Prenatal stress and hemodynamics in pregnancy: a systematic review
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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.
KeywordsBlood flow Doppler ultrasound Fetal well-being Hemodynamics Middle cerebral artery Pregnancy Pregnancy-specific stress Psychological distress Stress Umbilical artery Uterine artery
General Health Questionnaire
Hospital Anxiety and Depression Scale
Hamilton Rating Scale for Anxiety
Impact of Event Scale
Kessler Psychological Distress Scale
Middle cerebral artery
Pregnancy Experiences Scale
Perceived Stress Scale by Sheldon Cohen
State–Trait Anxiety Inventory
Umbilical vein volume blood flow
World Health Organization Five Well-Being Index
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.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
The authors have no financial relationships relevant to this article to disclose.
This manuscript does not contain clinical studies or patient data.
Terri Levine receives a PhD studentship from Queen’s University Belfast in Northern Ireland.
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