Skip to main content

Advertisement

SpringerLink
Log in

Prenatal stress and hemodynamics in pregnancy: a systematic review

  • Review Article
  • Published:
Archives of Women's Mental Health Aims and scope Submit manuscript

Abstract

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. 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 well-accepted quality appraisal guidelines. Of 2532 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 resistance (RI) and pulsatility (PI) indices, umbilical artery RI, PI, and systolic/diastolic ratio, fetal middle cerebral artery PI, cerebroplacental ratio, and umbilical vein volume blood flow were found. 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

CPR:

Cerebroplacental ratio

GHQ-28:

General Health Questionnaire

HADS:

Hospital Anxiety and Depression Scale

HAM-A:

Hamilton Rating Scale for Anxiety

IES:

Impact of Event Scale

K-10:

Kessler Psychological Distress Scale

MCA:

Middle cerebral artery

PES-Brief:

Pregnancy Experiences Scale

PI:

Pulsatility index

PSS:

Perceived Stress Scale by Sheldon Cohen

RI:

Resistance index

S/D:

Systolic/diastolic ratio

STAI:

State–Trait Anxiety Inventory

UA:

Umbilical artery

UtA:

Uterine artery

UVVBF:

Umbilical vein volume blood flow

WHO-5:

World Health Organization Five Well-Being Index

References

  • Aardema MW, Saro MC, Lander M, DeWolf BT, Oosterhof H, Aardnoudse JG (2004) Second trimester Doppler ultrasound screening of the uterine arteries differentiates between subsequent normal and poor outcomes of hypertensive pregnancy: two different pathophysiological entities? Clin Sci (Lond) 106:377–382

    Article  CAS  Google Scholar 

  • Adamson SL, Morrow RJ, Bascom PA, Mo LY, Ritchie JW (1989) Effect of placental resistance, arterial diameter, and blood pressure on the uterine arterial velocity waveform: a computer modelling approach. Ultrasound Med Biol 15:437–442

    Article  CAS  PubMed  Google Scholar 

  • Alderdice F, Lynn F (2011) Factor structure of the Prenatal Distress Questionnaire. Midwifery 27:553–559

    Article  PubMed  Google Scholar 

  • Andersson L, Sundstrom-Poromaa I, Wulff M, Astrom M, Bixo M (2004) Neonatal outcome following maternal antenatal depression and anxiety: a population-based study. Am J Epidemiol 159:872–881

    Article  PubMed  Google Scholar 

  • Arias F (1994) Accuracy of the middle-cerebral-to-umbilical-artery resistance index ratios in the prediction of neonatal outcome in patients at high risk of fetal and neonatal outcomes. Am J Obstet Gynecol 171:1541–1545

    Article  CAS  PubMed  Google Scholar 

  • Austin M, Hadzi-Pavlovic D, Leader L, Saint K, Parker G (2005) Maternal trait anxiety, depression and life event stress in pregnancy: relationships with infant temperament. Early Hum Dev 81:183–190

    Article  PubMed  Google Scholar 

  • Aylard PR, Gooding JH, McKenna PJ, Snaith RP (1987) A validation study of three anxiety and depression self-assessment scales. J Psychosom Res 31:261–268

    Article  CAS  PubMed  Google Scholar 

  • Bahado-Singh RO, Kovanci E, Jeffres A, Oz U, Deren O, Copel J, Mari G (1999) The Doppler cerebroplacental ratio and perinatal outcome in intrauterine growth restriction. Am J Obstet Gynecol 180:750–756

    Article  CAS  PubMed  Google Scholar 

  • Bailey BA (2010) Partner violence during pregnancy: prevalence, effects, screening, and management. Int J Women's Health 2:183–197

    Article  Google Scholar 

  • Barker DJ (1998) In utero programming of chronic disease. Clin Sci (Lond) 95:115–128

    Article  CAS  Google Scholar 

  • Barker DJ, Eriksson JG, Forsen T, Osmond C (2002) Fetal origins of adult disease: strength of effects and biological basis. Int J Epidemiol 31(6):1235–1239

    Article  CAS  PubMed  Google Scholar 

  • Bartha JL, Comino-Delgado R, Gonzalez-Mena C, Lopez I, Arrabal J (1998) Umbilical blood flow and neonatal morphometry: a multivariate analysis. Eur J Obstet Gynecol Reprod Biol 79:27–33

    Article  CAS  PubMed  Google Scholar 

  • Bouthoorn SH, van Lenthe FJ, Gaillard R, Hofman A, Steegers EAP, Jaddoe VWV, Raat H (2014) Socioeconomic inequalities in placental vascular resistance: a prospective cohort study. Fertil Steril 101:1367–1374.e4

    Article  PubMed  Google Scholar 

  • Brouwers EP, van Baar AL, Pop VJ (2001) Maternal anxiety during pregnancy and subsequent infant development. Infant Behav Dev 24:95–106

    Article  Google Scholar 

  • Brunton PJ, Arunachalam S, Russell JA (2008) Control of neurohypophyseal hormone secretion, blood osmolality and volume in pregnancy. J Physiol Pharmacol 59(Supplement 8):27–45

    PubMed  Google Scholar 

  • Buss C, Davis EP, Hobel CJ, Sandman CA (2011) Maternal pregnancy-specific anxiety is associated with child executive function at 6–9 years of age. Stress 14(6):665–676

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Buss C, Davis EP, Muftuler LT, Head K, Sandman CA (2010) High pregnancy anxiety during mid-gestation is associated with decreased gray matter density in 6–9-year-old children. Psychoneuroendocrinology 35:141–153

    Article  PubMed  PubMed Central  Google Scholar 

  • Buss C, Davis EP, Shahbaba B, Pruessner JC, Head K, Sandman CA, Sandman CA (2012) Maternal cortisol over the course of pregnancy and subsequent child amygdala and hippocampus volumes and affective problems. Proc Natl Acad Sci 109(20):E1312–E1319

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Caliskan E, Ozkan S, Cakiroglu Y, Yalcinkaya O, Polat A, Corakci A (2009) The effects of maternal anxiety prior to amniocentesis on uterine and fetal umbilical blood flow. J Turkish German Gynecol Assoc 10:162–167

    Google Scholar 

  • Calkins K, Devaskar SU (2011) Fetal origins of adult disease. Curr Probl Pediatr Adolesc Health Care 41(6):158–176

    Article  PubMed  PubMed Central  Google Scholar 

  • Campbell JC (1998) Abuse during pregnancy: progress, policy, and potential. Am J Public Health 88:185–187

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Cohen S, Kamarck T, Mermelstein R (1983) A global measure of perceived stress. J Health Soc Behav 24:385–396

    Article  CAS  PubMed  Google Scholar 

  • Cohen S, Williamson G (1988) Perceived stress in a probability sample of the United States. In: Spacapan S, Oskamp S (eds) The social psychology of health: Claremont Symposium on Applied Social Psychology. Sage, Newbury Park, CA, pp 31–67

    Google Scholar 

  • Davis EP, Glynn LM, Dunkel-Schetter C, Hobel C, Chicz-Demet A, Sandman CA (2005) Corticotropin-releasing hormone during pregnancy is associated with infant temperament. Dev Neurosci 27:299–305

    Article  CAS  PubMed  Google Scholar 

  • Davis EP, Glynn LM, Dunkel-Schetter C, Hobel C, Chicz-Demet A, Sandman CA (2007) Prenatal exposure to maternal depression and cortisol influences infant temperament. J Am Acad Child Adolesc Psychiatry 46:737–746

    Article  PubMed  Google Scholar 

  • Davis EP, Glynn LM, Waffarn F, Sandman CA (2011) Prenatal maternal stress programs infant stress regulation. J Child Psychol Psychiatry 52(2):119–129

    Article  PubMed  Google Scholar 

  • Davis EP, Snidman N, Wadhwa P, Dunkel-Schetter C, Glynn LM, Sandman CA (2004) Prenatal maternal anxiety and depression predict negative behavioral reactivity in infancy. Infancy 6:319–331

    Article  Google Scholar 

  • Davis EP, Sandman CA (2010) The timing of prenatal exposure to maternal cortisol and psychosocial stress is associated with human infant cognitive development. Child Dev 81(1):131–148

    Article  PubMed  PubMed Central  Google Scholar 

  • Diego MA, Jones NA, Field T, Hernandez-Reif M, Schanberg S, Kuhn C, Gonzalez-Garcia A (2006) Maternal psychological distress, prenatal cortisol, and fetal weight. Psychosom Med 68:747–753

    Article  PubMed  Google Scholar 

  • DiPietro JA, Costigan KA, Sipsma HL (2008) Continuity in self-report measures of maternal anxiety, stress, and depressive symptoms from pregnancy through two years postpartum. J Psychosom Obstetr Gynecol 29:115–124

    Article  Google Scholar 

  • DiPietro JA, Ghera MM, Costigan K, Hawkins M (2004) Measuring the ups and downs of pregnancy stress. J Psychosom Obstetr Gynecol 25:189–201

    Article  CAS  Google Scholar 

  • DiPietro JA, Hilton SC, Hawkins M, Costigan KA, Pressman EK (2002) Maternal stress and affect influence fetal neurobehavioral development. Dev Psychol 38:659–668

    Article  PubMed  Google Scholar 

  • DiPietro JA, Novak MF, Costigan KA, Atella LD, Reusing SP (2006) Maternal psychological distress during pregnancy in relation to child development at age two. Child Dev 77:573–587

    Article  PubMed  Google Scholar 

  • Dole N, Savitz DA, Hertz-Picciotto I, Siega-Riz AM, McMahon MJ, Buekens P (2003) Maternal stress and preterm birth. Am J Epidemiol 157(1):14–24

    Article  CAS  PubMed  Google Scholar 

  • Duncan AF, Watterberg KL, Nolen TL, Vohr BR, Adams-Chapman I, Das A (2012) Effect of ethnicity and race on cognitive and language testing at age 18–22 months in extremely preterm infants. J Pediatr 160(6):966–971

    Article  PubMed  PubMed Central  Google Scholar 

  • Duvekot JJ, Peeters LL (1994) Maternal cardiovascular hemodynamic adaptation to pregnancy. Obstetr Gynecol Survey 49(Supplement 12):S1–S14

    Article  CAS  Google Scholar 

  • Ellman LM, Schetter CD, Hobel CJ, Chicz-Demet A, Glynn LM, Sandman CA (2008) Timing of fetal exposure to stress hormones: effects on newborn physical and neuromuscular maturation. Dev Psychobiol 50(3):232–241

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Entringer S, Epel ES, Lin J, Buss C, Shahbaba B, Blackburn EH, Wadhwa PD (2013) Maternal psychosocial stress during pregnancy is associated with newborn leukocyte telomere length. Am J Obstetr Gynecol 208:134.e1–134.e7

    Article  Google Scholar 

  • Entringer S, Buss C, Wadhwa PD (2010) Prenatal stress and developmental programming of human health and disease risk: concepts and integration of empirical findings. Curr Opinion Endocrinol Diabetes Obes 17(6):507–516

    Article  Google Scholar 

  • Galjaard S, Devlieger R, Van Assche FA (2013) Fetal growth and developmental programming. J Perinat Med 41(1):101–105

    Article  PubMed  Google Scholar 

  • Giscombe CL, Lobel M, Giscombé CL, Lobel M (2005) Explaining disproportionately high rates of adverse birth outcomes among African Americans: the impact of stress, racism, and related factors in pregnancy. Psychol Bull 131(5):662–683

    Article  PubMed  Google Scholar 

  • Glynn LM, Schetter CD, Hobel CJ, Sandman CA, Glynn LM, Schetter CD, Sandman CA (2008) Pattern of perceived stress and anxiety in pregnancy predicts preterm birth. Health Psychol 27(1):43–51

    Article  PubMed  Google Scholar 

  • Goldberg D (1978) Manual of the General Health Questionnaire. NFER-Nelson, Windsor

    Google Scholar 

  • Gramellini D, Folli MC, Raboni S, Vadora E, Merialdi A (1992) Cerebral–umbilical Doppler ratio as a predictor of adverse perinatal outcome. Obstet Gynecol 74:416–420

    Article  Google Scholar 

  • Gurung RA, Dunkel-Schetter C, Collins N, Rini C, Hobel CJ (2005) Psychosocial predictors of prenatal anxiety. J Soc Clin Psychol 14:41–51

    Google Scholar 

  • Gutteling BM, de Weerth C, Willemsen-Swinkels SH, Huizink AC, Mulder EJ, Visser GH, Buitelaar JK (2005) The effects of prenatal stress on temperament and problem behavior of 27-month-old toddlers. Eur Child Adolesc Psychiatry 14:41–51

    Article  PubMed  Google Scholar 

  • Haelterman E, Qvist R, Barlow P, Alexander S (2003) Social deprivation and poor access to care as risk factors for severe pre-eclampsia. Eur J Obstet Gynecol Reprod Biol 111:25–32

    Article  PubMed  Google Scholar 

  • Hamilton M (1959) The assessment of anxiety states by rating. Br J Med Psychol 32:50–55

    Article  CAS  PubMed  Google Scholar 

  • Harville EW, Savitz DA, Dole N, Herring AH, Thorp JM, Light KC (2008) Stress and placental resistance measured by Doppler ultrasound in early and mid-pregnancy. Ultrasound Obstet Gynecol 32:23–30

    Article  CAS  PubMed  Google Scholar 

  • Hayden JA, Cote P, Bombardier C (2006) Evaluation of the quality of prognosis studies in systematic reviews. Ann Intern Med 144(6):427–437

    Article  PubMed  Google Scholar 

  • Helbig A, Kaasen A, Malt UF, Haugen G (2011) Psychological distress after recent detection of fetal malformation: short-term effect on second-trimester uteroplacental and fetoplacental circulation. BJOG Int J Obstetr Gynecol 118:1653–1657

    Article  CAS  Google Scholar 

  • Helbig A, Kaasen A, Malt UF, Haugen G (2013) Does antenatal maternal psychological distress affect placental circulation in the third trimester? PLoS ONE 8(2):e57071

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Henrichs J, Schenk JJ, Roza SJ, van den Berg MP, Schmidt HG, Steegers EA, Tiemeier H (2010) Maternal psychological distress and fetal growth trajectories: the Generation R Study. Psychol Med 40(4):633–643

    Article  CAS  PubMed  Google Scholar 

  • Hilmert CJ, Dominguez TP, Schetter CD, Srinivas SK, Glynn LM, Hobel CJ, Sandman CA (2014) Lifetime racism and blood pressure changes during pregnancy: implications for fetal growth. Health Psychol 33(1):43–51

    Article  PubMed  Google Scholar 

  • Hollis B, Prefumo F, Bhide A, Ra S, Thilaganathan B (2003) First-trimester uterine artery blood flow and birth weight. Ultrasound Obstet Gynecol 22:373–376

    Article  CAS  PubMed  Google Scholar 

  • Horowitz M, Wilner N, Alvarez W (1979) Impact of Event Scale: a measure of subjective stress. Psychosom Med 41(3):209–218

    Article  CAS  PubMed  Google Scholar 

  • Huizink AC, Robles de Medina PG, Mulder EJ, Visser GH, Buitelaar JK (2002) Psychological measures of prenatal stress as predictors of infant temperament. J Am Acad Child Adolesc Psychiatry 41:1078–1085

    Article  PubMed  Google Scholar 

  • Huizink AC, Robles de Medina PG, Mulder EJ, Visser GH, Buitelaar JK (2003) Stress during pregnancy is associated with developmental outcome in infancy. J Child Psychol Psychiatry 44(6):810–818

    Article  PubMed  Google Scholar 

  • Huizink AC, Robles de Medina PG, Mulder EJ, Visser GH, Buitelaar JK (2004) Is pregnancy anxiety a distinctive syndrome? Early Hum Dev 79:81–91

    Article  PubMed  Google Scholar 

  • James SA (1994) John Henryism and the health of African Americans. Cult Med Psychiatry 18:163–182

    Article  CAS  PubMed  Google Scholar 

  • Japundzic-Zigon N (2013) Vasopressin and oxytocin in control of the cardiovascular system. Curr Neuropharmacol 11:218–230

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Johnson P, Stojilkovic T, Sarkar P (2001) Middle cerebral artery Doppler in severe intrauterine growth restriction. Ultrasound Obstet Gynecol 17:416–420

    Article  CAS  PubMed  Google Scholar 

  • Kent A, Hughes P, Ormerod L, Jones G, Thilaganathan B (2002) Uterine artery resistance and anxiety in the second trimester of pregnancy. Ultrasound Obstet Gynecol 19:177–179

    Article  CAS  PubMed  Google Scholar 

  • Kessler RC (2003) Epidemiology of women and depression. J Affect Disord 74:5–13

    Article  PubMed  Google Scholar 

  • Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand SL, Zaslavsky AM (2002) Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med 32:959–976

    Article  CAS  PubMed  Google Scholar 

  • King S, Laplante DP (2005) The effects of prenatal maternal stress on children’s cognitive development: Project Ice Storm. Stress 8(1):35–45

    Article  PubMed  Google Scholar 

  • Kinsella MT, Monk C (2009) Impact of maternal stress, depression, & anxiety on fetal neurobehavioral development. Clin Obstet Gynecol 52(3):425–440

    Article  PubMed  PubMed Central  Google Scholar 

  • Kivlighan KT, DiPietro JA, Costigan KA, Laudenslager ML (2008) Diurnal rhythm of cortisol during late pregnancy: associations with maternal psychological well-being and fetal growth. Psychoneuroendocrinology 33(9):1225–1235

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Kochenour NK (1993) Doppler velocimetry in pregnancy. Seminars in Ultrasound, CT, and MRI 14:249–266

    Article  CAS  PubMed  Google Scholar 

  • Kramer MS, Lydon J, Seguin L, Goulet L, Kahn SR, McNamara H, Platt RW (2009) Stress pathways to spontaneous preterm birth: the role of stressors, psychological distress, and stress hormones. Am J Epidemiol 169(11):1319–1326

    Article  PubMed  Google Scholar 

  • Laplante DP, Barr RG, Brunet A, Du Fort GG, Meaney ML, Saucier J, King S (2004) Stress during pregnancy affects general intellectual and language functioning in human toddlers. Pediatr Res 56(3):400–410

    Article  PubMed  Google Scholar 

  • Littleton H, Breitkopf C, Berenson A (2007) Correlates of anxiety symptoms during pregnancy and association with perinatal outcomes: a meta-analysis. Am J Obstet Gynecol 196:424–432

    Article  PubMed  Google Scholar 

  • Lobel M (1994) Conceptualizations, measurement, and effects of prenatal maternal stress on birth outcomes. J Behav Med 17(3):225–272

    Article  CAS  PubMed  Google Scholar 

  • Lobel M, Hamilton JG, Cannella DT (2008) Psychosocial perspectives on pregnancy: prenatal maternal stress and coping. Soc Personal Psychol Compass 2(4):1600–1623

    Article  Google Scholar 

  • Lombardo MV, Ashwin E, Auyeung B, Chakrabarti B, Lai M, Taylor K, Baron-Cohen S (2012) Fetal programming effects of testosterone on the reward system and behavioral approach tendencies in humans. Biol Psychiatry 72:839–847

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Maina G, Saracco P, Giolito MR, Danelon D, Bogetto F, Todros T (2008) Impact of maternal psychological distress on fetal weight, prematurity and intrauterine growth retardation. J Affect Disord 111(2–3):214–220

    Article  PubMed  Google Scholar 

  • McFarlane J, Soeken K, Wiist WH (2000) An evaluation of interventions to decrease intimate partner violence in pregnant women. Public Health Nurs 17(6):443–451

    Article  CAS  PubMed  Google Scholar 

  • Mendelson T, DiPietro JA, Costigan KA, Chen P, Henderson J (2011) Associations of maternal psychological factors on umbilical and uterine blood flow. J Psychosom Obstetr Gynecol 32(1):3–9

    Article  Google Scholar 

  • Monk C, Newport DJ, Korotkin JH, Long Q, Knight B, Stowe ZN (2012) Uterine blood flow in a psychiatric population: impact of maternal depression, anxiety, and psychotropic medication. Biol Psychiatry 72:483–490

    Article  PubMed  PubMed Central  Google Scholar 

  • Moser K, Li L, Power C (2003) Social inequalities in low birth weight in England and Wales: trends and implications for future population health. J Epidemiol Community Health 57:687–691

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Niederhofer H, Reiter A (2004) Prenatal maternal stress, prenatal fetal movements, and perinatal temperament factors influence behaviour and school marks at the age of 6 years. Fetal Diagn Ther 19:160–162

    Article  PubMed  Google Scholar 

  • O’Connor TG, Heron J, Golding J, Glover V (2003) Maternal antenatal anxiety and behavioural/emotional problems in children: a test of a programming hypothesis. J Child Psychol Psychiatry 44(7):1025–1036

    Article  PubMed  Google Scholar 

  • Odibo AO, Riddick C, Pare E, Stamilio DM, Macones GA (2005) Cerebroplacental Doppler ratio and adverse perinatal outcomes in intrauterine growth restriction. J Ultrasound Med 24(9):1223–1228

    PubMed  Google Scholar 

  • Peacock JL, Bland JM, Anderson HR (1995) Preterm delivery: effects of socioeconomic factors, psychological stress, smoking, alcohol, and caffeine. Br Med J 311:531–535

    Article  CAS  Google Scholar 

  • Perkin M, Bland J, Peacock J, Anderson H (1993) The effect of anxiety and depression during pregnancy on obstetric complications. Br J Obstet Gynaecol 100:629–634

    Article  CAS  PubMed  Google Scholar 

  • Qiu A, Rifkin-Graboi A, Chen H, Chong Y, Kwek K, Gluckman PD, Meaney MJ (2013) Maternal anxiety and infants’ hippocampal development: timing matters. Transl Psychiatry 3, e306

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Raum E, Arabin B, Schlaud M, Walter U, Schwartz FW (2001) The impact of maternal education on intrauterine growth: a comparison of former West and East Germany. Int J Epidemiol 30:81–87

    Article  CAS  PubMed  Google Scholar 

  • Roesch SC, Dunkel-Schetter C, Woo G, Hobel CJ (2004) Modeling the types and timing of stress in pregnancy. Anxiety Stress Coping 17(1):87–102

    Article  Google Scholar 

  • Rondo PH, Ferreira RF, Nogueira F, Ribeiro MC, Lobert H, Artes R (2003) Maternal psychological stress and distress as predictors of low birth weight, prematurity, and intrauterine growth restriction. Eur J Clin Nutr 57:266–272

    Article  CAS  PubMed  Google Scholar 

  • Roos A, Geerts L, Koen N, Faure SC, Vythilingum B, Stein DJ (2015) Psychosocial predictors of fetoplacental blood flow during pregnancy. Compr Psychiatry 57:125–131

    Article  CAS  PubMed  Google Scholar 

  • Ross MG, Beall MH (2008) Adult sequelae of intrauterine growth restriction. Semin Perinatol 32(3):213–218

    Article  PubMed  PubMed Central  Google Scholar 

  • Sandman CA, Davis EP, Buss C, Glynn LM (2012) Exposure to prenatal psychobiological stress exerts programming influences on the mother and her fetus. Neuroendocrinology 95(1):7–21

    Article  PubMed  CAS  Google Scholar 

  • Sandman CA, Glynn L, Dunkel-Schetter C, Wadhwa P, Garite T, Chicz-DeMet A, Hobel C (2006) Elevated maternal cortisol early in pregnancy predicts third trimester levels of placental corticotropin releasing hormone (CRH): priming the placental clock. Peptides 27:1457–1463

    Article  CAS  PubMed  Google Scholar 

  • Sandman CA, Wadhwa PD, Chicz-DeMet A, Dunkel-Schetter C, Porto M (1997) Maternal stress, HPA activity, and fetal/infant outcome. Ann N Y Acad Sci 814:266–275

  • Sarason IG, Johnson JH, Siegel JM (1978) Assessing the impact of life changes: development of the life experiences survey. J Consult Clin Psychol 46:932–946

    Article  CAS  PubMed  Google Scholar 

  • Scheyer K, Urizar GG (2016) Altered stress patterns and increased risk for postpartum depression among low-income pregnant women. Arch Womens Ment Health 19:3017–328

  • Silva LM, Coolman M, Steegers EA, Jaddoe VW, Moll HA, Hofman A, Raat H (2008) Low socioeconomic status is a risk factor for preeclampsia: the Generation R Study. J Hypertens 26:1200–1208

    Article  CAS  PubMed  Google Scholar 

  • Silva LM, Jansen PW, Steegers EA, Jaddoe VW, Arends LR, Tiemeier H, Raat H (2010) Mother's educational level and fetal growth: the genesis of health inequalities. Int J Epidemiol 39:1250–1261

    Article  PubMed  Google Scholar 

  • Sjostrom K, Valentin L, Thelin T, Marsal K (1997) Maternal anxiety in late pregnancy and fetal hemodynamics. Eur J Obstet Gynecol Reprod Biol 74:149–155

    Article  CAS  PubMed  Google Scholar 

  • Spielberger CD (1983) Manual for the State-Trait Anxiety Inventory. Consulting Psychologists Press, Palo Alto

    Google Scholar 

  • Spies G, Stein DJ, Roos A, Faure SC, Mostert J, Seedat S, Vythilingum B (2009) Validity of the Kessler 10 (K-10) in detecting DSM-IV defined mood and anxiety disorders among pregnant women. Arch Womens Ment Health 12:69–74

    Article  CAS  PubMed  Google Scholar 

  • Teixeira JM, Fisk NM, Glover V (1999) Association between maternal anxiety in pregnancy and increased uterine artery resistance index: cohort based study. Br Med J 318:153–157

    Article  CAS  Google Scholar 

  • van den Bergh BR, Mennes M, Oosterlaan J, Stevens V, Stiers P, Marcoen A, Lagae L (2005) High antenatal maternal anxiety is related to impulsivity during performance on cognitive tasks in 14- and 15-year-olds. Neurosci Biobehavioural Rev 29:259–269

    Article  Google Scholar 

  • van den Bergh BR, van Calster B, Smits T, van Huffel S, Lagae L (2008) Antenatal maternal anxiety is related to HPA-axis dysregulation and self-reported depressive symptoms in adolescence: a prospective study on the fetal origins of depressed mood. Neuropsychopharmacology 33:536–545

    Article  PubMed  Google Scholar 

  • Vythilingum B, Geerts L, Fincham D, Roos A, Faure S, Jonkers J, Stein DJ (2010) Association between antenatal distress and uterine artery pulsatility index. Archiv Women's Mental Health 13:359–364

    Article  Google Scholar 

  • Wadhwa PD, Entringer S, Buss C, Lu MC (2011) The contribution of maternal stress to preterm birth: issues and considerations. Clin Perinatol 38:351–384

    Article  PubMed  PubMed Central  Google Scholar 

  • Wadhwa PD, Sandman CA, Porto M, Dunkel-Schetter C, Garite TJ (1993) The association between prenatal stress and infant birth weight and gestational age at birth: a prospective investigation. Am J Obstetr Gynecol 169(4):858–865

    Article  CAS  Google Scholar 

  • Wadhwa PD, Garite TJ, Porto M, Glynn L, Chicz-DeMet A, Dunkel-Schetter C, Sandman CA (2004) Placental corticotropin-releasing hormone (CRH), spontaneous preterm birth, and fetal growth restriction: a prospective investigation. Am J Obstet Gynecol 191(4):1063–1069

    Article  CAS  PubMed  Google Scholar 

  • Wilkinson MJB, Barczak P (1988) Psychiatric screening in general practice, comparison of the General Health Questionnaire and the Hospital Anxiety and Depression Scale. J Royal College Gen Pract 38:311–313

    CAS  Google Scholar 

  • Winn N, Records K, Rice M (2003) The relationship between abuse, sexually transmitted diseases, and group B streptococcus in childbearing women. Am J Matern Child Nurs 28(2):106–110

    Article  Google Scholar 

  • Wisborg K, Barklin A, Hedegaard M, Henriksen TB (2008) Psychological stress during pregnancy and stillbirth: prospective study. BJOG Int J Obstetr Gynecol 115:882–885

    Article  CAS  Google Scholar 

  • Wright RJ, Visness CM, Calatroni A, Grayson MH, Gold DR, Sandel MT, Gern JE (2010) Prenatal maternal stress and cord blood innate and adaptive cytokine responses in an inter-city cohort. Am J Respir Crit Care Med 182:25–33

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Zigmond AS, Snaith RP (1983) The Hospital Anxiety and Depression scale. Acta Psychiatr Scand 67:361–370

    Article  CAS  PubMed  Google Scholar 

Download references

Contributors’ statement

Terri A. Levine conducted the systematic review, drafted the initial manuscript, revised the manuscript critically for important intellectual content, and approved the final manuscript as submitted. Fiona A. Alderdice and Ruth E. Grunau aided in quality assessment of included studies, revised the manuscript critically for important intellectual content, and approved the final manuscript as submitted. Fionnuala M. McAuliffe supervised the systematic review process, aided in quality assessment of included studies, revised the manuscript critically for important intellectual content, and approved the final manuscript as submitted.

Author information

Authors and Affiliations

  1. School of Nursing and Midwifery, Queen’s University Belfast, Belfast, Northern Ireland

    Terri A. Levine, Fiona A. Alderdice & Ruth E. Grunau

  2. Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada

    Ruth E. Grunau

  3. Child and Family Research Institute, Vancouver, Canada

    Ruth E. Grunau

  4. UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Northern Ireland

    Fionnuala M. McAuliffe

Authors
  1. Terri A. Levine
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fiona A. Alderdice
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ruth E. Grunau
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fionnuala M. McAuliffe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fionnuala M. McAuliffe.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Financial disclosure

The authors have no financial relationships relevant to this article to disclose.

Ethical statement

This manuscript does not contain clinical studies or patient data.

Funding source

Terri Levine receives a PhD studentship from Queen’s University Belfast in Northern Ireland.

Appendices

Appendix 1. Example search strategy

("pregnancy"[MeSH Terms] OR "pregnancy"[All Fields]) AND ("Stress"[Journal] OR "stress"[All Fields]) AND ("blood"[Subheading] OR "blood"[All Fields] OR "blood"[MeSH Terms]) AND ("foetus"[All Fields] OR "fetus"[MeSH Terms] OR "fetus"[All Fields]) AND Doppler[All Fields] AND ("ultrasonography"[Subheading] OR "ultrasonography"[All Fields] OR "ultrasound"[All Fields] OR "ultrasonography"[MeSH Terms] OR "ultrasound"[All Fields] OR "ultrasonics"[MeSH Terms] OR "ultrasonics"[All Fields])

Appendix 2

Table 4 Guidelines for assessing quality in prognostic studies on the basis of framework of potential biases (Hayden et al. 2006)
Full size table

Appendix 3. Standardized stress measures

  1. 1.

    Cohen Perceived Stress Scale (PSS-10) (Cohen et al. 1983; Cohen and Williamson 1988; DiPietro et al. 2008): a ten-item self-report measure that assesses the extent to which life is experienced by the participant as unpredictable, uncontrollable, and demanding. Participants rate their distress during the last month, and higher scores indicate higher perceived stress. PSS-10 was used in three of the included studies (Harville et al. 2008; Roos et al. 2015; Vythilingum et al. 2010).

  2. 2.

    General Health Questionnaire (GHQ) (Goldberg 1978): a measure of the prevalence of mental disorders in a given population, or of psychological distress and well-being in clinical and non-clinical populations. The 28-item version has four subscales rated on a Likert scale of 0–3, with subscale scores ranging from 0 to 21. Scores of ≥6 are considered clinically relevant. The four subscales are Somatization, Social Dysfunction, Anxiety and Insomnia, and Depression. The GHQ was used in two of the included studies (Helbig et al. 2011, 2013).

  3. 3.

    Hamilton Rating Scales of Anxiety (HAM-A) (Hamilton 1959): a 17-item scale that measures symptoms of anxiety, including items related to mood, tension, concentration, insomnia, memory, fears, and somatic symptoms. The HAM-A was used in two of the included studies (Maina et al. 2008; Monk et al. 2012).

  4. 4.

    Hospital Anxiety and Depression Scale (HADS) (Aylard et al. 1987; Wilkinson and Barczak 1988; Zigmond and Snaith 1983): a self-rating scale designed for use in hospital and community settings with a threshold score for definite cases of anxiety (≥11 on a 0–28 scale). The HADS was used in one of the included studies (Kent et al. 2002).

  5. 5.

    Impact of Event Scale (IES) (Horowitz et al. 1979): a 22-item scale that measures subjective psychological distress after a specific traumatic event using three subscales—Intrusion (seven items, 0–35 range), dealing with unbidden thoughts, emotions, and memories; Avoidance (seven items, 0–35 range), dealing with emotional numbness and avoiding stimuli or thoughts related to the event; and Arousal (eight items, 0–40 range), dealing with symptoms of psychophysiological activation such as hypervigilance, irritability, and heightened startle response. Subscale scores ≥20 indicate clinical relevance. The IES was used in two of the included studies (Helbig et al. 2011, 2013).

  6. 6.

    John Henryism (James 1994): a 12-item scale that assesses coping in an active way, overcoming obstacles, and “making one’s own way in the world.” John Henryism was used in one of the included studies (Harville et al. 2008).

  7. 7.

    Kessler-10 (K-10) (Kessler et al. 2002; Kessler 2003; Spies et al. 2009): a ten-item self-report measure that assesses general distress. Participants rate statements about their feelings during the last month on a five-point Likert scale. A cutoff score of 20 is considered clinically significant. The K-10 was used in two of the included studies (Roos et al. 2015; Vythilingum et al. 2010).

  8. 8.

    Pregnancy Experiences Scale (PES-Brief) (DiPietro et al. 2004): the PES-Brief includes the ten most frequently endorsed hassles and uplifts from the full PES. Each item is rated on a 0–4 Likert scale and then averaged—higher values reflect higher perceived intensity of negative or positive feelings about the pregnancy. The PES-Brief was used in one of the included studies (Mendelson et al. 2011).

  9. 9.

    Sarason’s Life Experiences Survey (LES) (Sarason et al. 1978): a 39-item scale designed to measure life events and their perceived impact. The LES was used in one of the included studies (Harville et al. 2008).

  10. 10.

    Spielberger’s State–Trait Anxiety Inventory (STAI) (DiPietro et al. 2008; Spielberger 1983): a widely used 40-item self-report inventory of the current (state, S) and inherent (trait, T) level of anxiety. Twenty items are dedicated to evaluating state anxiety; the other 20 evaluate trait anxiety. The S score indicates how anxious the patient is feeling in response to a defined situation, while the T score indicates how anxious the individual generally feels. Each item is scored 1–4, and total scores range between 20 and 80. The STAI was used in seven of the included studies (Caliskan et al. 2009; Harville et al. 2008; Mendelson et al. 2011; Roos et al. 2015; Sjostrom et al. 1997; Teixeira et al. 1999; Vythilingum et al. 2010).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Levine, T.A., Alderdice, F.A., Grunau, R.E. et al. Prenatal stress and hemodynamics in pregnancy: a systematic review. Arch Womens Ment Health 19, 721–739 (2016). https://doi.org/10.1007/s00737-016-0645-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00737-016-0645-1

Keywords

Search

Navigation