Prenatal effects of maternal nutritional stress and mental health on the fetal movement profile.

PURPOSE: Prenatal sub-optimal nutrition and exposure to maternal stress, anxiety and depression in pregnancy have been linked to increased postnatal morbidity and mortality. Fetal growth is most vulnerable to maternal dietary deficiencies, such as those evident in hyperemesis gravidarum (HG), early in pregnancy. The purpose of this pilot study was to examine the effects of HG on fetal movement profiles as a measure of fetal healthy development in the 3rd trimester of pregnancy, and to assess whether nutritional stress on the mother can be evaluated using isotopic analysis of hair. METHOD: We analyzed fetal movement profiles using 4D ultrasound scans at 32- and 36-weeks' gestation. Fetuses of women (N = 6) diagnosed with HG, having lost more than 10% of their body weight in the first trimester of pregnancy were compared to a healthy group (N = 6), controlling for stress, depression and anxiety. We tested carbon and nitrogen isotope ratios in maternal hair as a measure of both diet and nutritional changes due to catabolism of body proteins and fats. RESULTS: HG and catabolism were significantly correlated (p = 0.02). Furthermore, at 32-weeks' gestation movement profiles of fetuses of mothers with HG differed significantly from the movement profiles of fetuses of healthy mothers. Fetuses of mothers suffering from HG showed a significantly increased ratio of fine-grained movements at 32 weeks (p = 0.008); however, there were no significant differences detectable at 36-weeks' gestation. CONCLUSION: The effect of HG on fetal development as expressed by variations in fetal movement profiles in this pilot study suggest that prenatal effects of HG can be measured using movement profiles. Isotope analysis of hair can supplement this with information on nutritional imbalances early in pregnancy.

Effects of maternal anxiety and depression on fetal neuro-development.

BACKGROUND: Fetal development is affected by maternal mental health with research indicating that maternal anxiety and depression are co-morbid; nevertheless differential effects on the fetus have been found. This study examines, prenatally, effects of maternal stress, anxiety and depression on fetal eye-blink reactions to experimental sound and light stimulation. METHODS: Two groups of singleton fetuses (mean 32-weeks gestation) were examined using 4D ultrasound: a control group (N = 14, 7 female) with no stimulation and an experimental group (N = 21, 13 female) exposed to experimental sound, light and cross-modal stimulation. For both groups ultrasound scans were performed and fetal eye-blink was assessed. Mothers completed the Hospital-Anxiety-and-Depression Scale and the Perceived-Stress Scale. Analysis was carried out using Poisson mixed effects modelling. RESULTS: Fetal eye-blink rate during experimental stimulation was significantly and differentially associated with maternal mental health with a 20% increase of fetal eye-blink rate for each unit increase in anxiety score (p = 0.02) and a decrease of 21% of eye blink rate for each unit of increase in depression score (p = 0.02). Sound stimulation but not light stimulation significantly affected blink-rate with fetuses habituating to the stimuli (p < 0.001). LIMITATIONS: Limitations are the relatively small number of fetuses and that a follow up after birth is essential to establish potential long-term effects. CONCLUSIONS: Of clinical importance is the finding that although fetuses are affected by maternal mental health in general here we demonstrate, using eye-blink-rate during stimulation as measure of neuro-development, that fetuses are differentially affected by maternal anxiety and depression with anxiety increasing and depression decreasing fetal reactivity significantly.