BMJ 1999;318:153-157 ( 16 January )

Papers

Association between maternal anxiety in pregnancy and increased uterine artery resistance index: cohort based study

Jerónima M A Teixeira, research fellow,  Nicholas M Fisk, professor of obsetrics and gynaecology,  Vivette Glover, reader in perinatal psychobiology. 

Centre for Fetal Care, Division of Paediatrics, Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, London W6 0XG

Correspondence to: Dr Glover vglover{at}rpms.ac.uk

Objective: To investigate whether maternal anxiety in the third trimester is associated with an increased uterine artery resistance index.
Design: Cohort based study.
Subjects: 100 pregnant women, with a mean gestation of 32 weeks.
Outcome measures: Self rating Spielberger questionnaire for state anxiety and trait anxiety, and uterine blood flow waveform patterns as assessed by colour Doppler ultrasound.
Results: A significant association was found between uterine artery resistance index and scores for both Spielberger state anxiety and trait anxiety (rs=0.31, P<0.002 and 0.28 P<0.005 respectively). Women with state anxiety scores >40 (n=15) had a higher mean uterine resistance index than those with scores =<40 (mean difference with mean resistance index 24%, 95% confidence interval 12% to 38%; P<0.0001). Similarly, women with trait anxiety scores >40 (n=32) had a higher mean resistance index than those with scores =<40, although to a lesser extent. The presence of notches in the waveform pattern produced by uterine artery blood flow was found in 4/15 (27%) women with high state anxiety scores compared with 4/85 (5%) with low anxiety scores (P<0.02).
Conclusions: This study shows an association between maternal anxiety in pregnancy and increased uterine artery resistance index. It suggests a mechanism by which the psychological state of the mother may affect fetal development, and may explain epidemiological associations between maternal anxiety and low birth weight. The influence of maternal anxiety may be one mechanism by which the intrauterine environment contributes to later disease in offspring.

Key messages

  • Women who were anxious during pregnancy had significantly abnormal patterns of blood flow through the uterine arteries

  • Of the most anxious group, 27% had an increased resistance index of clinical concern, compared with 4% in the less anxious group

  • The study did not establish whether the impaired blood flow was predominantly linked with state anxiety or trait anxiety

  • The findings may help to explain previous studies that have linked stress or anxiety in pregnancy with small for gestational age babies




© BMJ 1999
Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?

Relevant Articles

Cited studies did not show relation between maternal anxiety and birth weight
Michael Perkin
BMJ 1999 318: 1288. [Extract] [Full Text]

Maternal anxiety is associated with impaired blood flow to the fetus
BMJ 1999 318: 0. [Full Text]

This article has been cited by other articles:

  • Conlon, O., Lynch, J. (2008). Maternal depression: risk factors and treatment options during pregnancy. The Obstetrician and Gynaecologist 10: 151-155 [Abstract] [Full text]  
  • Diego, M. A., Jones, N. A., 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 [Abstract] [Full text]  
  • Hemels, M. E., Einarson, A., Koren, G., Lanctot, K. L, Einarson, T. R (2005). Antidepressant Use During Pregnancy and the Rates of Spontaneous Abortions: A Meta-Analysis. The Annals of Pharmacotherapy 39: 803-809 [Abstract] [Full text]  
  • Canivet, C. A., Ostergren, P.-O., Rosen, A.-S., Jakobsson, I. L., Hagander, B. M. (2005). Infantile colic and the role of trait anxiety during pregnancy in relation to psychosocial and socioeconomic factors. Scand J Public Health 33: 26-34 [Abstract]  
  • Hofberg, K, Ward, M R (2003). Fear of pregnancy and childbirth. Postgrad. Med. J. 79: 505-510 [Abstract] [Full text]  
  • Linnet, K. M., Dalsgaard, S., Obel, C., Wisborg, K., Henriksen, T. B., Rodriguez, A., Kotimaa, A., Moilanen, I., Thomsen, P. H., Olsen, J., Jarvelin, M.-R. (2003). Maternal Lifestyle Factors in Pregnancy Risk of Attention Deficit Hyperactivity Disorder and Associated Behaviors: Review of the Current Evidence. Am. J. Psychiatry 160: 1028-1040 [Abstract] [Full text]  
  • Hendrick, V., Altshuler, L. (2002). Management of Major Depression During Pregnancy. Am. J. Psychiatry 159: 1667-1673 [Full text]  
  • O'CONNOR, T. G., HERON, J., GOLDING, J., BEVERIDGE, M., GLOVER, V. (2002). Maternal antenatal anxiety and children's behavioural/emotional problems at 4 years: Report from the Avon Longitudinal Study of Parents and Children. Br. J. Psychiatry 180: 502-508 [Abstract] [Full text]  
  • GLOVER, V., O'CONNOR, T. G. (2002). Effects of antenatal stress and anxiety: Implications for development and psychiatry. Br. J. Psychiatry 180: 389-391 [Full text]  
  • Chung, T. K.H., Lau, T. K., Yip, A. S.K., Chiu, H. F.K., Lee, D. T.S. (2001). Antepartum Depressive Symptomatology Is Associated With Adverse Obstetric and Neonatal Outcomes. Psychosom. Med. 63: 830-834 [Abstract] [Full text]  
  • Evans, J., Heron, J., Francomb, H., Oke, S., Golding, J. (2001). Cohort study of depressed mood during pregnancy and after childbirth. BMJ 323: 257-260 [Abstract] [Full text]  
  • Williams, K., Oke, S. (2000). Lithium and pregnancy. Psychiatr. Bull. 24: 229-231 [Full text]  
  • Perkin, M. (1999). Cited studies did not show relation between maternal anxiety and birth weight. BMJ 318: 1288b-1288 [Full text]  
  • (1999). Maternal Anxiety Affects Uterine Blood Flow. JWatch Psychiatry 1999: 18-18 [Full text]  
  • (1999). Maternal Anxiety and Uterine Artery Resistance Index. JWatch Women's Health 1999: 10-10 [Full text]  
  • (1999). Maternal Anxiety Affects Uterine Blood Flow. JWatch General 1999: 4-4 [Full text]  

Rapid Responses:

Read all Rapid Responses

Maternal stress and the unborn child
Tom Oommen
bmj.com, 15 Jan 1999 [Full text]
Migraine & effects on Foetus
Amit Kumar
bmj.com, 22 Jan 1999 [Full text]
Maternal blood pressure, social class and weight were not considered as potential confounders
Rachel Bennett
bmj.com, 13 Feb 1999 [Full text]
Doc2Doc Vacancy
Access jobs at BMJ Careers
Whats new online at Student BMJ