Maternal prenatal stress, fetoplacental hemodynamics, and early childhood development in the context of intrauterine growth restriction

• Main Author: Levine, Hester Ann
• Published: Queen's University Belfast 2017
• Subjects: 618.3
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.727420

Intrauterine growth restriction (IUGR) occurs in 5-8% of pregnancies and is associated with neonatal and paediatric morbidity and mortality. The aims of this follow-up study were to 1) determine whether pregnancy-specific stress (PSS) is associated with fetoplacental hemodynamics or neonatal outcomes in women with small for gestational age (SGA) pregnancies, and 2) examine differences in health-related quality of life (HRQoL), behavioural problems, and visual-motor integration (VMI)' in SGA three-year-olds. Measures used included the Prenatal Distress Questionnaire, the Pediatric Quality of Life Inventory, the Child Behavior Checklist, and the Beery-Buktenica Developmental Test of Visual-Motor Integration. PSS was associated with decreased UA PI and MCA PI, increased odds of AEDF, decreased CPR, birth weight <2500 g, prematurity, and decreased odds of NICU admission. IUGR children had poorer HRQoL, more affective and withdrawn behavioural problems, and poorer VMI than SGA children. Children who had been exposed to AEDF had more somatic complaints, withdrawn, attention, and internalising behavioural problems, and children who had been exposed to abnormal CPR had more withdrawn and attention behavioural problems. Term IUGR children had poorer physical functioning than preterm SGA children. Preterm IUGR children had more attention problems and poorer VMI than term SGA children, and more oppositional defiant, withdrawn, aggressive, and externalising behavioural problems than preterm SGA children. Male IUGR children had poorer HRQoL, more behavioural problems, and poorer VMI. This multicentre prospective observational study provided a unique opportunity to comprehensively assess PSS and early childhood development in a large cohort of women and SGA children in Ireland and Northern Ireland. This study provides the first available evidence of associations between PSS and fetoplacental hemodynamics and neonatal outcomes in SGA pregnancy. This study also provides novel insights into the developmental differences between SGA and IUGR children, and into the specific developmental vulnerabilities of premature or male IUGR children.