Stress and anxiety in pregnant women exposed to ultrasound

Silva, Elaine C P Da; Silva, Sônia V L; Damião, Rievani; Fonseca, Eduardo Borges da; Garcia, Sidney Antonio Lagrosa; Lippi, Umberto Gazi

doi:10.3109/14767058.2011.574299

Cited by 13 publications

(6 citation statements)

References 15 publications

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“…However, that study also finds that a low‐risk result increased reassurance and relief. These findings are in line with several other studies that demonstrate a reassuring affect and increased fetal‐maternal attachment following a normal screening result.…”

Section: Discussionsupporting

confidence: 92%

Does screening for Down's syndrome cause anxiety in pregnant women? A systematic review

Lou

Mikkelsen

Hvidman

et al. 2014

Acta Obstet Gynecol Scand

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Section: Discussionsupporting

confidence: 92%

Does screening for Down's syndrome cause anxiety in pregnant women? A systematic review

Lou

Mikkelsen

Hvidman

et al. 2014

Acta Obstet Gynecol Scand

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“…Therefore, an age-related decline in anti-in ammatory cytokines may increase vulnerability of women of AMA to in ammation and the associated detrimental effects observed on placental function and should therefore be further explored (54). We speculate that maternal aging creates a suboptimal environment for placental and fetal development that contributes to the vulnerability to adverse outcomes.…”

Section: Discussionmentioning

confidence: 94%

A Prospective Cohort Study providing Insights for Markers of Adverse Pregnancy Outcome in Women of Advanced Maternal Age

Lean

Jones

Roberts

et al. 2020

Preprint

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Background Advanced maternal age (AMA; ≥35 years) is associated with increased rates of adverse pregnancy outcome. Better understanding of underlying pathophysiological processes may improve identification of AMA mothers who are at greatest risk of adverse outcome. This study aimed to investigate changes in oxidative stress and inflammation in AMA women and identify clinical and biochemical predictors of adverse pregnancy outcome in women of AMA.Methods The Manchester Advanced Maternal Age Study (MAMAS) was a multicentre, observational, prospective cohort study of 527 mothers. Participants were divided into three age groups for comparison 20-30 years (n=158), 35-39 years (n=212) and ≥40 years (n=157). Demographic and medical data were collected along with maternal blood samples at 28 and 36 weeks’ gestation. Multivariable analysis was conducted to identify variables associated with adverse outcome, defined as one or more of: small for gestational age (<10th centile), FGR (<5th centile), stillbirth, NICU admission, preterm birth <37 weeks gestation or Apgar score <7 at 5 minutes. Biomarkers of inflammation, oxidative stress and placental dysfunction were quantified in maternal serum. Univariate and multivariable statistical analyses were used to identify associations with composite adverse fetal outcome.Results: Maternal smoking was associated with adverse outcome in older mothers (Adjusted Odds Ratio (AOR) 4.34, 95% Confidence Interval (95%CI) 1.88, 9.99), whereas multiparity reduced the odds (AOR 0.56, 95% CI 0.34, 0.99). In uncomplicated AMA pregnancies, lower circulating anti-inflammatory IL-10, IL-RA and increased antioxidant capacity (TAC) were seen. In AMA with adverse outcome, TAC and oxidative stress markers were increased and levels of maternal circulating placental hormones (hPL, PlGF and sFlt-1) were reduced (p<0.05). Of these, placental growth factor had the strongest predictive accuracy (Area Under the Receiver Operator Characteristic (AUROC) = 0.74) followed by TAC (AUROC=0.69).Conclusions: This study identified alterations in circulating inflammatory and oxidative stress markers in AMA women and in AMA women with adverse pregnancy outcome providing preliminary evidence of mechanistic links. Further, larger studies are required to determine if these markers can be developed into a predictive model of an individual AMA woman’s risk of APO, enabling a reduction in stillbirth rates whilst minimising unnecessary intervention.

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“…The research on cognitive bias in imaging studies originates almost exclusively from static imaging tests (radiographs and computed tomography/magnetic resonance imaging) and does not take into account the particulars of ultrasound, especially obstetric ultrasound, which is performed in the presence of the parents and is broadly anticipated to alleviate their anxiety and deliver good news. The presence of unexpected findings can cause significant emotional stress to the parents, and the examiners, knowing this, may subconsciously downplay (i.e.…”

Section: Bias At Level Of Studiesmentioning

confidence: 99%

Systematic error and cognitive bias in obstetric ultrasound

Sotiriadis

Odibo

2019

Ultrasound in Obstet & Gyne

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This issue of the Journal hosts an important systematic review assessing methodological aspects of studies constructing Doppler reference values for two clinically important vessels, the umbilical and fetal middle cerebral arteries. In this review, Oros et al. 1 developed a 24-item scale with which to assess the methodology of Doppler reference studies over three domains, namely, study design, statistics and reporting methods. Most of the included studies performed moderately for most of the items, which was reflected in the 51.4% overall quality score. Common methodological limitations included retrospective collection of data from fetuses which were scanned for clinical rather than for research reasons, performance of the measurements by a single operator, non-blinded measurements and lack of monitoring of ultrasound quality. A consequence of the multiple limitations, as well as of the methodological heterogeneity of the Doppler studies, is that there was significant variation in normal ranges, even across high-quality studies, which may undermine the clinical applicability of these ranges. Having detected several problematic areas, the authors propose a set of criteria aiming to limit bias in future studies 1 .Although ultrasound examination is an integral part of current obstetric care and a major tool for making clinical decisions, the systematic errors affecting its efficacy have been assessed only marginally. The literature on obstetric ultrasound is abundant in studies assessing its repeatability and agreement, but it is alarmingly poor when it comes to sources of error. Error in obstetric ultrasound can occur at the level of studies, in the form of bias, and at the level of the individual examiner, in the form of mistaken interpretation of the clinical evidence, leading to mistaken diagnosis and, possibly, mismanagement of the patient. Although these two levels commonly overlap and interact, we will discuss them separately for the sake of clarity. Bias at level of studiesAll studies, especially non-randomized and retrospective trials, are susceptible to various sources of bias. In this Editorial, we will focus on specific types of bias that are particularly pertinent to obstetric ultrasound studies. Expectation biasOros et al. 1 reported that Doppler measurements were blinded in only one of 38 Doppler reference studies, which renders their results susceptible to expected-value bias or expectation bias. In this scenario, clinical examiners affected by expectation bias subconsciously regress their measurements closer to the expected range when the latter is known at the time of the examination. As a result, the dispersion of the measurements decreases. Although there is no quantitative information available on the magnitude of this effect, it is reasonable to hypothesize that normal ranges constructed using data acquired retrospectively will be relatively narrow, and examiners using them will then modify their measurements to conform to these narrow ranges, for as long as this remains technically feasible....

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Stress and anxiety in pregnant women exposed to ultrasound

Abstract: Pregnant women did not have a higher level of stress compared with the nonpregnant women, and maternal age is the only significant independent predictor of stress. Pregnant women are more anxious, and after the ultrasound examination, the level of anxiety decreased.

Cited by 13 publications

References 15 publications

Does screening for Down's syndrome cause anxiety in pregnant women? A systematic review

Does screening for Down's syndrome cause anxiety in pregnant women? A systematic review

A Prospective Cohort Study providing Insights for Markers of Adverse Pregnancy Outcome in Women of Advanced Maternal Age

Systematic error and cognitive bias in obstetric ultrasound

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