Psychological impact of early miscarriage and client satisfaction with treatment: comparison between expectant management and misoprostol treatment in a randomized controlled trial.

OBJECTIVES: To compare the short- and long-term emotional distress (grief, anxiety and depressive symptoms) after early miscarriage and satisfaction with treatment between women randomized to expectant management vs vaginal misoprostol treatment. METHODS: This was a preplanned analysis of data collected during a randomized controlled trial comparing expectant management with misoprostol treatment in women with early anembryonic or embryonic miscarriage and vaginal bleeding. If the miscarriage was not complete on day 31 after inclusion, surgical evacuation was recommended. The main outcomes were levels of anxiety and grief, depressive symptoms and client satisfaction with the treatment, which were assessed using the following validated psychometric self-assessment instruments: Spielberger State-Trait Anxiety Inventory (STAI, Form Y), Perinatal Grief Scale (PGS), Montgomery-Åsberg Depression Rating Scale (MADRS-S; self-reported version) and Client Satisfaction Questionnaire (CSQ-8). All women were assessed at four timepoints: on the day of randomization, on the day when the miscarriage was judged to be complete, and at 3 months and 14 months after complete miscarriage. The psychometric and client satisfaction scores were compared between the misoprostol group and the expectant-management group at each assessment. Analysis was performed by the intention-to-treat principle. RESULTS: Ninety women were randomized to expectant management and 94 to misoprostol treatment. The psychometric and client satisfaction scores were similar in the two treatment groups at all assessment timepoints. At inclusion, 41% (35/86) of the women managed expectantly and 37% (34/92) of those treated with misoprostol had a STAI-state score of > 46 ('high level of anxiety'), and 9% (8/86) and 10% (9/91), respectively, had symptoms of moderate or severe depression (MADRS-S score ≥ 20). In both treatment groups, symptom scores for anxiety and depression were significantly higher at inclusion than after treatment and remained low until 14 months after complete miscarriage. Grief reactions were mild in both groups, with a median PGS score of 40.0 at 3 months and 37.0 at 14 months after complete miscarriage in both treatment groups. Four women treated with misoprostol and two women managed expectantly had a PGS score of > 90 (indicating deep grief) 3 months after complete miscarriage, while one woman managed expectantly had a PGS score of > 90 14 months after complete miscarriage. Women in both treatment groups were satisfied with their management, as indicated by a median CSQ-8 score of > 25 at each assessment. More than 85% of participants in each of the two groups reported that they would recommend the treatment they received to a friend. CONCLUSIONS: The psychological response to and recovery after early miscarriage did not differ between women treated with misoprostol and those managed expectantly. Satisfaction with treatment was high in both treatment groups. Our findings support patient involvement when deciding on the management of early miscarriage. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Psychological differences between early- and late-onset psoriasis: a study of personality traits, anxiety and depression in psoriasis.

BACKGROUND: Onset of psoriasis may occur at any age. Early negative experiences often influence personality development, and may lead to physical disease, anxiety and depression in adulthood. Knowledge about onset of psoriasis and psychopathology is limited. OBJECTIVES: To examine whether patients with early-onset psoriasis differ psychologically from patients with late-onset psoriasis, regarding personality traits, anxiety and depression. METHODS: A descriptive cross-sectional study was conducted among 101 consecutively recruited outpatients with psoriasis. A psychosocial interview was performed followed by self-assessment of validated questionnaires: Swedish Universities Scales of Personality (SSP), Spielberger State-Trait Anxiety Inventory and Beck Depression Inventory. Psoriasis severity was assessed by the Psoriasis Area and Severity Index. RESULTS: Patients with early-onset psoriasis (age < 20 years) were significantly more anxious and depressed than patients with late-onset psoriasis. In multiple linear regression models, younger age at onset of psoriasis was a significant determinant of higher scores of four personality traits: SSP-embitterment, -trait irritability, -mistrust and -verbal trait aggression. CONCLUSIONS: Our results indicate that early detection of psychological vulnerability when treating children and adolescents with psoriasis seems to be of great importance. Traits of psychological vulnerability and pessimistic personality traits were found to be significantly associated with the early onset of psoriasis, but not with disease duration in this study. These traits may be seen as a consequence of psoriasis, and/or as individual traits modulating and impairing clinical course and efforts to cope with psoriasis.

Effects of a participatory approach, with systematic impact matrix analysis in herd health planning in organic dairy cattle herds.

The animal health and welfare status in European organic dairy production does not in all aspects meet the organic principles and consumers' expectations and needs to be improved. To achieve this, tailored herd health planning, targeted to the specific situation of individual farms could be of use. The aim of this study was to apply herd health planning in a structured participatory approach, with impact matrix analysis, not previously used in this context, in European organic dairy farms and to assess changes in animal health and welfare. Herd health planning farm visits were conducted on 122 organic dairy farms in France, Germany and Sweden. The farmer, the herd veterinarian and/or an advisor took part in the farm discussions. The researcher served as facilitator. Baseline data on the animal health status of the individual farm, collected from national milk recording schemes, were presented as an input for the discussion. Thereafter a systematic impact matrix analysis was performed. This was to capture the complexity of individual farms with the aim to identify the farm-specific factors that could have a strong impact on animal health. The participants (i.e. farmer, veterinarian and advisor) jointly identified areas in need of improvement, taking the health status and the interconnected farm system components into account, and appropriate actions were jointly identified. The researcher took minutes during the discussions, and these were shared with the participants. No intervention was made by the researcher, and further actions were left with the participants. The number of actions per farm ranged from 0 to 22. The change in mortality, metabolic diseases, reproductive performance and udder health was assessed at two time points, and potential determinators of the change were evaluated with linear regression models. A significant association was seen between change in udder health, as measured by the somatic cell count, and country. At the first follow-up, a significant association was also found between change in the proportion of prolonged calving interval and the farmers' desire to improve reproductive health as well as with an increase in herd size, but this was not seen at the second follow-up. The degree of implementation of the actions was good (median 67%, lower quartile 40%, upper quartile 83%). To conclude, the degree of implementation was quite high, improvement of animal health could not be linked to the herd health planning approach. However, the approach was highly appreciated by the participants and deserves further study.

Farm-specific failure costs of production disorders in European organic dairy herds.

On-farm decision support in animal health management requires a tailor-made failure costs (FCs) assessment of production disorders for the individual farm. In our study we defined a generic framework to estimate the FC of production disorders in dairy cows. We converted the framework to a practical tool in which the farm-specific FC of mastitis, ketosis, lameness and metritis were estimated for 162 organic dairy farms in four European countries. Along with the structure of the framework, the FC estimation required three distinct types of model input: performance input (related to herd performance parameters), consequential input (related to the consequences of the disorders) and economic input (related to price levels). Input was derived from official herd recordings (e.g. test-day records and animal health recordings) and farmers' responses (e.g. questionnaire replies). The average FC of mastitis, ketosis, lameness and metritis amounted to € 96, € 21, € 43 and € 10 per cow per year, respectively. The variation in FC outcomes was high among farmers and countries. Overall ranking of the disorders based on absolute values was the same for all countries, with mastitis being the costliest disorder followed in order by lameness, ketosis, and metritis. Farm specific estimates can be used to rank production related disorders in terms of their associated failure costs and thus provide valuable insights for herd health management. The practical calculation tool developed in this study should be considered by farmers or herd health advisors to support their animal health practices or advice.

A 2-year follow-up study of anxiety and depression in women referred for colposcopy after an abnormal cervical smear.

OBJECTIVES: The aim of this study was to determine if there were any long-lasting elevated anxiety levels in women attending colposcopy after an abnormal cervical smear. DESIGN: Prospective study. SETTING: Department of Obstetrics and Gynaecology, Malmö University Hospital, Sweden. POPULATION: One hundred consecutive women were invited to participate when referred for colposcopy. METHODS: Women in the study group completed the State-Trait Anxiety Inventory, the Montgomery-Asberg Depression Rating Scale-self-rate (MADRS-S) and had a psychosocial interview prior to colposcopy at their two follow-up visits. MAIN OUTCOME MEASURES: State anxiety levels and depression scores at first visit, 6 months and 2 years. RESULTS: At follow up, levels of state anxiety and the depression scores of the women studied had decreased and were comparable to those of Swedish normative data. Two variables from the MADRS-S, 'ability to focus on different activities' and 'emotional involvement with others and in activities' were the most prominent for women with moderate to severe depression. At the 2-year visit, 30% of the women still had a fear of cancer. CONCLUSIONS: Referral for colposcopy after an abnormal cervical smear does not seem to result in long-lasting anxiety and depression. However, a subgroup of women, with the initially highest depression scores, still had at 2-year state anxiety levels and depression scores significantly higher than normal. Almost one-third of the women still had a fear of cancer in spite of lower 2-year state anxiety levels.

A longitudinal study of sexual functioning in women referred for colposcopy: a 2-year follow up.

OBJECTIVE: To elucidate psychosexual problems in women referred for colposcopy after an abnormal cervical smear and a 6-month and 2-year follow up. DESIGN: Prospective study. SETTING: Department of Gynaecology, Malmö University Hospital, Sweden. POPULATION: One hundred consecutive women referred for colposcopy for the first time subsequent to receiving notification of an abnormal cervical smear. METHODS: The women completed the State-Trait Anxiety Inventory, a psychosexual questionnaire and had one psychosocial interview prior to colposcopy at all three visits. MAIN OUTCOME MEASURES: Depending upon the result of the cervical biopsy, women had either a loop electrosurgical excision procedure (LEEP) or not. Psychosexual variables, anxiety measures, and psychosocial variables were used to estimate sexual functioning at the beginning of the study and at follow up. Differences in sexual functioning between LEEP and non-LEEP groups were estimated. RESULTS: 'Spontaneous interest in sex', 'frequency of intercourse', and 'sexual arousal' were reported to be statistically significant lower at 6 months compared with the first visit, and at 2 years, 'spontaneous interest in sex' and 'frequency of intercourse' still remained low. There was no difference in sexual functioning between the LEEP and non-LEEP groups at follow up. CONCLUSIONS: Two years after referral for colposcopy, women still had an effect on sexual functioning, that is, lesser 'spontaneous interest' and decreased 'frequency of intercourse'. We found no support for a relationship between treatment of cervical intraepithelial neoplasia by LEEP and deterioration in sexual functioning.

Evaluation of the impact of a Herd Health and Production Management programme in organic dairy cattle farms: a process evaluation approach.

Animal health planning activities are not always providing a satisfactory positive impact on herd health and welfare. Moreover, evaluating the impact of advisory programmes is complex due to multiple interacting elements that influence its outcome. Therefore, measuring solely health outcomes is not sufficient: the whole process of the implementation and use of such programmes should be evaluated. In order to evaluate the impact of an intervention with a Herd Health and Production Management (HHPM) programme a process evaluation framework was designed and used. The intervention involved 20 organic dairy cattle farmers and their advisors, in both France and Sweden. In both countries 20 organic dairy farms were selected as control herds. The evaluation of the HHPM programme was based on: (a) the compliance to the programme; (b) the programme's functions influencing herd health management practices and stimulating dialogue between farmers and advisors; (c) its effectiveness in terms of improving herd health compared with control farms. Complete compliance to the programme was fulfilled by 21 out of 40 farmers-advisors. Results from a questionnaire showed that the programme functioned as intended (e.g. by allowing early identification of herd health problems), stimulated change in farmers' herd health management practices and farmer-advisor dialogue. Even though the majority of the users perceived that the programme contributed to herd health improvements, no significant differences in health outcomes were found when compared with control farms 12 months after the start of the intervention. The programme allowed creating an environment promoting the exchange of information between farmers and advisors, necessary to define pertinent advice in a farm-specific situation. Future research should aim at improving methods for the evaluation of the effect of advisory programmes, by identifying early indicators for effective advice and developing methods to evaluate the quality of advisory situations without interfering with them.

Clonal and capsular types decide whether pneumococci will act as a primary or opportunistic pathogen.

BACKGROUND: Streptococcus pneumoniae is a major cause of morbidity and mortality worldwide. The role of the different capsular and clonal types in invasive disease severity remains to be defined. METHODS: Disease severity and disease type were correlated to age, underlying disease, capsular serotype, and clonal type of the causative agent for 494 adult patients with invasive pneumococcal disease. RESULTS: Pneumococcal isolates of serotypes 1 and 7F were genetically homogenous, had the highest potential to infect previously healthy individuals, and were not causing deaths. Also, type 1 isolates were only found among younger adults, whereas other serotypes were mainly found among elderly persons (e.g., type 23F). Some serotypes and/or clones were more prone to cause more-severe disease, as observed by high APACHE II scores calculated at admission, and were also associated with a high mortality (e.g., clones of type 3 and 11A). We found no evidence of an impact of penicillin resistance on disease severity and disease type. CONCLUSIONS: We suggest that clones with capsular types 1 and 7F, which are known to have a high invasive disease potential, behave as primary pathogens, whereas clones with other capsular types with a lower relative risk of causing invasive disease are more opportunistic, primarily affecting patients with underlying disease. Disease caused by the latter group, however, was more severe, even in previously healthy individuals.

A participatory approach to design monitoring indicators of production diseases in organic dairy farms.

Production diseases have an important negative effect on the health and welfare of dairy cows. Although organic animal production systems aim for high animal health levels, compliance with European organic farming regulations does not guarantee that this is achieved. Herd health and production management (HHPM) programs aim at optimizing herd health by preventing disease and production problems, but as yet they have not been consistently implemented by farmers. We hypothesize that one reason is the mismatch between what scientists propose as indicators for herd health monitoring and what farmers would like to use. Herd health monitoring is a key element in HHPM programs as it permits a regular assessment of the functioning of the different components of the production process. Planned observations or measurements of these components are indispensable for this monitoring. In this study, a participatory approach was used to create an environment in which farmers could adapt the indicators proposed by scientists for monitoring the five main production diseases on dairy cattle farms. The adaptations of the indicators were characterized and the farmers' explanations for the changes made were described. The study was conducted in France and Sweden, which differ in terms of their national organic regulations and existing advisory services. In both countries, twenty certified organic dairy farmers and their animal health management advisors participated in the study. All of the farmers adapted the initial monitoring plan proposed by scientists to specific production and animal health situation on their farm. This resulted in forty unique and farm-specific combinations of indicators for herd health monitoring. All but three farmers intended to monitor five health topics simultaneously using the constructed indicators. The qualitative analysis of the explanations given by farmers for their choices enabled an understanding of farmers' reasons for selecting and adapting indicators. This is valuable information for scientists involved in the design of HHPM programs. Advisors in the field also can benefit from this participatory approach because it transforms monitoring tools provided by scientists into farm-specific tools.

Acetic acid as a decontamination method for sink drains in a nosocomial outbreak of metallo-ß-lactamase-producing Pseudomonas aeruginosa.

BACKGROUND: Pseudomonas aeruginosa may colonize water systems via biofilm formation. In hospital environments, contaminated sinks have been associated with nosocomial transmission. Here we describe a prolonged outbreak of a metallo-ß-lactamase-producing P. aeruginosa (Pae-MBL) associated with sink drains, and propose a previously unreported decontamination method with acetic acid. AIM: To describe a nosocomial outbreak of Pae-MBL associated with hospital sink drains and to evaluate acetic acid as a decontamination method. METHODS: The outbreak was investigated by searching the microbiology database, microbiological sampling and strain typing. Antibacterial and antibiofilm properties of acetic acid were evaluated in vitro. Pae-MBL-positive sinks were treated with 24% acetic acid once weekly and monitored with repeated cultures. FINDINGS: Fourteen patients with positive cultures for Pae-MBL were identified from 2008 to 2014. The patients had been admitted to three wards, where screening discovered Pae-MBL in 12 sink drains located in the patient bathrooms. Typing of clinical and sink drain isolates revealed identical or closely related strains. Pae-MBL biofilm was highly sensitive to acetic acid with a minimum biofilm eradication concentration of 0.75% (range: 0.19-1.5). Weekly treatment of colonized sink drains with acetic acid resulted in negative cultures and terminated transmission. CONCLUSION: Acetic acid is highly effective against Pae-MBL biofilms, and may be used as a simple method to decontaminate sink drains and to prevent nosocomial transmission.

Characterization of a laccase gene from the white-rot fungus Trametes versicolor and structural features of basidiomycete laccases.

A gene coding for the multi-copper phenol oxidase laccase has been isolated from the white-rot basidiomycete Trametes versicolor. The gene, which is preceded by a TATA box and a pyrimidine-rich region, is predicted to contain ten introns. The mature translation product, preceded by a 22-residue signal peptide, should consist of 498 residues. Comparisons with Edman degradation data of peptides from T. versicolor laccase strongly suggest that two disulfide bridges are formed by Cys-85/Cys-487 and Cys-117/Cys-205, respectively. The encoded protein contains five Cys, and the sequence surrounding the remaining Cys-452 is consistent with its involvement in the ligation of type-1 copper. Alignment of sequences indicates that T. versicolor laccase displays a Phe at the position corresponding to a residue (Met in ascorbate oxidase and azurin) considered important for the reduction potential of type-1 copper proteins.

Link between pregnancy complications and minor physical anomalies in monozygotic twins discordant for schizophrenia.

OBJECTIVE: The aim of the current study was to explore the relevancy of early pregnancy complications for the development of minor physical anomalies in monozygotic twins discordant and concordant for schizophrenia. METHOD: Pregnancy complications and minor physical anomalies were independently assessed in 22 discordant, 10 concordant, and six normal comparison monozygotic twin pairs. RESULTS: Complications occurring during early pregnancy were associated with a higher frequency of minor physical anomalies in the total group and in the discordant twin pairs particularly. While no significant differences in anomaly rates were observed among the discordant, concordant, and normal comparison groups, the discordant ill twins showed a trend toward having more anomalies than their well co-twins. CONCLUSIONS: Complications occurring early in pregnancy are relevant for the development of minor physical anomalies and may be of particular importance for the development of these anomalies in twin pairs discordant for schizophrenia.

Are neurological abnormalities in well discordant monozygotic co-twins of schizophrenic subjects the result of perinatal trauma?

OBJECTIVE: Neurological abnormalities found in schizophrenic subjects and their healthy relatives have raised questions concerning etiology. The aim of the present study was to investigate the genetic and environmental antecedents of neurological impairment in monozygotic twins discordant for schizophrenia, with particular focus on the well discordant twins. The etiological factors of interest were history of obstetric complications, family history of psychosis, history of substance abuse, and history of postnatal cerebral trauma. METHOD: History of obstetric complications, including information from pregnancy through the neonatal period, and data on neurological "hard" and "soft" signs were obtained blindly and separately for each member of 22 monozygotic twin pairs discordant for schizophrenia and seven normal comparison monozygotic twin pairs. Clinical and family interviews provided information about background factors. RESULTS: Degree of neurological impairment in the well discordant monozygotic twins was significantly positively related to history of both neonatal and total obstetric complications. None of the three other background factors investigated was related to degree of neurological impairment in the ill or well co-twins. CONCLUSIONS: The contribution of obstetric complications to the current level of neurological impairment in well discordant co-twins suggests that the spectrum of neuroabnormality, ranging from neurological signs to schizophrenia, in monozygotic discordant twins may be the result of subtle gene-environment interaction.

Obstetric complications as antecedents of schizophrenia: empirical effects of using different obstetric complication scales.

The new McNeil-Sjöström Scale for obstetric complications (OCs), as well as scales of Lewis et al. (Schizophrenia: Scientific progress. Oxford University Press, 1989) and Parnas et al. (British Journal of Psychiatry, 140, 416-420, 1982), were applied to the OC histories of 70 singleton schizophrenics and 70 demographically-matched controls from the same hospital delivery series, using blindly assessed hospital pregnancy and birth record information. With the McNeil-Sjöström scale, schizophrenics were found to have significantly increased rates of OCs for the total reproduction, as well as for labor-delivery and the neonatal period but not for pregnancy. Significant increases in OCs in these schizophrenics were also found in scores produced by the Lewis et al. scale but not by the Parnas et al. scale. Further application of these three scales to OC data obtained through parental report for 23 monozygotic (MZ) twin pairs discordant and 10 pairs concordant for schizophrenia, as well as seven normal control MZ pairs, showed a significant difference in OC rates across the different twin pair groups, when assessed by the McNeil-Sjöström and Parnas et al. scales, but not by the Lewis et al. scale. The particular scoring system used in a study is thus of considerable importance not only for findings concerning OC histories of schizophrenics vs. controls, but also for the relationship between OCs and other presumed etiological factors in schizophrenia. Among the three scales, the McNeil-Sjöström scale provided the most sensitive assessment of OC history for schizophrenics.

Maternal demographic correlates of increased history of obstetric complications in schizophrenia.

Evidence that history of obstetric complications (OCs) may contribute to the development of schizophrenia has generated renewed focus on characteristics of mothers of preschizophrenics. We studied the relationship between increased history of obstetric complications (OCs) and maternal age, parity, and social class in 70 Research Diagnosis Criteria schizophrenic patients vs 70 demographically matched controls. The sample has previously been studied concerning OC rates in schizophrenic patients, their relationship to other presumptive etiological factors, as well as head circumference at birth. Parity was the only maternal characteristic significantly associated with increased OCs in mothers of preschizophrenics. As compared with nulliparous control mothers, nulliparous mothers of preschizophrenics had significantly increased rates of total OCs and labour/delivery complications, while primi- and multiparous mothers of preschizophrenics (vs parity-matched control mothers) did not have increased rates of OCs. Abnormal labour length was significantly increased in the nulliparous mothers of preschizophrenics. Previous findings of significantly reduced head circumference at birth in preschizophrenic neonates vs controls were reconfirmed selectively in the nulliparous group.

Prenatal origin of schizophrenia in a subgroup of discordant monozygotic twins.

Neuropathological, obstetrical, and epidemiological evidence increasingly suggest that some cases of adult-onset schizophrenia have prenatal or neonatal etiological roots. We evaluated the developmental histories of 23 monozygotic twin pairs discordant for schizophrenia to determine when they markedly and permanently began diverging from each other in motor skills or unusual behavior. Seven of the twins (30%) who later developed schizophrenia had become permanently different from their cotwins by age 5 years. The early divergence group differed from the others by multivariate tests (p = 0.002) for within-twin pair effects and by univariate tests for physical anomaly scores (p = 0.01), total finger ridge counts (p = 0.001), family history of psychosis (p = 0.004), and serious perinatal complications or low birth weight (p = 0.05). It is concluded that some cases of adult-onset schizophrenia are associated with prenatal events, which may include neurodevelopmental abnormalities or specific insults such as anoxia or infectious agents.

Clinical expression of Best's vitelliform macular dystrophy in Swedish families with mutations in the bestrophin gene.

OBJECTIVE: To examine the clinical phenotype of three Swedish families with Best's vitelliform macular dystrophy (BMD) and three different mutations in the recently identified bestrophin gene. METHODS: Three families, including 13 patients, were examined clinically using visual acuity testing, electro-oculography, fundus inspection, and fundus photography. The mutations were previously determined by direct sequence analysis of the individual exons in the bestrophin gene. RESULTS: The largest family (SL76), with the Y85K (T357C) mutation in the bestrophin gene, demonstrated a clinical phenotype characterized by a variable degree of visual acuity reduction and a marked intrafamilial variability in macular pathology. The electro-oculograms, however, demonstrated similar results in all patients regardless of the severity of the macular dysfunction. The smallest family (SL3), with the mutation V9A (T130C) in the bestrophin gene, and the family (SL2) with the mutation D104E (C416A) demonstrated a similar clinical phenotype. The majority of patients (11/13 examined subjects) had a binocular visual acuity of 20/63 or better at a late stage of the disease course, indicating a relatively good prognosis for visual acuity in this specific phenotype. The ophthalmoscopic changes were followed in one of the patients for 38 years and in three of the patients for 19 years and showed that the macular appearance seems to be stable after adolescence. CONCLUSIONS: Patients with BMD and mutations in the bestrophin gene have a similar clinical phenotype characterized by a variable, but relatively moderate visual acuity reduction, atrophic changes in the macula, and pathological results of the electro-oculograms. The macular appearance remains essentially unchanged through the atrophic stage (stage IV) in the majority of patients, indicating a stationary disease course associated with this specific genotype.

Do pre-, early, and mid-pregnancy life events influence gestational length?

The aim of this study was to determine whether the frequency and quality of reported life events during the 6 months before pregnancy to mid-pregnancy influence gestational age at birth. Seventy nulliparous women were studied at 12 and 25 gestational weeks with a 64-item self-rated life event questionnaire developed for obstetric groups. Life events were categorised into eight psychosocial areas according to the diagnostic and statistic manual (DSM-III-R). The women rated each experienced event as strainful or not strainful. Gestational age was determined by ultrasound biometry before 20 gestational weeks. The number of life events during the following periods was recorded from 6 months before pregnancy to 12 gestational weeks, from 12 gestational weeks to 25 gestational weeks, from 6 months before pregnancy to 25 gestational weeks. No significant relationships were found between the number of reported life events and pregnancy duration. Life events in different psychosocial areas also did not influence gestational age at birth. A non-significant relationship (p = 0.06) was found between pregnancy duration and the number of strainful events reported from 6 months before pregnancy to 25 gestational weeks, shorter pregnancy duration being found in women reporting many strainful events. Our findings suggest that life events in general do not influence pregnancy duration. However, if they are perceived as strainful, pregnancy length tends to decrease.

Maternal anxiety in late pregnancy and fetal hemodynamics.

The aim of this study was to investigate if fetal circulation is affected by maternal anxiety. 37 nulliparous women were studied prospectively in the third trimester of pregnancy, with self-rate tests of anxiety (STAI). Doppler ultrasound examination of the umbilical artery and fetal middle cerebral artery was performed at 37-40 gestational weeks. The pulsatility index (PI) was calculated and corrected for heart rate. The women were divided into groups of increasing levels of anxiety. The fetuses of women with high trait anxiety scores had significantly higher PI values in the umbilical artery (p = 0.0056), significantly lower PI values in the fetal middle cerebral artery (p = 0.0029) and significantly lower cerebro-umbilical PI ratios (p = 0.0002), suggesting a change in blood distribution in favor of brain circulation in the fetuses. Maternal weight, weight-increase, height, age, marital status, smoking habits, drinking habits and socio-economic factors known to affect fetal well-being did not interfere with these findings. No significant differences in birth-weight, length and head circumference were found between infants born to mothers with higher trait anxiety levels compared to mothers with lower trait anxiety levels. Our results suggest that maternal stress, in terms of trait anxiety, influences fetal cerebral circulation.