Mother’s anxiety and depression and associated risk factors during early pregnancy: effects on fetal growth and activity at 20–22 weeks of gestation

To examine effects of mother's anxiety and depression and associated risk factors during early pregnancy on fetal growth and activity. Repeated measures of mother's anxiety (State-Anxiety Inventory (STAI-S)) and depression (Edinburgh Postnatal Depression Scale (EPDS)) and related socio demographics and substance consumption were obtained at the 1st and 2nd pregnancy trimesters, and fetus' (N = 147) biometric data and behavior was recorded during ultrasound examination at 20-22 weeks of gestation. Higher anxiety symptoms were associated to both lower fetal growth and higher fetal activity. While lower education, primiparity, adolescent motherhood, and tobacco consumption predicted lower fetal growth, coffee intake predicted lower fetal activity. Vulnerability of fetal development to mother's psychological symptoms as well as to other sociodemographic and substance consumption risk factors during early and mid pregnancy is suggested.

Autoimmune diseases and pregnancy: analysis of a series of cases

BACKGROUND: An autoimmune disease is characterized by tissue damage, caused by self-reactivity of different effector mechanisms of the immune system, namely antibodies and T cells. All autoimmune diseases, to some extent, have implications for fertility and obstetrics. Currently, due to available treatments and specialised care for pregnant women with autoimmune disease, the prognosis for both mother and child has improved significantly. However these pregnancies are always high risk. The purpose of this study is to analyse the fertility/pregnancy process of women with systemic and organ-specific autoimmune diseases and assess pathological and treatment implications. METHODS: The authors performed an analysis of the clinical records and relevant obstetric history of five patients representing five distinct autoimmune pathological scenarios, selected from Autoimmune Disease Consultation at the Hospital of Braga, and reviewed the literature. RESULTS: The five clinical cases are the following: Case 1-28 years old with systemic lupus erythematosus, and clinical remission of the disease, under medication with hydroxychloroquine, prednisolone and acetylsalicylic acid, with incomplete miscarriage at 7 weeks of gestation without signs of thrombosis. Case 2-44 years old with history of two late miscarriages, a single preterm delivery (33 weeks) and multiple thrombotic events over the years, was diagnosed with antiphospholipid syndrome after acute myocardial infarction. Case 3-31 years old with polymyositis, treated with azathioprine for 3 years with complete remission of the disease, took the informed decision to get pregnant after medical consultation and full weaning from azathioprine, and gave birth to a healthy term new-born. Case 4-38 years old pregnant woman developed Behcet's syndrome during the final 15 weeks of gestation and with disease exacerbation after delivery. Case 5-36 years old with autoimmune thyroiditis diagnosed during her first pregnancy, with difficult control over the thyroid function over the years and first trimester miscarriage, suffered a second miscarriage despite clinical stability and antibody regression. CONCLUSIONS: As described in literature, the authors found a strong association between autoimmune disease and obstetric complications, especially with systemic lupus erythematosus, antiphospholipid syndrome and autoimmune thyroiditis.

Lower NPAS3 expression during the later stages of abnormal lung development in rat congenital diaphragmatic hernia

Purpose Congenital diaphragmatic hernia (CDH) is characterized by a developmental defect in the diaphragm, pulmonary hypoplasia and pulmonary hypertension. NPAS3 is a PAS domain transcription factor regulating Drosophila tracheogenesis. NPAS3 null mice develop pulmonary hypoplasia in utero and die after birth due to respiratory failure. We aimed to evaluate NPAS3 expres- sion during normal and abnormal lung development due to CDH. Methods CDH was induced by administering 100 mg/ml nitrofen to time-pregnant dams on embryonic day (E) 9 of gestation. Lungs were isolated on E15, E18 and E21 and NPAS3 localization was determined by immunohisto- chemistry and quantified using Western blotting. Results We found that only E21 hypoplastic CDH lungs have reduced expression of NPAS3 in the terminal sac- cules. Western blotting confirmed the down-regulation of NPAS3 protein in the nitrofen-induced hypoplastic lungs. Conclusions We demonstrate for the first time that ni- trofen-induced hypoplastic CDH lungs have reduced NPAS3 expression in the terminal saccules during the later stages of abnormal lung development. Our findings suggest that NPAS3 is associated with pulmonary hypoplasia in CDH.

Aplicação da metodologia ROC na avaliação de desempenho de índices de gravidade clínica em unidades de neonatologia de Portugal

Tese de Doutoramento em Engenharia Industrial e de Sistemas

Sex differences in the fetal heart rate variability indices of twins

Aims: To evaluate the differences in linear and complex heart rate dynamics in twin pairs according to fetal sex combination [male-female (MF), male-male (MM), and female-female (FF)]. Methods: Fourteen twin pairs (6 MF, 3 MM, and 5 FF) were monitored between 31 and 36.4 weeks of gestation. Twenty-six fetal heart rate (FHR) recordings of both twins were simultaneously acquired and analyzed with a system for computerized analysis of cardiotocograms. Linear and nonlinear FHR indices were calculated. Results: Overall, MM twins presented higher intrapair average in linear indices than the other pairs, whereas FF twins showed higher sympathetic-vagal balance. MF twins exhibited higher intrapair average in entropy indices and MM twins presented lower entropy values than FF twins considering the (automatically selected) threshold rLu. MM twin pairs showed higher intrapair differences in linear heart rate indices than MF and FF twins, whereas FF twins exhibited lower intrapair differences in entropy indices. Conclusions: The results of this exploratory study suggest that twins have sex-specific differences in linear and nonlinear indices of FHR. MM twins expressed signs of a more active autonomic nervous system and MF twins showed the most active complexity control system. These results suggest that fetal sex combination should be taken into consideration when performing detailed evaluation of the FHR in twins.

Maternal adjustment and maternal attitudes in adolescent and adult pregnant women

Study Objective: This study analyzes differences between adolescent and adult pregnant women and the contribution of maternal age to maternal adjustment and maternal attitudes during pregnancy. Design, Setting, and Participants: A sample of 398 Portuguese pregnant women (111 younger than 19 years) was recruited in a Portuguese Maternity Hospital and completed the Maternal Adjustment and Maternal Attitudes Questionnaire between the 24th and 36th weeks of gestation. Main Outcome Measures: Maternal Adjustment and Maternal Attitudes Questionnaire. Results: Adolescent pregnant women show lower maternal adjustment (poorer body image and worse marital relationship) and poorer maternal attitudes (more negative attitudes to sex) than adult pregnant women. When controlling for socio-demographics, age at pregnancy predicts poorer body image and more negative attitudes to sex, but not a worse marital relationship, more somatic symptoms or negative attitudes to pregnancy and the baby. A worse marital relationship was better predicted by living without the partner, and more somatic symptoms and negative attitudes to pregnancy and the baby was predicted by higher education. Conclusion: Adolescent pregnant women show lower maternal adjustment and poorer maternal attitudes than adult pregnant women according to socio-demographics and unfavorable developmental circumstances.

Fetal behavior and heart rate in twin pregnancy: a review

Fetal movements and fetal heart rate (FHR) are well-established markers of fetal well-being and maturation of the fetal central nervous system. The purpose of this paper is to review and discuss the available knowledge on fetal movements and heart rate patterns in twin pregnancies. There is some evidence for an association or similarity in fetal movement incidences or FHR patterns between both members of twin pairs. However, the temporal occurrence of these patterns seems to be for the most part asynchronous, especially when stricter criteria are used to define synchrony. The available data suggest that fetal behavior is largely independent of sex combination, fetal position, and presentation. Conversely, chorionicity appears to have some influence on fetal behavior, mainly before 30 weeks of gestation. There is preliminary evidence for the continuity of inter-individual differences in fetal activity and FHR patterns over pregnancy. Comparisons between studies are limited by large methodological differences and absence of uniform concepts and definitions. Future studies with high methodological quality are needed to provide a more comprehensive knowledge of normal fetal behavior in twin pregnancy.

Qualidade do relacionamento com pessoas significativas: comparação entre grávidas adolescentes e adultas

Na gravidez, a mulher experiencia mudanças desenvolvimentais ao nível dos seus relacionamentos significativos. Este estudo compara a qualidade do relacionamento com o companheiro e com outra figura significativa em grávidas adolescentes e adultas, e analisa preditores sócio-demográficos para a qualidade destes relacionamentos. Uma amostra de 130 grávidas (66 adolescentes e 64 adultas) foi avaliada no terceiro trimestre de gestação quanto às características sociais e demográficas e à qualidade do relacionamento com figuras significativas. Os resultados mostram que as adolescentes referem menor confiança (χ2 = 3.365, p = 0,055) e maior discórdia (χ2 = 3.842, p = 0,041) no relacionamento com o companheiro e maior sentimento de ligação (χ2 = 19.126, p = 0,000) e apatia (χ2 = 8.568, p = 0,004) no relacionamento com a outra figura significativa, comparativamente com as adultas. Verifica-se ainda que a gravidez na adolescência associa-se a relacionamentos de menor qualidade, especialmente devido a situações sócio-demográficas mais desfavoráveis e não tanto à condição de ser ou não adolescente.

Prenatal dysthymia versus major depression effects on maternal cortisol and fetal growth

To determine differences between pregnant women diagnosed with Dysthymia versus Major Depression, depressed pregnant women (N=102) were divided by their diagnosis into Dysthymic (N=48) and Major Depression (N=54) groups and compared on self-report measures (depression, anxiety, anger, daily hassles and behavioral inhibition), on stress hormone levels (cortisol and norepinephrine), and on fetal measurements. The Major Depression group had more self-reported symptoms. However, the Dysthymic group had higher prenatal cortisol levels and lower fetal growth measurements (estimated weight, femur length, abdominal circumference) as measured at their first ultrasound (M=18 weeks gestation). Thus, depressed pregnant women with Dysthymia and Major Depression appeared to have different prenatal symptoms.

Prenatal dopamine and neonatal behavior and biochemistry

Depressed pregnant women (N=126) were divided into high and low prenatal maternal dopamine (HVA) groups based on a tertile split on their dopamine levels at 20 weeks gestation. The high versus the low dopamine group had lower Center for Epidemiological Studies-Depression Scale (CES-D) scores, higher norepinephrine levels at the 20-week gestational age visit and higher dopamine and serotonin levels at both the 20- and the 32-week gestational age visits. The neonates of the mothers with high versus low prenatal dopamine levels also had higher dopamine and serotonin levels as well as lower cortisol levels. Finally, the neonates in the high dopamine group had better autonomic stability and excitability scores on the Brazelton Neonatal Behavior Assessment Scale. Thus, prenatal maternal dopamine levels appear to be negatively related to prenatal depression scores and positively related to neonatal dopamine and behavioral regulation, although these effects are confounded by elevated serotonin levels.

Chronic prenatal depression and neonatal outcome

Four hundred and thirty pregnant women were recruited at approximately 22 weeks gestation at prenatal clinics. Of these, 86 (20%) were diagnosed as depressed. The women were seen again at approximately 32 weeks gestation and after delivery. Chronicity of depression was evidenced by continuing high depression scores in those women diagnosed as depressed. Comorbid problems were chronically high anxiety, anger, sleep disturbance, and pain scores. Less optimal outcomes for the depressed women included lower gestational age and lower birthweight of their newborns.

Massage therapy reduces pain in pregnant women, alleviates prenatal depression in both parents and improves their relationships

Prenatally depressed women (N=47) were randomly assigned to a group that received massage twice weekly from their partners from 20 weeks gestation until the end of pregnancy or a control group. Self-reported leg pain, back pain, depression, anxiety and anger decreased more for the massaged pregnant women than for the control group women. In addition, the partners who massaged the pregnant women versus the control group partners reported less depressed mood, anxiety and anger across the course of the massage therapy period. Finally, scores on a relationship questionnaire improved more for both the women and the partners in the massage group. These data suggest that not only mood states but also relationships improve mutually when depressed pregnant women are massaged by their partners.

Actividade física e qualidade de vida na gravidez

Pouco se conhece acerca da actividade física e qualidade de vida da mulher na gravidez. Este estudo teve como objectivos 1) comparar os padrões de actividade física antes e durante a gravidez, 2) avaliar a percepção da qualidade de vida relacionada com a saúde durante os primeiros seis meses de gestação, e 3) comparar a percepção da qualidade de vida nas mulheres activas e insuficientemente activas considerando as recomendações de saúde pública. Método: Estudo longitudinal com 59 grávidas seleccionadas em consultórios médicos privados. Às 10-15 semanas foi recolhida informação sociodemográfica e médica, bem como informação sobre a actividade física três meses antes da concepção. Medidas de auto-relato foram administradas entre as 10-15 semanas e as 19-24 semanas de gestação para avaliar o tempo de actividade física (QAFG) (no trabalho, lazer, deslocações) e a qualidade de vida (SF-36). Resultados: A prevalência de actividade física recomendada é menor durante do que antes da gravidez (16.7% e 17.5% nos 1.º e 2.º trimestres, respectivamente vs. 47.4% antes da gravidez). Com a gravidez, não se verificaram alterações no tempo médio em diferentes tipos de actividade física, mas a actividade física no lazer registou uma diminuição significativa no 1.º trimestre face ao período anterior à concepção. Em comparação com uma amostra normativa de mulheres portuguesas, as grávidas apresentam, nos dois primeiros trimestres de gestação, uma percepção de qualidade da vida mais positiva na generalidade das dimensões do SF-36. No 2.º trimestre, o nível de limitação é significativamente maior nas dimensões físicas, à excepção da Dor Corporal, e nos resultados sumários do Componentes Físico e Mental. As mulheres que no 1.º trimestre atingem os níveis recomendados de actividade física no lazer (≥150 minutos por semana) apresentam melhor estado de saúde geral e estados de humor mais positivos do que as menos activas. Conclusão: A actividade física no lazer, embora diminua após a concepção, tem um impacto positivo na percepção do estado saúde geral e estados de humor da grávida, o que sugere a sua importância para a saúde da mulher também durante este período da vida.

Qualidade da vinculação e dos relacionamentos significativos na gravidez

O estudo apresentado neste artigo destinou-se a investigar a qualidade da vinculação e das relações significativas na gravidez. Mais precisamente, teve por objectivos (1) determinar as características sociais e demográficas e as condições anteriores de existência que se associam e permitem prever um estilo de vinculação (in)seguro e (2) estimar o impacto do estilo de vinculação na qualidade do relacionamento e do apoio por parte do companheiro e de uma outra pessoa significativa, na gravidez. Uma amostra de 130 grávidas (66 adolescentes e 64 adultas) foi avaliada no último trimestre de gestação quanto ao estilo de vinculação e à qualidade do relacionamento e do apoio por parte do companheiro e de uma outra pessoa significativa (com base na Attachment Style Interview, ASI; Bifulco, Figueiredo, Guedeney, Gorman, Hays et al., 2004; Bifulco, Moran, Ball & Bernazzani, 2002a; Bifulco, Moran, Ball & Lillie, 2002b). A amostra foi recolhida na Maternidade de Júlio Dinis (Porto) e é bastante heterogénea do ponto de vista social e demográfico, em características como: a idade, o nível educacional, o estado civil, o estatuto ocupacional e o tipo de agregado familiar, embora fundamentalmente constituída por grávidas primíparas. Os resultados mostram que um estilo inseguro de vinculação pode ser previsto na sequência de separação ou divórcio parental durante a infância ou adolescência e quando a grávida está desempregada, e que a gravidez na adolescência se associa ao estilo de vinculação desligado. Mostram ainda que um estilo inseguro de vinculação permite prever um pior relacionamento na gravidez, quer com o companheiro, quer com a outra pessoa significativa, principalmente a presença de relações discordantes com o companheiro e de relações apáticas com a outra pessoa significativa. As estratégias emaranhadas afectam a relação com o companheiro (em aspectos como menos confiança, menos suporte emocional e mais interacção negativa), mas não a relação com a outra pessoa significativa; enquanto as estratégias desligadas afectam a relação com a outra pessoa significativa (em aspectos como menos actividades partilhadas e menos interacção positiva), mas não a relação com o companheiro, e as estratégias amedrontadas afectam o relacionamento, tanto com o companheiro (em aspectos como menor sentimento de ligação) quanto com a outra pessoa significativa (em aspectos como menos confiança). De acordo com a Teoria da Vinculação, conclui-se que condições adversas de existência (anteriores e actuais) propiciam vinculação insegura e que o estilo de vinculação interfere na qualidade do relacionamento com o companheiro e com outras pessoas significativas, nomeadamente na capacidade da grávida recorrer a apoio.