Scale and the General Health Questionnaire-28. Uterine and umbilical artery pulsatility indices, notching and heart rates were measured by Doppler ultrasound. Psychological distress was high in the anomaly group, but circulatory outcome measures did not differ between groups. Multiple regression analyses did not show an increase in circulatory resistance measures even at high distress levels.Keywords Doppler ultrasound, fetal malformation, pregnancy, psychological distress, umbilical artery, uterine artery.Please cite this paper as: Helbig A, Kaasen A, Malt U, Haugen G. Psychological distress after recent detection of fetal malformation: short-term effect on second-trimester uteroplacental and fetoplacental circulation.

Prenatal stress and hemodynamics in pregnancy: a systematic review

“…One study (Caliskan et al, 2009) failed to provide exclusion criteria, and two studies failed to describe the study sample for key characteristics (Kent et al, 2002;Teixeira et al, 1999). Six studies (Caliskan et al, 2009;Helbig et al, 2011;Helbig et al, 2013;Kent et al, 2002;Teixeira et al, 1999;Vythilingum et al, 2010) were cross-sectional, with participants assessed at varying gestational ages, which can make it more difficult to assess acute versus chronic stress as well as changes in blood flow over time. All but one (Harville et al, 2008) study had small sample sizes, which can make it difficult to detect minor effects and does not allow conclusions about clinical significance.…”

“…Standardized outcome measures decrease measurement bias and make comparability across studies less problematic but increase the risk of subjective response bias, and the choice of stress measures varied considerably. Only three studies (Helbig et al, 2011;Helbig et al, 2013;Mendelson et al, 2011) addressed pregnancyspecific stress. Four studies (Harville et al, 2008;Maina et al, 2008;Monk et al, 2012;Sjostrom et al, 1997) included a clinical interview to assess maternal psychological state, while eight (Caliskan et al, 2009;Helbig et al, 2011;Helbig et al, 2013;Kent et al, 2002;Mendelson et al, 2011;Roos et al, 2015;Teixeira et al, 1999;Vythilingum et al, 2010) relied on self-report measures.…”

“…Five studies explicitly excluded participants on the basis of a pre-existing psychiatric diagnosis (Helbig et al, 2011;Helbig et al, 2013;Maina et al, 2008;Mendelson et al, 2011;Monk et al, 2012), and seven did not (Caliskan et al, 2009;Harville et al, 2008;Kent et al, 2002;Roos et al, 2015;Sjostrom et al, 1997;Teixeira et al, 1999;Vythilingum et al, 2010).…”

“…Seven of the studies assessed healthy, medically low-risk pregnant women (Helbig et al, 2013;Kent et al, 2002;Mendelson et al, 2011;Roos et al, 2015;Sjostrom et al, 1997;Teixeira et al, 1999;Vythilingum et al, 2010), two assessed medically high-risk pregnant women (Caliskan et al, 2009;Helbig et al, 2011), and Harville et al (2008) included both high-and low-risk participants. Two studies specifically assessed pregnant women with existing psychiatric diagnoses (Maina et al, 2008;Monk et al, 2012).…”

“…Adjustment for potentially confounding factors was only adequate in one study (Monk et al, 2012). Data analysis was adequately described in seven of the included studies (Caliskan et al, 2009;Harville et al, 2008;Helbig et al, 2011;Helbig et al, 2013;Roos et al, 2015;Sjostrom et al, 1997;Vythilingum et al, 2010).…”