Issn Print: 0029-7828

Publication Date: 1999/09/01


Print

Association Between Maternal Anxiety in Pregnancy and Increased Uterine Artery Resistance Index: Cohort Based Study

Jeronima M. A. Teixeira; Nicholas M. Fisk; Vivette Glover

    loading  Checking for direct PDF access through Ovid

Excerpt

Most cultures believe that the mother's psychological state can somehow influence her unborn child, and some studies have demonstrated lower birth weights and earlier births when mothers are stressed or anxious. Apart from increased transfer of maternal hormones across the placenta, one possible mechanism is abnormal blood flow in the uterine arteries, an effect demonstrated in primates. Whether this happens in humans as well has now been studied in 100 women with singleton pregnancies at 28 to 32 weeks' gestation. Uterine arterial flow was assessed by color Doppler ultrasonography, which estimates arterial resistance and detects notches in the flow waveform, which is indicative of particularly high resistance to blood flow. The Spielberger questionnaire was used to measure state and trait anxiety.
Peak arterial resistance correlated significantly with both state and trait anxiety scores. Whether measured by a mean resistance index, peak resistance, or notching, women with high state anxiety had significantly worse uterine velocity waveforms than those with a low level of state anxiety. Most women with the highest trait anxiety scores also had high state anxiety levels. A combination of state anxiety and maternal heart rate best predicted the average arterial resistance index. Only state anxiety scores predicted peak resistance or notching. Clinical variables could not be related to levels of either state or trait anxiety.
Reduced blood flow through highly resistant uterine arteries could explain in part why women who suffer anxiety during pregnancy tend to have smaller infants. It may also help explain associations between the intrauterine environment and later-developing disease in offspring, such as coronary heart disease.
This study provides data to answer a question frequently posed by pregnant women: "Is it possible that my emotional state will harm my baby?" Using Doppler measurements of uterine artery resistance, the authors found a statistically significant association between maternal anxiety and increased uterine artery resistance. Maternal anxiety was assessed by a questionnaire that measured both "state," or acute, anxiety, and "trait," or chronic, anxiety. Interestingly, the association between maternal anxiety and increased uterine artery resistance was much stronger with state (acute) anxiety than with trait (chronic) anxiety.
(The authors performed the combined emotional state assessment and the measurement of uterine artery resistance on only one occasion between 28 and 32 weeks' gestation for each patient. Of great interest would be the results of the same combination of tests repeated several times in the same patients over a more extended period of gestation. An obvious question is whether the same relationship between uterine artery resistance and maternal anxiety is sustained over time.
The relationship between maternal emotional and physical stress and fetal outcome has long intrigued investigators. More than 20 years ago, Morishima et al., in experiments with pregnant rhesus monkeys, found that maternal agitation induced by exposure to bright light caused a decrease in fetal heart rate and arterial oxygenation (Am J Obstet Gynecol 1978;131:286). Katz et al. compared pregnancy outcomes in physicians with those in nonphysicians of similar socioeconomic status and found that the physicians had a 1.86 (1.00-3.46) relative risk of an adverse pregnancy outcome, including a 4.0 (1.58-10.1) increased risk for preterm labor (J Reprod Med 1989;34:790). In a subsequent study of pregnant physicians and intensive care nurses, Katz et al. showed that urinary catecholamines were increased by 58 percent during work periods compared with nonwork periods (Obstet Gynecol 1991;77:338). Increased uteroplacental blood flow resistance detected by Doppler velocimetry is predictive for preeclampsia and fetal growth restriction (S Bewley et al., Br J Obstet Gynaecol 1991;98:871).
    loading  Loading Related Articles